Behavior and Mental Health Flashcards
“Tangential” speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
Derailment (loosening of associations)
Derailment is seen in schizophrenia, manic episodes, and other psychotic disorders
What are the key features of personality disorders?
Long-term, chronic, enduring, pervasive pattern
Cluster A Personality Disorders
Odd or Eccentric Disorders
- Paranoid
- Schizoid
- Schizoitypal
A 40-year-old female bank teller has recently been diagnosed with obsessive-compulsive disorder by her therapist. Which of the following symptoms characterize this disorder?
a) ritualistic behaviors that the patient feels compelled to repeat
b) increased anxiety when attempting to ignore or suppress the repetitive behaviors
c) frequent intrusive and repetitive thoughts and impulses
d) all of the above
d - all of the above
OCD is an anxiety disorder in which people have unwanted and repeated thoughts, feelings, ideas, sensations (obsessions), or behaviors that make them feel driven to do something (compulsions). Often the person carries out the behaviors to get rid of the obsessive thoughts, but this only provides temporary relief. Not performing obsessive rituals can cause great anxiety.
When testing for aphasia, you ask the patient to follow a one-stage command such as “point to your nose.” This assesses for:
Word comprehension
What personality disorder has these central features: disregard for and exploitation of the rights of others (repeatedly performs acts that are grounds for arrest)
Antisocial Personality Disorder
A complex symbolic system for expressing, receiving , and comprehending words; as with consciousness, attention and membory, this is essential for assessing other mental functions
Language
A more pervasive and sustained emotion that colors the person’s perception of the world.
** May be euthymic (in the normal range), elevated or dysphoric (unpleasant, possibly as sad, anxious, or irritable), for example
Mood (Affect is to mood as weather is to climate)
Repetition of the words and phrases of others
Echolalia
Echolalia occurs in manic episodes and schizophrenia
Screening questions for depression
- Over the past 2 weeks, have you felt down, depressed, or hopeless?
- Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)?
What personality disorder has these central features:
attention-seeking with excessive emotionality (uncomfortable when not the center of attention)
Histrionic Personality Disorder
What personality disorder has these central features: instability in relationships, identity, behavior, and affect (unstable and overly intense interpersonal relationships, highly impulsive)
Borderline Personality Disorder
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected.
Flight of Ideas
Flight of ideas is most frequently noted in maic episodes.
A fluctuating pattern of observable behaviors that expresses subjective feelings or emotions through tone of voice facial expression, and demeanor
Disturbed may be flat, blunted, labile, or inappropriate
Affect
What personality disorder has these central features: general distrust and suspiciousness (suspects, without sufficient basis, that others are exploiting, harming, or deceiving him/her)
Paranoid Personality Disorder
What personality disorder has these central features:
submissive and clinging behavior related to excessive needs to be taken cared of (urgently and indiscriminately seeks another relationship when a close relationship ends)
Dependent
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory.
Confabulation
Confabulation is seen in Korsakoff syndrome from alcoholism
What is the DSM-5?
Diagnostic and Statistical Manual of Mental Disorders - 5th edition
Resource used by clinicians for official diagnostic criteria for menal health disorders
What personality disorder has these central features: detachment from others, restricted range of emotional expression (neither desires nor enjoys close relationships)
Schizoid Personality Disorder
What personality disorder has these central features:
arrogance, need for admiration, and grandiosity (elevated and unrealistic sense of self-importance, lack of empathy)
Narcissistic Personality Disorder
(Note: both narcissistic and antisocial have a lack of empathy)
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
Clanging
Clanging occurs in schizophrenia and manic episodes
What personality disorder has these central features:
preoccupation with orderliness, perfectionism, and control (preoccupied with details, rules, lists, organization, or schedules to the extent that the major point of the activity is lost)
Obsessive-compulsive
What personality disorder has these central features:
social inhibition and hypersensitivity to criticism and rejection (avoids social and occupational activities that involve significant interpersonal contact due to insecurities and anxieties)
Avoidant Personality Disorder
Cluster B Personality Disorders
Dramatic, Emotional, or Erratic Disorders
- Antisocial
- Borderline
- Histrionic
- Narcissistic
The 5 steps of the mental status exam
1) appearance and behavior
2) speech and language
3) mood
4) thoughts and perceptions
5) cognitive function: memory, attention, information and vocabulary, calculations, abstract thinking, and constructional ability
The mildest thought disorder, consisting of speech with unnecessary detail, indirection and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have this type of speech.
