adjustment disorder Flashcards

Question

Atypical Antidepressants

Answer 1

bupropion, mirtizapine, nefazodone, trazodone

Answer 2

A treatment course of 6 to 8 weeks at therapeutic dose is considered adequate to assess response After response is determined, may proceed with dose increase, augmentation, or change to new agent Continuation of treatment for 9 months is recommended to achieve durable remission. If respond treat for 12 months (ROSH)

Answer 3

SGAs and divalproex are considered first line treatments Monitor metabolic parameters due to risk of increased lipids and metabolic syndrome Antidepressants avoided if possible, but if needed must be combined with SGA or mood stabilizer Ongoing treatment recommended to prevent future episodes

Answer 4

Classic treatment for bipolar mania* Can be used for antidepressant supplementation Long term risk of renal impairment (so many salts), thyroid impairment(competes with thaimine), tremor, others Requires blood monitoring for serum levels and has “tight” therapeutic window, want level to be = 1. Toxicity can cause disorientation, psychosis, and may be fatal

Answer 5

must go to ICU, Toxicity can cause disorientation, psychosis, and may be fatal

Answer 6

Cognitive Behavioral Therapy (CBT) , or Psychoanalytic Therapy, dialectal therapy for pedophelia

Answer 7

focuses on interaction between core beliefs, thoughts, and feelings and guides patient to reformulate these connections to improve mood and reduce distress

Answer 8

explores childhood experiences and long-standing paradigms of thought

Answer 9

chronic persistent depression

Answer 10

Anxiety is state of increased worry, fear, and concern, especially over future events (real or imagined) Associated with physical symptoms of agitation, (pain in their chest etc) increased heart and respiratory rate, tension May include avoidance behaviors and fears of “losing it” or “going crazy”

Answer 11

heart attack. EKG, Trop.

Answer 12

10 minutes or so, speeds them up

Answer 13

Sudden and recurrent onset of Panic Attacks nocturnal Panic : Up to 25% of patients experience Attacks that may awaken them from sleep patient experiences fear of recurrence and experiences increased anxiety over the possibility of further attacks: For at least one month afterwards, Patient engages in avoidance behaviors to prevent future attacks - isolates, changes jobs or relationships, etc. Agoraphobia specifier - “fear of the marketplace” (

Answer 14

“fear of the marketplace” (fear of being out in public), fear of small spaces

Answer 15

if it's effecting behavior /unable to function and affect their personal life, normal will adjust,

Answer 16

panic disorder symptoms that persist "all day" or can ramp up to seem like panic attack or say "i'm losing my mind" excessive, intrusive worries about everyday situations that causes significant distress and functional impairment Accompanied by physical symptoms of anxiety such as muscle tension, restlessness, insomnia, GI disturbances, chronic headaches, fatigue, and difficulty concentrating May have episodes of increased anxiety resembling Panic Attacks

Answer 17

dig into what they are saying (from broad to small) look on first lecture for more

Answer 18

Other Anxiety Disorders - refusal to speak due to increased anxiety, more common in children

Answer 19

Other Anxiety Disorders, - debilitating anxiety in social situations and avoidance of socialization

Answer 20

Other Anxiety Disorders, avoidance of a specific situation or object that causes debilitating anxiety

Answer 21

SSRIs (takes a few weeks,), patients with anxiety more likely to respond to real or immagined effects, start low dose and titrate up SNRIs, Buspirone, Benzodiazepines CBT, Mindfulness Physical Activity, Structured Social Activities

Answer 22

SSRIs (takes a few weeks,), patients with anxiety more likely to respond to real or immagined effects, start low dose and titrate up SNRIs, Buspirone, Benzodiazepines CBT, Mindfulness Physical Activity, Structured Social Activities

Answer 23

SSRIs and SNRIs both effective for anxiety, but SNRIs not shown to be effective for Panic Disorder

Answer 24

5-7 days usual effect | non-addictive treatment for GAD and other anxiety disorders, but ineffective for Panic Disorder

Answer 25

are effective short-term (5hr 1/2life) but carry long term risks of dependence (addiction), sedation, mental clouding, increased mortality " tranks" abusable, can be issues when mixed with opiates, popular. Better if under use and as needed.

