Behavioral Dynamics

Question 1

Psychiatrist characteristics - degree, what they do?

Answer 1

• MD
• diagnostic evals
• psychotherapy
• med management
• speciality areas

Question 2

Clinical psychologist - What do they do?

Counseling psychologist?

Answer 2

• PhD or PsyD
• admin and interpret psych testing
• development of prevention and tx programs
• psychotherapy
• expert testimony
• counseling psychologist: PhD - counseling, psychotherapy, assessments and consultation

Question 3

Educational psychologist - what do they do?

Answer 3

• masters in ed. psychology
• dx and psych assessments
• counseling
• mediation, co-ordinates with and refers to other professionals

Question 4

Licensed clinical professional counselor - training?

Answer 4

• masters training in counseling

- therapists

Question 5

Psych social worker - training and work?

Answer 5

• masters or doctorate in social work
• mental health assessments
• case management
• group facilitators

Question 6

What does counseling entail? Therapy?

Answer 6

• counseling: personal guidance, std psych methods - collect case history data, and test for interests and aptitudes
• therapy: relieving or curing a disability or illness

Question 7

Psychotherapy - psychodynamic/psychoanalytic?

Answer 7

- freudian traditions:
unconscious conflicts
family issues from early life
difficulties with current relationships
- severe and chronic personality disorders
- persistent problems in coping with life events
- few months to a few years
- rarely used today

Question 8

Behavioral therapy- entails what, used for?

Answer 8

• reducing sxs by:
  relaxation techniques
  changing factors that reinforce sxs, graduated exposure to distressing stimuli
• anxiety disorders, depression, psychomatic complaints - OCD, phobias
• generally brief: 6-12 sessions
• guided imagery - learning how to relax while imagining feared situation

Question 9

Cognitive thinking (CBT)- what is it used for?

Answer 9

• assumption that negative thoughts promote anxiety or depression
• pt taught to challenge negative thoughts
• depression, anxiety, problems related to substance abuse issues
• 10-20 sessions

Question 10

What is dialectical behavior therapy? used in what?

Answer 10

• CBT and mindfulness (in the here and now)
• acceptance and change
• 1st therapy to show positive change in borderline personality disorder

Question 11

Use of group therapy?

Answer 11

• support group - cancer, grief
• education
• can be open ended, or time-limited
• any theoretical orientation
• personality disorders, grief work, physical health issues

Question 12

Sign vs symptom?

Answer 12

• sign: what you see

- sx: is what pt says that they are experiencing

Question 13

What is consciousness? Emotion? motor behavior?

Answer 13

• consciousness: awareness of self and environment, orientation to person, place and time
• emotion: psychic feeling with physiological response
• motor behavior: physical agitated (restless); motor slowed

Question 14

Cognitive process of thinking?

Answer 14

• fomring mental images or concepts
• can be concrete or abstract
• linear, goal directed vs Tangential/flight of ideas

Question 15

Perceptions?

Answer 15

• recognition and interpretation of sensory stimuli
• hallucinations: responding to internal stimuli
• illusion: perception from an external stimulus, usually auditory (voices on wind)
• delusion: fixed belief not basd on reality

Question 16

Definition and components of intelligence?

Answer 16

- potential ability and capacity to:
acquire
retain
apply:
understanding
knowledge
reasoning
judgement

Question 17

Diff b/t psych and medical-surgical interview?

Answer 17

• rather than just trying to determine what their sxs are - find out what they are experiencing
• insight oriented instead of sx oriented
• psych interview involves:
  obtaining hx, eval mental status, collecting auxillary data, summarizing principle findings, dx, making prognosis, determining tx plan

Question 18

Diff methods of psych interview?

Answer 18

• want to make pt feel comfortable, foster trust, and develop expectation that tx will help
• reflection: pick up feeling of pt’s message and repeats it back to pt, encourages pt to clarify
• silence: giving pt time to communicate feelings
• confrontation: presenting their behaviors and apparent feelings back to them

Question 19

Components of the mental status exam? appearance, behavior, speech, mood, congruency, perception?

Answer 19

• describe:
  behavior
  speech
  emotions
  cognition
  perceptual processes
• objective report
• appearance: clothes, posture, grooming, degree of alertness
• behavior: motor activity - hyper motor/slowed, impulse control, gestures, gait
• speech: volume, rate, accents, clarity
• mood: how are they feeling
• affect: what expressions you observe: lability - go from crying to laughing
  stability: mood stable?
  congruency: is affect congruent with what they are saying
• perception: hallucinations (hearing, seeing, smelling, feeling things), illusions

Question 20

MSE - thought process, thought content?

