behavioral health Flashcards
1
Q
symptoms of mental disorders classified as either:
A
- psychological: reflecting a mental or emotional state
- physical: relating to a body sensation (pain, fatigue, palpitation
2
Q
symptoms of mental disorders also called:
A
SOMATIC:
pain from headaches
backache
MSK
GI
sexual/reproductive
neurologic
dizziness or loss of balance
3
Q
with mental disorders, instead of a single complaint there are
A
clusters of functional syndromes
4
Q
examples of clusters of functional syndromes
A
irritable bowel syndrome
fibromyalgia
chronic fatigue
TMJ
multiple chemical sensitivities
5
Q
2/3 of patients with depression present with
A
multiple unexplained or somatic symptoms
6
Q
patients with unexplained and somatic symptoms and frequent users of healthcare system
A
“frequent flyers”
7
Q
20% of primary care visits are labeled this due to underlying anxiety and depression with somatic manifestations
A
“difficult encounters”
8
Q
what can cause provider burnout
A
frequent flyers and difficult encounters
9
Q
why do we not do mental health screening for all patients
A
it is time consuming and expensive
10
Q
when should we do mental health screening
A
unexplained conditions lasting more than 6 weeks should prompt screening for depression, anxiety, or both
11
Q
what is the two tier approach
A
- brief screening questions with high sensitivity/specificity to identify those a high risk
- follow up detailed investigation when indicated
12
Q
what is PRIME-MD (primary care evaluation of mental disorders) screening questionnaire
A
- serves as initial screen for 5 general groups of mental disorders
- 26 questions takes 10 minutes
13
Q
indications for mental health screening
A
- medically unexplained physical symptoms > 50% have depression or anxiety
- high symptoms count
- high severity of presenting somatic symptom
- chronic pain
- symptoms > 6 weeks
- “difficult encounter”
- recent stress
- low self rating of overall health
- frequent use of health care services
- substance abuse
14
Q
common and concerning symptoms in the health history
A
changes in attention, mood, speech, insight, orientation, memory
this demonstrates anxiety, panic, ritualistic behavior, phobias, delirium, dementia
15
Q
how to make the pt encounter feel less like an interrogation
A
integrate evaluation of mental status into history
16
Q
major depression affects ______% of the population
A
9
17
Q
depression is twice as common in ____
A
women
18
Q
high risk/early signs of depression
A
- low self esteem
- anhedonia: loss of pleasure in daily activities
- sleep disorders
- difficulty concentrating
- difficulty making decisions
19
Q
depression vulnerable pts
A
young
female
single
divorced/separated
chronically ill
seriously ill
bereaved
other psych disorders
substance abuse
20
Q
depression severity: none-minimal
treatment: none
A
total score: 0-4
21
Q
depression severity: mild
treatment: watchful waiting, repeat PHQ-9 at follow up
A
total score: 5-9
22
Q
depression severity: moderate
treatment: consider counseling, follow up and/or pharmacotherapy
A
total score: 10-14
23
Q
depression severity: moderately severe
treatment: active treatment with pharmacotherapy and or psychotherapy
A
total score: 15-19
24
Q
depression severity: severe
treatment: immediate initiation of pharmacotherapy and if severe impairment or poor response to therapy, expedited referral to a mental health specialist for psychotherapy
A
total score: 20-27
25
- 10th leading cause of death in US
- 2nd leading cause of death among ages 15-24
- highest rate among 45-54 and again >85
suicide
26
who has higher successful suicide rates
men by 4x
27
who attempts suicide more frequently
women
28
what has replaced illicit drugs as leading cause of drug induced death
prescription drugs
29
who should be asked about alcohol use, substance use, and misuse of prescription drugs
every patient
30
5 components of the mental status exam
1. appearance and behavior
2. speech and language
3. mood
4. thoughts and perceptions
5. cognitive function
31
what to look for in appearance and behavior
- level of consciousness (alert and oriented?)
- posture and motor behavior (how are they sitting and moving)
- dress, grooming, personal hygiene (how are they dressed/clean)
- facial expression (appropriate during rest and convo)
- manner, affect, and relationship to people and things (external expression matches inner emotions, openness)
32
what to look for in speech and language
- quality: talkative/silent
- rate: speech fast or slow
- volume: loud or soft
- articulation of words: clear or nasally
- fluency: rate, flow, melody of speech, circumlocutions, paraphrasisas
- terminology
33
saying "what you write with" instead of "pen"
circumlocutions
34
words are malformed "I write with a den" or invented "I write with a dar" or incorrect "I write with a bar"
paraphrasias
35
defective articulation
dysarthria
36
disorder of language
aphasia
37
T/F
a person who can write a correct sentence does not have aphasia
true
38
impaired comprehension with fluent speech
receptive aphasia
39
preserved comprehension with slow non fluent speech
expressive aphasia
40
results from impaired volume, quality or pitch of voice
dysphonia
41
testing for aphasia
1. word comprehension
2. repetition
3. naming
4. reading comprehension
5. writing
42
ask pt to follow a now stage command such as "point to your nose". then try two stage command "point to mouth, then knee"
word comprehension
43
ask patient to name parts of a watch
naming
44
ask the patient to repeat a phrase of one syllable words "no ifs ans or buts"
repetition
45
ask pt to read a paragraph out loud
reading comprhension
46
ask pt to write a sentence
writing
47
what questions to ask for mood
- ask the pt to describe their mood, including usual mood level, and fluctuations related to life events (how did you feel about that)
- intense, unchanged, labile, how long has it lasted, appropriate to situation
48
what should you do if you suspect depression
asses severity and ask about risk of suicide:
- how low do you feel
- what do you see for yourself in the future
- do you ever feel life is not worth living
- do you ever feel you want to be dead
- have you ever thought about killing yourself
- do you have a plan
- what do you expect will happen after you die
IT IS YOUR RESPONSIBILTY TO ASK DIRECT QUESTIONS ABOUT SUICIDAL THOUGHTS!