Answer 26

benzo don't have to take consistently and best used as emergency rescue for panic attack , ssri and snri are daily meds with ongoing compliance needed. but ssri can have issues after being off them for a month or so.

Answer 27

very effective: CBT helps patients manage anxious thoughts, increase functionality, reduce panic and anxiety attacks Mindfulness practices proven to help reduce clinical anxiety Structured activities help patient gradually resume normal psychosocial functioning “Exposure therapy” for specific phobias is effective but intensive and time consuming (face your fears)

Answer 28

Characterized by significant disorders of thought process and content Like mood, psychosis is considered a “spectrum” of thought disorder

Answer 29

Five symptoms of psychosis: Delusions - fixed, false beliefs Hallucinations - sensory perceptions in the absence of external stimuli Disorganized Speech - nonsensical or severely disorganized speech Disorganized or Catatonic Behavior - extreme movement disturbance Negative Symptoms Psychotic symptoms are the defining symptoms of Schizophrenia and other psychotic disorders, but can be present in other disorders

Answer 30

Fixed, false beliefs that persist in the face of negative evidence May be persecutory, erotomanic, paranoid, or other types “Fragmentary” (change) delusions can be seen in psychotic disorders, but some patients present with sustained, complex (usually built up over years) and organized delusional systems (also can be a part of other systems) Resistant to pharmacology and psychotherapy

Answer 31

- becomes increasingly specific over time (and tend to "grow")

Answer 32

believed loved by someone ex: lady sells stuff to move in with someone who has no idea and doesn't know she's trying to move in with all her stuff.

Answer 33

culturally based | ex; Americans more so with technology

Answer 34

Persecution - becomes increasingly specific over time Erotomanic - belief that one is loved by another Technological - invasion or control by machines, electronics, unseen forces Medical - belief in illness not diagnosable by current techniques

Answer 35

Any sensory modality - auditory, visual, olfactory, tactile, gustatory Auditory and Visual most common in Psychotic Disorders Patient appears distracted, not following conversation May respond directly to unseen stimuli these come from correct area in brain

Answer 36

drug use, than in other kinds.

Answer 37

Voices - single or multiple, sometimes overlapping, occasionally music or “crowd noise” Visions - usually normally sized people in psychotic disorders, more disorganized in medication or drug induced states Tactile - “ants crawling on skin,” body sensations misinterpreted as technological or intrusive

Answer 38

Cannot stay on topic Suddenly stops or “blocks” in mid-sentence Non-sequitur responses Nonsensical responses

Answer 39

Bizarre posturing Excessive or inappropriate clothing and grooming Lack of responsiveness to environment Inappropriate emotional responses

Answer 40

what gave psychotic it's initial name of early dimensia, (happy to do nothing) Monotonic speech with minimal content Flat, unresponsive facial expressions Slow, labored thought processes Lack of motivation and inability to start simple projects Lack of spontaneity Lack of interest in social and interpersonal interactions

Answer 41

primary psychiatric disorder Characterized by two or more of the five psychotic symptoms At least one of the symptoms must be delusions, hallucinations, or disorganized speech Significant impairment in social, occupational, or self-care activities since onset of psychosis Psychotic symptoms present for at least one month and syndrome lasts at least six months Not better explained by mood disorder or autistic spectrum disorder Frequent onset in late teen to early adult years

Answer 42

primary psychiatric disorder Characterized by two or more of the five psychotic symptoms At least one of the symptoms must be delusions, hallucinations, or disorganized speech Significant impairment in social, occupational, or self-care activities since onset of psychosis Psychotic symptoms present for at least one month and syndrome lasts at least six months Not better explained by mood disorder or autistic spectrum disorder Frequent onset in late teen to early adult years

Answer 43

Inappropriate affect Dysphoric mood Erratic sleep pattern Poor insight Anxiety and phobias, sometimes obsessive Feelings of derealization and depersonalization Difficulty with social “cues” and interactions Psychosis may cause hostility and aggression

Answer 44

Inappropriate affect (flat) Dysphoric mood Erratic sleep pattern Poor insight Anxiety and phobias, sometimes obsessive Feelings of derealization and depersonalization Difficulty with social “cues” and interactions (weird) Psychosis may cause hostility and aggression (especially of acting on halucination)