Answer 20

thought process: continuity - linear and goal directed or flight of ideas/loose associations
- thought content:
word usage -
neologisms: saying things that make no sense at all
approximations: dementia - can’t name a clock but can describe it
content: logical vs illogical (my body conforms to my clothes)

Question 21

MSE - concentration, attention, orientation, memory, judgement?

Answer 21

• concentration: ability to focus
• attention: ability to sustain focus
• orientation: person, place, time, situation
• memory: remote(last to go), recent, immediate
• judgement - social situations

Question 22

MSE - insight, intelligence?

Answer 22

• insight: complete denial
  dim awareness
  awareness but inappropriate blame
  awareness with knowledge of internal source
• intelligence: average, below average, above average - what you perceive it to be

Question 23

MMSE - orientation, registration, attention and calculation, recall?

Answer 23

• MMSE: possible to get 30 pts, anything unde 24 - abnormal, avg for dementia is 10
• orientation - possible 10
• registration: attention and concentration - spelling backward
• attention and calculation - serial 7s backwards
• recall: immed memory: ask for 3 objects told in registration

Question 24

MMSE - language, visual motor integrity, level of consciousness along continuum?

Answer 24

• language: 6 steps - understangin, following instructions - write a sentence, folllow commands
• visual motor integrity: copy design of intersecting shapes
• level of consciousness along a continuum

Question 25

SLUMS intrument?

Answer 25

- dementia:
orientation
executive fxning - making change
memory - repeat list
language - name animals
calculation
visuoconstructive skills: draw clock

Question 26

MOCA?

Answer 26

• Montreal cognitive assessment - rapid screening for mild cog impairment
• over 26 is normal (out of 30):
  attention and concentration
  executive fxning
  memory
  language
  calculations
  orientation
  visuoconstructive skills

Question 27

Zung self-rating depression scale?

Answer 27

• pt fills it out

- avg score for depression 50-69, over 69 is severe depression

Question 28

Hamilton rating scale for depression?

Answer 28

• rating severity and progress or lack of progress, performed by health professional (psychiatric)
  21 ?s - score first 17 ?s
• use when pt is already dx with depression
• 0-7 WNL
• 8-19 mild depression
• over 20 moderate to severe

Question 29

Beck anxiety inventory?

Answer 29

• pt fills this out
• 0-7 WNL
• 8-15 mild
• 16-25 mod
• 26-63 severe

Question 30

Mood disorder questionnaire is used when?

Answer 30

• used in bipolar disorder
• answer yes to 7 or more items in question 1
• yes to 2 and 3 - positive for bipolar

Question 31

DSM I?

Answer 31

• 1952
• diagnoses were loosely defined
• psych etiologies - depressive reaction, paranoid rxns

Question 32

DSM II?

Answer 32

• 1968
• conformity to WHO international classification of disease
• diagnostic criteria vague and open to bias - african americans

Question 33

DSM III? multiaxial diagnoses?

Answer 33

• 1985
  explicit, readily verifiable and specific diagnostic criteria
• multiaxial system of diagnoses
• diff classes of meds developed and correct diagnoses were needed to choose appropriate meds
• multiaxial diagnoses:
  axis 1: chief psychiatric diagnoses
  axis 2: personality disorders, intellectual disabilities
  axis 3: medical
  axis 4: social issues
  axis 5: global assessment of fxning

Question 34

DSM IV?

Answer 34

• 1994
• scientific evidence determined diagnostic categories
• descriptive approach
• clearly delineated, objective, verifiable criteria
• pts don’t have identical clinical characteristics

updated- IV-TR in 2000

Question 35

DSM V?

Answer 35

• 2013
• ICD 10
• developmental and lifespan considerations: begins with early life through later life
• gender differences: express diff
• diagnoses: ex - autism spectrum disorder
• enhanced specificity: major and mild neurocog. disorders that were previously lumped under dementia
• section III - new disorders requiring further study
• online enhancements available

Question 36

Psych charting components - progress note?

Answer 36

progress note:
- Hx of current illness: reason for admission
- current status - suicidal ideation?
response to tx
- MSE
- medical status
- plan

Question 37

Admit note (or H&P)?

Answer 37

• Identifying info (age, appearance)
• HPI: suicidality?
• psych hx:
  previous diagnoses
  hospitalizations
  professionals
  meds
• substance abuse hx
• past medical hx (any self harm?)
• family hx - good response to med?
• developmental/social hx:
  family life: relationships, marital status
  education
  occupation
  housing
  physical, mental, emotional abuse
• MSE
• plan: testing - labs, xrays, CT scans, MRI, neuro eval, referrals, meds, therapy

Question 38

Everything that is included in the MSE - goes in note?

Answer 38

• appearance
• mood
• orientation
• intellect
• thought processes
• speech
• perceptions
• judgement
• insight