Behavioral Flashcards
What can help recognize mental health disorders?
unexplained symptoms, “difficult encounters”, dual diagnosis, chronic illness
How are mental disorders classified?
psychological (mental/emotional state) or physical (relating to a body sensation, or can also be called somatic)
Often symptoms are described by patients in ___________ of _________ ____________
clusters of functional syndromes
What are some clusters of functional syndromes patients could presente with that could indicate a mental disorder?
IBS, fibromyalgia, chronic fatigue, TMJ disorder, sensitivities
Often there are several ______ symptoms rather than a _______ complaint
related, single
What also could indicate a medical disorder?
frequent flyers
What should prompt screening for depression and anxiety?
unexplained conditions lasting more than 6 weeks
What approach is a brief screening questions w/ high sensitivity/specificity to identify those a high risk with detailed follow-up when indicated?
two-tier approach
What approach serves as initial screen for 5 general groups of mental disorders?
PRIME-MD, only 26 questions
What are some indications for mental health screening?
- unexplained physical symptoms
- high amount of symptoms
- high severity of presenting symptom
- chronic pain
- symptoms > 6 weeks
- “difficult encounter”
- recent stress
- low self rating of health
- frequent use of health care
- substance abuse
What are common and concerning symptoms?
- changes in attention, mood, speech, insight, orientation, memory that can demonstrate anxiety, panic, ritualistic behavior, phobias, delerium, dementia
- try to integrate into history so it will seem less like an interrogation
How much does major depression affect the population?
9%
What are some early/high risk signs of depression?
low self esteem, anhedonia (loss of pleasure in daily activities), sleep disorders, difficulty concentrating and making decisions
What are some vulnerable patients to depression?
young, female, single, divorced, chronically ill, seriously ill, bereaved, other disorders, substance abuse
How common is serious mental illness?
1 in 25
How common is mental illness?
1 in 5
Suicide is the ___ leading cause of death in the US
10th
T/F: Suicide is the 2nd cause of death 15-24yo
true
Do men have higher or lower suicide rates than women?
higher, but women attempt more frequently
T/F: not every patient needs to be screened for alcohol use, substance use, and misuse of drugs
false. Everyone!
What are the 5 components you are looking at with the mental status exam?
1) appearance and behavior
2) speech and language
3) mood
4) thoughts and perceptions
5) cognitive function
When analyzing appearance and behavior, what are you looking at?
- level of consciousness
- posture and motor behavior
- dress, grooming, personal hygiene
- facial expression
- manner, affect, relationship to people and things
What are you analyzing with speech and language?
quality, rate, volume, articulation, fluency, terminology (any disorders?)
How can you test for aphasia?
word comprehension (following commands), repetition (repeating), naming (ask to name), reading comprehension (read aloud), writing (ask to write)
What must you ask about mood?
“how did you feel about that?” “how is your overall mood?”
** it is your responsibility to ask direct questions about suicidal thoughts **
What are some ways to assess suicide risk?
- how low do you feel?
- what do you see for yourself in the future?
- do you ever feel like life isn’t worth living? Do you ever feel that you want to be dead?
- Have you ever thought about killing yourself? do you have a plan?
- what do you expect to happen after you die?
What are you analyzing with thoughts and perceptions?
circumstantiality, derailment,, flights of ideas, neologisms, incoherence, blocking, confabulation, perseveration, echolalia, clanging
What is circumstantiality and what does it indicate?
speech w/ unnecessary detail, indirection, delay in reaching a point (obsession)
What is derailment and what does it indicate?
shifting topics that are loosely connected/unrelated (schizo, mania, others)
What is flight of ideas and what does it indicate?
continuous flow, accelerated speech, abrupt changes of topics (manic episodes)
What is neologisms and what does it indicate?
invented or distorted words (schizo, psychotic, aphasia)
What is incoherence and what does it indicate?
illogical, incomprehensible speech, lack of meaningful connections (severe psych disturbances, schizo)
What is blocking and what does it indicate?
sudden interruption of speech, losing train of thoguht (schizo)
What is confabulation and what does it indicate?
fabrication of facts or events, filling gap with impaired memory (Korsakoff syndrome from alcoholism)
What is perserveration and what does it indicate?
persistent repitition of words and ideas (schizo and other psych disorders)
What is echolalia and what does it indicate?
repititon of words and phrases of others (manic and schizo)
What is clanging and what does it indicate?
chose words based on sounds/rhymes/puns rather than meaning (schizo and manic)
What abnormalities can occur in thought content?
compulsions, obsessions, phobias, anxieties, feelings of unreality, depersonalization, delusions
What are compulsions, obsessions, phobias, and anxieties often a sign of?
anxiety disorders
What are delusions, feeling of unreality or depersonalization often associated with?
psychotic disorders, or delirium, severe mood disorders, dementia
When may illusions occur?
grief reactions, delirium, acute and PTSD, schizophrenia
When may hallucinations occur?
delirium, dementia, PTSD, schizo, substance use
Who often lack insight into their illness?
patients w/ psychotic disorders
What else can influence judgement?
anxiety, mood, delirium, dementia, psychotic states, intelligence, education, income, cultural values
When can disorientation occur?
when attention is impaired like delirium
What are tests to test attention?
digit span (recite series of digits and ask to repeat back – normal should be 5 forward, 4 backward, stop after second failure)
serial 7s (subtract from 100, normal can be 1.5m)
spelling backward
What are some causes of poor performance in digit span?
delirium, dementia, intellectual disability, performance anxiety
What are some causes of poor performance in serial 7s?
resulting from delirium, late stage of dementia, intellectual disability, anxiety, depression, education
What should you be testing in memory?
remote (birthdays, SSNs, names, previous jobs) and recent memory (events of day, weather, time) - impaired in dementia, delirium, anxiety, depression, intellectual disability
How can you test a new learning ability?
give patient 3-4 words, ask patient to repeat them, after 5 minutes ask patient to repeat again
How can you test information and vocabulary?
ask about work, hobbies, reading, favorite TV programs, current events (helps distingush adults w/ lifelong intellectual impairment)
How can you test calculation abilities?
ask patient to perform calculations — poor performance = dementia or aphasia but also can be measured against person’s knowledge and level of education
How can you test a patient’s abstract thinking?
ask patient to meaning of a proverb, and with concrete responses = intellectual disability, delirium, dementia
can check similarities by asking patient to see how things are alike
How can you test a patient’s constructional abilities?
ask patient to draw a clock (with intact vision and motor ability!) otherwise, poor = dementia or parietal lobe damage
What is a special technique used by any provider to screen for cognitive dysfunction or dementia to follow over time?
MMSE - mini mental status exam