Answer 45

Presence of persistent delusions, Other psychotic symptoms usually not present "fixed delusions", may be compartmentalized

Answer 46

intended to be combo mood and psychotic disorder -key element, is mood and psychotic symptoms in absence of another (get better in one way but keep another disorder) Characterized by presence of both psychotic and mood disorder symptoms Mood symptoms and psychotic symptoms persist in the absence of the other Mood symptoms at least 50% of the time Psychotic symptoms in absence of mood symptoms

Answer 47

resolves in one month, Presence of psychotic symptoms in previous non-psychotic patient Resolves within one month with full return to baseline level of functioning Not related to drug use or medical illness

Answer 48

first drugs developed to treat psychosis First Generation medications - Thorazine, Haldol, Prolixin, others (first tried from surgery) Second Generation medications - Risperdal, Seroquel, Zyprexa, Geodon, Abilify, Latuda, others Clozapine (gold standard for treatment resistant schitzo

Answer 49

pancytopenia (can't make blood cells) req weekly monitoring for 6months + people who live at home with supportive parents

Answer 50

Antidepressants - common in schizophrenia (5% suicide rate) Socialization - group therapy, group community living, day programs Primary care - medical illnesses common Case Management - assistance with access to resources, transportation, housing, daily living

Answer 51

lots of medical problems

Answer 52

assistance with access to resources, transportation, housing, daily living

Answer 53

Enduring patters (not short term) about environment and oneself. Trouble getting along in society, deviates significantly from cultural standards. Inflexible, flexible to change, maladaptive (make life harder aka trouble with jobs and school), functional. Develop by early childhood.

Answer 54

enduring patterns, two or more of: - cognition, affectivity (range, appropriateness, intensity of open expressiveness of emotion), interpersonal functioning, impulse control. - Rule out other mental disorders and clinical causes

Answer 55

personality changes, distress, not caused by other medical disorders

Answer 56

Cluster A - odd or eccentric Cluster B - dramatic, emotional, erratic Cluster C - anxious or fearful

Answer 57

different from parania of psychotic person (is in episodes and biological) diagnosis requires 4 of these paranoid in many areas Pervasive mistrust and suspiciousness as represented by at least four of the following. Suspects, without sufficient basis, others of exploiting, harming, or deceiving them Preoccupied with unjustified doubts about the loyalty of others Reluctant to confide in others for fear of betrayal Reads demeaning or threatening messages into benign statements or events Persistently bears grudges Perceives hidden attacks and reacts angrily Recurrent, unjustified suspicions of infidelity

Answer 58

diagnosis req 4 of these 7 Detachment from social and emotional relationships, as evidenced by four of the following: Lack of interest in close relationships Chooses solitary activities Little interest in sexuality Few pleasurable activities Lacks close friends or confidants other than family Indifferent to praise or criticism Emotional detachment, coldness, or flattened affect

Answer 59

variant of Schizoid, diff from psychosis because relatively well functioning and not acute psychotic symptoms. "odd eccentric thought patterns" Discomfort with personal relationships combined with eccentricities of thought or behavior, as evidence by five or more: ``` Ideas of reference Magical thinking Unusual perceptive experiences Odd thinking or speech patterns Suspiciousness or paranoia Inappropriate or constricted affect Eccentric behaviors Lack of close friendships Excessive social anxiety despite familiarity ```