49
what to consider for thoughts and perceptions
is thought process a logical flow? relevant? organized? coherent?
50
speech with unnessesary detail, indirection, delay in reaching a point
circumstantiality
51
circumstantiality seen in
people with obsessions
52
shifting topics that are loosely connected/unrelated
derailment
53
derailment seen in
schizo, mania, and others
54
continuous flow, accelerated speech, abrupt changes of topic
flight of ideas
55
flight of ideas seen in
manic episodes
56
invented or distorted words
neologisms
57
neologisms seen in
schizophrenia, psychotic disorders, and aphasia
58
illogical, incomprehensible speech, lack of meaningful connections
incoherence
59
incoherence seen in
severe psychotic disturbances (usually schizophrenia)
60
sudden interruption of speech in mid sentence, "losing the thought"
blocking
61
blocking common in
schizophrenia
62
persistant répétition of words and ideas
perseveration
63
perseveration occurs in
schizophrenia and other psychotic disorders
64
repetition of the words and phrases of others
echolalia
65
echolalia occurs in
manic episodes and schizophrenia
66
chose words based on sounds/rhymes/puns rather than meaning. "two eyes, one nose, the nose knows, two to now, the ayes have it"
clanging
67
clanging occurs in
schizophrenia and manic episodes
68
repetitive behaviors that the person feels driven to perform in response to obsession in order to reduce anxiety
compulsions
69
recurrent thoughts, images, urges experienced as intrusive or unwanted, with attempts to suppress
obsessions
70
persistant irrational fears, compelling desires to avoid the stimulus
phobias
71
apprehensive anticipation of future danger
anxieties
71
compulsions, obsessions, phobias and anxieties often occur in
anxiety disorders
72
a sense that the environment is strange, unreal, remote
feelings of unreality
73
a sense that ones identity is different, changed, unreal, lost
feelings of depersonalization
74
false fixed personal beliefs that are not amenable to change in the light of conflicting evidence (persectory, grandiose, jealous, erotomatic, somatic)
delusions
75
delusions and feeling of unreality or depersonalization are often associated with
psychotic disorders
76
delusions may also occur in
delirium, severe mood disorders, and dementia
77
should you pursue false perceptions
yes
78
misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices
illusions
79
perception like experiences that seem real but lack actual external stimuli
hallucinations
80
illusions common in
grief reactions, delirium, acute and post traumatic stress disorders, and schizophrenia
81
hallucinations common in
delirium, PTSD, schizophrenia, substance use
82
try to evaluate if pt knows his symptoms, mood, thought, perceptions are part of an illness
insight
83
T/F
patients with psychotic disorders often lack insight into their illness
true
84
how to assess pts judgment
noting their response to family, job, money, interpersonal conflict situations. are their decisions based on reality or impulse
85
what else can influence judgement
anxiety, mood disorders, delirium, dementia, psychotic states, intelligence, education, income, and cultural values
86
person, place, time
orientation (cognitive function)
87
when is disorientation common
when attention is impaired, as in delirium
87
three tests for attention
1. digit span (a person should be able to repeat correctly at least five digits forward and four backward)
2. serial 7s (starting from 100, subtract 7 and keep going)
3. spelling backward
88
poor performance of digit span could be because of
delirium, dementia, intellectual disability, performance anxiety
89
poor performance of serial 7 could be
delirium, late stage dementia, intellectual disability, anxiety, or depression, educational level
90
inquire about birthdays
social security numbers
names form school days
previous jobs
remote memory (long term)
91
_________ usually preserved in early stages of dementia but may be impaired in later stages
long term memory
92
events of the day
weather
appointment time
recent memory (short term)
93
______ impaired in dementia, delirium, anxiety, depression, and intellectual disability
short term memory
94
- give the pt 3-4 words
- ask them to repeat them
- after 5 mins ask pt to repeat them again
- normally a person would be able to remember the words
new learning ability
95
- can provide a rough estimate of the patients baseline abilites
- ask about work, hobbies, reading
- start with simple questions then move to more difficult
information and vocabulary
96
testing information and vocabulary helps distinguish....
adults with lifelong intellectual impairment
97
ask the pt to perform arithmetical calculations. start simple and proceed to more difficult
calculating abilities
98
what does poor performance on calculating abilities suggest
dementia or aphasia but should be measured against the pts fund knowledge and level of education
99
ask patient a meaning to a well known proverb like "a stitch in time saves nine"
concrete response: sew a rip before it gets bigger
abstract: prompt attention to a problem prevents trouble
abstract thinking
100
people with intellectual disability, delirium, or dementia respond to proverb meaning with
concrete response
101
asking pt to tell you how the following are alike:
a cat and a mouse
abstract: cat and mouse are both animals
concrete: both have tails
checking similarities
102
check pts ability to copy figures of increasing complexity onto a piece of blank paper
or a clock
constructional abilities
103
with intact vision and motor ability, poor construction ability suggests
dementia or parietal lobe damage
104
- special technique used by providers to screen for cognitive dysfunction or dementia
- and them follow their course over time
- sample questions:
what is the date
repeat 3 words
point to object and ask what it is
mini mental status exam
105
score 24-30
normal range
106
score 20-23
mild cognitive impairment or possible early stage mild Alzheimers disease
107
score 10-19
middle stage/moderate Alzheimers disease
108
score 0-9
late stage/severe alzheimers disease