Circumstantiality
Circumstantiality occurs in people with obsessions
Invented or distorted words, or words with new and highly idiosyncratic meanings
Neologisms
Neologisms are observed in schizophrenia, psychotic disorders, and aphasia
A type of anxiety disorder in which patient’s exhibit intense, disturbing thoughts and feelings related a past traumatic experience. The patient may relive the event through flashbacks or nightmares, may feel sadness, fear, or anger, or they may feel detached or estranged from other people
Post Traumatic Stress Disorder (PTSD)
If you suspect your patient has depression, what are some important questions to ask?
- Do you feel discouraged or depressed?
- How low do you feel?
- What do you see for yourself in the future?
- Do you ever feel that life isn’t worth living? Or that you want to be dead?
- Have you ever thought of killing yourself?
- How did (do) you think you would do it? Do you have a plan?
- What do you think would happen after you were dead?
** It is your responsibility to ask directedly about suicidal thoughts
Cluster C Personality Disorders
Anxious or Fearful Disorders
- Avoidant
- Dependent
- Obsessive-compulsive
Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought.” Occurs in normal people
Blocking
Blocking may be striking in schizophrenia
Screening questions for anxiety
- Over the past 2 weeks, have you been feeling nervous, anxious, or on edge?
- Over the past 2 weeks, have you been unable to stop or control worrying?
- Over the past 4 weeks, have you had an anxiety attack-suddenly feeling fear or panic?
A mental health screening is indicated in these patients:
- medically unexplained physical symptoms
- “high symptom count”
- multiple physical or somatic symptoms
- high severity of the presenting somatic symptom
- chronic pain
- symptoms for more than 6 weeks
- “difficult encounter”
- recent stress
- low self-rating of overall health
- frequent use of health care services
- substance abuse
**chronic pain may be a spectrum d/o in pts w/ anxiety, depression, or somatic symptoms
What personality disorder has these central features: discomfort in close relationships, cognitive or perceptual distortions, and eccentric behaviors (odd beliefs, magical thinking, and unusual perceptual experiences)
Schizotypal Personality Disorder
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce this.
Incoherence
Incoherence is seen in severe psychotic disturbances (usually schizophrenia)
Alterations in speech and language may indicate:
- Depression (slow speech)
- Mania (accelerated louder speech)
- Defective articulation (dysarthria)
- Disorder of language (aphasia)
- Impaired volume, quality, or pitch of voice (dysphonia)
Assessed by vocabulary, fund of information, abstract thinking, calculations, constructions of objects that have two or three dimensions
Higher cognitive functions
Persistent repetition of words or ideas
Perseveration
Perseveration occurs in schizophrenia and other psychotic disorders
A mental health disorder characterized by feelings of worry or fear that are strong enough to interfere with one’s daily activities
Anxiety disorder
A type of anxiety disorder characterized by sudden feelings of terror when there is no real danger and/or feelings of losing control. Patient may also have physical symptoms such as a rapid heart rate, chest or stomach pain, difficulty breathing, sweating, feeling hot or a cold chill, tingly or numb hands.
Panic disorder
Patient experiences ‘panic attacks’
A chronic mental health condition in which social interactions cause irrational anxiety. Everyday social interactions cause fear, self-consciousness, and embarrassment.
Social anxiety disorder
The second leading cause of death among 15 to 24 year olds.
Suicide
The portion of the mental status exam that looks at awareness of personal identity, place, and time; requires both memory and attention
Orientation
Name a category of the mental status examination
- Appearance and Behavior
- Speech and Language
- Mood
- Thoughts and Perceptions
- Cognition (including memory, attention, information and vocabulary, calculations, abstract thinking, and constructional ability
Excessive worry persisting over a 6-month period
Anxiety disorder
Chracterized by re-experiencing, avoidance, persistent negative alterations in cognition and mood, and alterations in arousal and reactivity
PTSD