Answer 60

``` Disregard for and violation of the rights of others, evidenced by three or more: Frequent illegal acts Chronic deceitfulness (conning people) Impulsivity and failure to plan ahead Frequent physical aggressiveness Reckless disregard for the safety or self or others ( knew was bad idea but did it anyway, different than negligence) Irresponsibility Lack of remorse ```

Answer 61

“Psychopathy” overlaps with DSM ASPDO Callous, charming, manipulative Frequently violent and impulsive Associated with serial violence or sexual violence May “disguise” traits with significant social success. "people are tools to be used"

Answer 62

Instability in relationships (main part), self-image, affect, and impulsivity, requiring five of the following: Frantic efforts to avoid real or imagined abandonment Unstable and intense relationships (from love to hate) Unstable self-image (=x know self) Impulsivity in high-risk activities Recurrent suicidal threats, gestures, or self mutilating behaviors Marked mood and affect reactivity and instability Chronic feelings of emptiness Inappropriate and intense anger Transient stress-related paranoia or dissociative symptoms

Answer 63

from greek word "actor/acting" Pattern of excessive emotionality and attention seeking, requiring five of the following: Need to be center of attention in all settings Interactions tend to be sexualized or provocative Rapidly shifting and shallow emotions Draws attention by physical appearance Impressionistic but non-detailed speech Emotions are dramatic, theatrical, and exaggerated Easily influenced by others or by situations Exaggerates intimacy of relationships NO ANGER OR DESTRUCTIVE TRAIT (THAT BORDERLINE PERSONALITY DISORDER BRINGS) AKA ALL ABOUT THE DRAMA

Answer 64

Pattern of grandiosity, need for admiration, and lack of empathy (of admiration for other people), requiring five of: Exaggerated sense of self importance Preoccupied with fantasies of success, power, ideal love, brilliance, or beauty Belief in “specialness” and only wants to associate with those who other “special” people Requires excessive admiration Sense of entitlement Exploitative in relationships Fails to recognize the feelings of others Often envious of others, and believes others envy them Arrogant, haughty behaviors or attitudes aka extreme self regard

Answer 65

"pathological shyness" Pattern of social inhibition, inadequacy, and hypersensitivity to negative evaluations, requiring four of the following: Avoids jobs with potential for criticism or rejection Avoids friendships unless certain of being liked Avoids relationships with potential for shame or ridicule Preoccupied with fear of criticism in social situations Inhibited in new relationships due to feelings of inadequacy Views self as unappealing, socially inept, or inferior Reluctant to take risks or do new things due to fears of embarassment (cause don't want to see poeple)

Answer 66

Pervasive and excessive need to be taken care of leading to submissive and clinging behaviors, by five of: Needs excessive advice or encouragement for everyday decisions Needs others to take responsibility for most major areas of life Difficulty disagreeing with others due to fear of losing their support Difficulty initiating projects on their own Goes to excessive lengths to obtain nurturance and support Uncomfortable or helpless when alone Urgently seeks new relationships when old ones end Preoccupied with fears of being left to take care of self

Answer 67

in cluster c Pattern of preoccupation with orderliness, perfectionism, and interpersonal control, as evidenced by four of the following: Preoccupied with details, rules, list, order, etc. to the point where the major point of the activity is lost Excessively devoted to work and productivity Perfectionism that interferes with task completion Overconscientious, scrupulous, and inflexible about moral and ethical values Unable to discard useless or worn out objects (hoarders) that have no sentimental value Reluctant to delegate tasks to others Adopts a miserly spending style Shows rigidity and stubbornness

Answer 68

Related to problems in self-control and behavior | Occur in children, adolescents, and adults

Answer 69

Recurrent behavioral outbursts representing a failure to control aggressive impulses, by either: Verbal aggression like temper tantrums, arguments, or fighting, twice weekly on average for a 3 month period; or Three behavioral outbursts involving damage or destruction of property or physical injury to others within a 12 month period Magnitude of aggression is out of proportion to provocation Not premeditated or committed to a tangible outcome Cause marked distress, functional impairment, or legal consequences Must be 6 years or older Not better explained by another disorder

Answer 70

Recurrent behavioral outbursts representing a failure to control aggressive impulses, by either: Verbal aggression like temper tantrums, arguments, or fighting, twice weekly on average for a 3 month period; or Three behavioral outbursts involving damage or destruction of property or physical injury to others within a 12 month period Magnitude of aggression is out of proportion to provocation Not premeditated or committed to a tangible outcome Cause marked distress, functional impairment, or legal consequences Must be 6 years or older Not better explained by another disorder "patients with extremely hot tempers" is a rule out diagnosis: if not a depressive or manic disorder or bipolar no psychosis or provocation, then this is one.

Answer 71

Deliberate and purposeful fire setting more than once Tension or affective arousal before the act Fascination with fire and its situations Pleasure, gratification, or relief when setting or witnessing fires Not done for monetary gain, political expression, or in response to a delusion Not associated with conduct disorder, mania, or ASPDO can be in childhood. not for arson, for internal pleasure. not a part of mania.

Answer 72

Recurrent failure to resist impulses to steal objects not needed for personal use or for their monetary value Increasing sense of tension immediately before committing the theft Pleasure, gratification, or relief afterwards Not committed to express anger or vengeance, not in response to delusion or hallucination Not explained by conduct disorder, mania, or ASPDO excitement of stealing and not related to anger, just excitement to steal and get away with it.

Answer 73

Presence of obsessions, compulsions, or both Time-consuming or cause significant functional impairment Not attributable to effects of a substance or medical condition Not better explained by another mental disorder Specify level of insight: poor, fair, or good Specify if related to tic disorder treat with benzo, SSRI (higher doses and longer treatments), psychotherapy can help Can gage how meds doing if behaviors better.

Answer 74

Recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, and cause marked anxiety or distress Individual attempts to ignore or suppress such thoughts, or tries to neutralize them with some other thought or action (compulsions) more common: cleanliness (germaphobic), security.

Answer 75

``` Contamination Symmetry Forbidden or taboo thoughts Harm to self or others Hoarding behaviors ``` common: excessive praying, washing hands many times, these relieve anxiety and aimed and making anxiety not come back. ``` Repetitive behaviors (hand washing, ordering, checking) or mental acts (counting, praying, repeating) that the individual feels driven to perform in response to an obsession or rigid, arbitrary rules Actions are aimed at preventing or reducing anxiety, or preventing some dreaded event. Actions may not be logical connected to what they are designed to prevent. ```

Answer 76

dislike their appearance Preoccupation with one or more perceived defects in physical appearance that are not perceived or appear slight to others At some point, individual has performed repetitive thoughts or behaviors in response to this belief Causes significant distress or functional impairment Not better explained as an eating disorder NOT A PART OF EATING

Answer 77

Persistent difficulty discarding objects regardless of their actual value Due to perceived need to save the items and distress associated with discarding them Living areas become cluttered and their function compromised Causes significant distress or impairment Not associated with other psychiatric or medical disorders Specify: Excessive acquisition of unneeded items Specify: Level of insight (absent, poor, fair, good)

Answer 78

personality arrange ENTIRE LIFE, where as disorder is SPECIFIC (gets in way of success)

Answer 79

no. Biological function of the brain =mind.

Answer 80

disorders may not have an explanation, different from normal & is a range and variations outside of range. Disease has known pathophysiology aka has an "explanation"

Answer 81

Mental disorders involve a “web of causation” Biological Factors - anatomy, genetics, cell biology, neurochemistry Psychological Factors - development, coping skills (w/stress), belief systems Social Factors - cultural, economic, political, financial (play into pt presentation)

Answer 82

"what's going on in pt brain" Interaction with a patient to assess their mental state at a given time and place (is a "snapshot") Includes conversation, inquiry, and observation Approaches “from the outside in” (genera to specific questioning)

Answer 83

Inception Reconnaissance Detailed Inquiry Conclusion

Answer 84

aka starts when enter the room-"snapshot" Chief Complaint, Psychiatric History, Social History, Family Medical and Psychiatric History, Social, educational, occupational military (histories), chemical dependence, legal history. may not have been like this before.

Answer 85

Chief Complaint - what, when, why now? HPI - duration, precipitating factors, specific symptoms, intensity of symptoms, any associated physical changes or illnesses -"job of digging into what's going on, most detailed part"

Answer 86

Psychiatric History - prior episodes of similar symptoms, other types of psychiatric illness, prior treatments and outcomes (effected by culture also note depression can be caused by hypothyroidism) Family Medical and Psychiatric History - mental disorders, chemical dependence, medical problems (aka can be genetic)

Answer 87

Social History - (past and current life) family composition, parents histories, family life, cultural milieu, significant or traumatic events (abuse/foster home) during development Educational History - academic achievement, attitudes toward school, likes/dislikes, socialization in school (social abilities) Occupational History - first job, duration of employments, changes in career, significant episodes of disability or unemployment

Answer 88

Military History (if applicable) - affiliation, duration, deployments, experience during combat Chemical Dependence - use patterns, legal involvements, treatment episodes Legal History - arrests or convictions, lawsuits, bankruptcy

Answer 89

Psychiatric equivalent of the physical examination Intended to describe patient’s mental state during the interview (“snapshot”) Uses past tense verbs

Answer 90

``` Appearance and Behavior Relationship to the Interviewer Mood and Affect Cognition and Memory Language Disorders of Thought Physiologic Function Insight and Judgment (think this way as this is order write note in) ```

Answer 91

Describes physical aspects of patient Should include pertinent positives or negatives Detailed but non-judgmental ex: neat, groomed, cooperative, evasive & details give clue to pt behavior

Answer 92

Catatonia - minimal or no movement (stiff) Akathesia - difficulty staying still Waxy Flexibility - “action figure” posing (catatonia like/no voluntary movements but not stiff) Mannerisms - picking, slapping, tapping hands or feet, etc.

Answer 93

Patient’s attitude towards examiner and examination Eye contact, body posture, facial expressions (“gestalt”) or (sad, annoyed, body posture) Note changes during interview and possible motivations for change

Answer 94

Mood is a sustained emotional quality Affect is a variable demonstration of the patient’s internal state Demeanor is the patient’s projection of a specific state, possibly not their true state (a type of faking it)

Answer 95

A sustained emotional state that is frequently, but not always, associated with a certain affect Depressed - sustained sadness Anxious - sustained worry or fear Irritable - easily angered or upset Euphoric - extreme elation Labile - rapidly changes from one affect to another Apathetic - lack of emotions

Answer 96

Moment to moment expression of emotions Demonstrate the patient’s feelings about themselves, others, and situations Mood states have “typical” affects but patients still maintain affective range

Answer 97

Euthymic - “normal” range of expression based on mood and circumstances Dysphoric - sad, emotionally numb Histrionic - rapidly changing, superficial (dramatic) Labile - suddenly changing without obvious provocation Flat - little expression of emotion, monotonous Angry - signs of hostility Incongruent - not consistent with statements or expressed mood (smiling and says super sad)

Answer 98

``` Describes quality of mental functions (make decisions) Alertness (glascow coma scale) Orientation Memory Attention Concentration ```

Answer 99

Fully alert - no impairment Coma - non-responsive to stimuli Stupor - briefly rousable by stimuli Torpor - restricted responses (more so than stupor) Twilight - brief sense of confusion and disorientation (comes and goes)

Answer 100

Waxing and waning consciousness (aware to disoriented) Lack of awareness of surroundings, agitation, hallucinations, restlessness, insomnia, combative, visual illusions, labile affect Frequent in ICU and post-op settings Caused by metabolic illness, infections, medication reactions, strokes, many other medical conditions -often from metabolic or chemistry that delays mental -if see delirum look for something causing, different than psychosis.

Answer 101

Person - rarely impaired except dissociative states Time - day, date, month, year, hour Place - building, city, state Situation - clinic, hospital, home

Answer 102

Immediate - initial registration by the brain Short term - maintained in hippocampus for several minutes Long term - memory traces in temporal and parietal lobes for retrieval

Answer 103

Retrograde Amnesia - loss of past memories after severe injury, metabolic illness, intoxication, psychosis, severe anxiety states, dissociative states -brain =x form new memories or blurry memory Anterograde Amnesia - loss of ability to form new memories following head injury or illness -remember before an event but not after

Answer 104

Falsification - making up new memories because your old ones suck (make up completely) Confabulation - false memories created to fill gaps caused by illness or dementia (=x remember but some sense so make it up) Perseveration - repeating the same information in response to different inquiries

Answer 105

Repeat three unrelated words to test immediate recall Ask patient to recall words a few minutes later to test short term memory Ask about remote events - names of schools, historical events, etc. (testing long term memory)

Answer 106

Ability to focus on a task Tests include serial 7 subtractions, spelling simple words (“world”) backwards Note distractibility during interview

Answer 107

Ability to reason in abstract concepts rather than concrete concepts Proverbs test Humor test

Answer 108

Note language functions throughout interview Flow of speech - fluent, sparse, stilted, over inclusive Initiation of speech - spontaneous, latency Comprehension - patient’s understanding

Answer 109

Aphasia - difficulty repeating words or phrases (often from a tumor) Muteness - lack of speech Paralogia - approximately correct answers (constantly almost right) Echolalia - answers echo questions Clang Speech - words chosen based on sound rather than meaning (no rhyme or reason) Word Salad - incoherent speech

Answer 110

Inferred by speech and actions Assessed throughout interview through observation and inquiry. rapid fire/racing thoughts or pressured speech or slow tempo/retarted tempo

Answer 111

Racing Thoughts - rapid thoughts that patient cannot slow voluntarily. Frequently accompanied by pressured speech. Retardation - slow, laborious thoughts with speech latency and sometimes loss of thread

Answer 112

Goal-Directed - patient is able to express coherent thoughts Circumstantial - expresses excessive detail and “side trips” but able to reach goal Tangential - thoughts follow each other with tentative connections to previous thought (last word of sentence triggers new topic from something mentioned prior) Flight of Ideas - thoughts skip rapidly between topics with minimal connection to previous thought (rapid fire changes, completely unrelated) Incoherent - thoughts essentially impossible to follow

Answer 113

Logical - no “abnormal” thoughts noted Paranoid - illogical fears, suspicion Delusions - fixed false beliefs Ideas of Reference - belief that benign stimuli refer to patient specifically (aka radio, news, video games) Thought Insertion - belief that others implant thoughts in patient Thought Broadcasting - belief that other can hear the patient’s thoughts

Answer 114

Illusions - falsely interpreted sensory stimulation (thought saw something or heart something that wasnt there, brain trying to pattern match) Hallucinations - false perception in the absence of sensory stimulation (come from temporal lobe place as visual or auditory)

Answer 115

Shadow passing by Someone in the room Heard someone’s voice Common in depression, anxiety, extreme stress, delirium

Answer 116

Auditory - hearing voices, music, etc. Visual - simple or complex forms Tactile - formication, touching (bugs or feels things) Olfactory and Gustatory - smells and tastes Somatic - physical symptoms appear to patient as stimulated by persecution/technology (ex: belief there's an alien in my body) -content may be cultural-

Answer 117

Sleep functions Appetite and Weight Changes Sexual Changes Musculoskeletal Changes - agitation, retardation, ambulation

Answer 118

Insight - understanding the presence of an illness and the risks and benefits of treatment Judgment - subjective evaluation of the quality and appropriateness of a patient’s decision making capacity

Answer 119

Initiation - greet patient, establish purpose Begin with open-ended questions Allow free-form answer then begin detailed inquiry (outside in approach) Focus on clinical and diagnostic symptoms (start digging) Use judgment on when to re-direct interview

Answer 120

Mood Disorders Anxiety Disorders Psychotic Disorders

Answer 121

Disorder - disruption in normal functioning of a body part or system (=x know source) Disease - pathophysiological response to external or internal factors

Answer 122

A change in mood that is persistent Accompanied by physical, emotional, and functional deficits May be intrinsic or related to other factors like stressors, illness, or substance abuse

Answer 123

Exists on a “spectrum” Evaluated in discrete episodes that usually represent a clear departure from “normal” Mania > Euthymia > Depression (euthymia is normal)

Answer 124

two of these (main ones) Depressed or irritable mood, most days Anhedonia - lack of pleasure in previously pleasurable activities plus 5 of these -Significant appetite disturbance or weight change -Sleep disturbance -Psychomotor agitation or retardation (cant relax and very slow) -Loss of energy or fatigue -Feelings of worthlessness -Decreased concentration or cognitive abilities -Recurrent thoughts of death or suicide Self-rejection (“better off dead”)

Answer 125

Symptoms of Major Depressive Episode for at least two weeks (not days) Symptoms cause significant social, occupational, or interpersonal functioning Exclude drug use, bereavement, or other primary mental disorders

Answer 126

Rate severity - mild, moderate, severe Note psychotic features - hallucinations, negativistic delusions or paranoia Note anxious distress - worry, “keyed up”, restless, fear of “something awful”, fear losing control Note peri-partum onset

Answer 127

Chronic depression without complete remission for two years or more (not improving) “Dysthymia”, “Melancholia” Includes episodes of Major Depression with incomplete remission between episodes