Ch 6 Mental health

Question 1

What does concurrent disorder refer to?

Answer 1

mental health disorder AND substance use disorder

-includes gambling

Question 2

What are the 5 areas of cognitive function tested by the MMSE?

Max score:
Score of ___ indicates cognitive impairment

Answer 2

• orientation
• registration
• attention and calculation
• recall
• language

Max score of 30
Score of 23 and lower = cognitive impairment

Question 3

MoCA is sensitive for detecting ______

Score of ___ or higher is normal

Answer 3

mild cognitive impairment

26+ is normal

Question 4

Mental status exam

What are the 3 components of BEHAVIOUR?

Answer 4

Mood: sustained emotion (inward subjective description of how someone feels)

Affect: outward objective expression of feelings/state of mind

Speech

Question 5

Mental status exam

What are the 5 components of COGNITION?

Answer 5

Consciousness
Orientation
Memory (immediate vs recent vs remote)
Attention + Concentration
Comprehension + Abstract Reasoning

Question 6

Mental status exam

What are the 5 components of THINKING?

Answer 6

Perception (sensory awareness)
Content (ideas, beliefs)
Process (the logical way someone thinks)
Insight (awareness of reality)
Judgment (the ability to choose logical decision)

Question 7

Detailed mental status exam

What are the 4 components of APPEARANCE?

Answer 7

• posture
• body movements
• dress (appropriate for season, setting)
• grooming/hygiene

Question 8

Detailed mental status exam

What are the 4 components of BEHAVIOUR

Answer 8

• level of consciousness
• facial expression (flat)
• speech
• mood and affect (labile vs congruent)

Question 9

Detailed mental status exam

What are the components of COGNITIVE FUNCTIONS?

Answer 9

• orientation
• attention
• memory (immediate vs recent vs remote)
• new learning (4 unrelated words)

Question 10

How would you test:

• immediate memory
• recent memory
• remote memory

Answer 10

Immediate: recall a sentence you just said

Recent: 24 hour diet recall, how pt arrived at clinic (has to be verified)

Remote: describe historical events relevant to pt (where did you go to school?)

Question 11

How would you screen for new learning (ie ability to make new memories)?

Answer 11

-lost with Alzheimer’s, anxiety and depression

• say 4 unrelated words (semantic/phonetic variety)
• ask them to recall in 5, 10 and 30 min

Normal in pt <60:
3-4 word recall after 5-10-30 min delay

Question 12

How do you define INSIGHT?

What questions would you ask to assess insight?

Insight is impaired in……

Answer 12

ability to recognize illness, need for treatment, consequence of behaviour stemming from illness

-“do you believe you need help?” “do you believe these feelings are normal?”

impaired in Alzheimer’s, schizophrenia, psychoses

Question 13

How do you define JUDGEMENT?

How would you assess for judgement?

Judgement is impaired in….

Answer 13

• ability to compare and evaluate options and come to appropriate decision
• ask about job plans, future plans, social obligations (realistic vs unrealistic, impulsive)
• intellectual disability, emotional dysfunction, schizophrenia, organic brain disease

Question 14

How would you assess THOUGHT PROCESS?

how would you describe normal thought process

Answer 14

does what they’re saying make sense?

-logical, goal directed, coherent, relevant

Question 15

How would you assess THOUGHT CONTENT?

Answer 15

• obsessions (intrusive thoughts, ideas, fears - )
• compulsions (unwanted repetitive action to neutralize/prevent discomfort)
• delusions (fixed false beliefs)

Question 16

What are some different types of delusions?

Answer 16

• grandiose
• religious
• persecution
• erotomanic (someone famous is in love with pt)
• jealousy
• thought insertion (someone is putting ideas into pt’s mind)
• ideas of reference (everything refers to pt)

Question 17

How would you assess for perception?

Answer 17

• illusions (misinterpretation of true sensation eg brown sock = mouse)
• hallucinations (perceptions when pt is awake/conscious, absence of external stimuli)

Question 18

SADPERSONAS for suicide risk assessment

Answer 18

S = Sex (male) 1-point
A = Age (<19 or >45 years) 1-point
D = Depression or hopelessness 2-point
P = Previous suicide attempts or psychiatric care 1-point
E = Excessive alcohol or drug use 1-point
R = Rational thinking loss 2-point
S = Separated, divorced or widowed 1-point
O = Organized or serious attempt 2-point
N = No social supports 1-point
A = Availability of lethal means 2-point
S = Stated future intent 2-point

Question 19

What is blocking?

Answer 19

-sudden interruption in train of thought related to strong emotion

eg unable to complete a sentence, “forgot what I was going to say”

Question 20

What is confabulation?

Answer 20

-fabricating events to fill memory gaps

Question 21

What is neologism?

Answer 21

-coining a new word with no meaning

eg “I have to turn on my thinkilator”

Question 22

What is circumlocution?

Answer 22

-roundabout expression

eg “that thing you open a door with”

Question 23

What is circumstantiality?

Answer 23

-excessive unnecessary detail

ie tangential

Question 24

What is loosening associations?

Answer 24

-shifting from one topic to unrelated topic

eg “my boss is angry with me. I saw that movie Lassie. She kept trying to land the airplane”

Question 25

What is flight of ideas?

Answer 25

-abrupt change, rapid skipping from topic, accelerated speech, play on words

eg “that pill is blue, I feel blue, she wore blue velvet”

Question 26

What is word salad?

Answer 26

incoherent mix of words and phrases
illogical, disconnected
(makes no sense)

eg beauty, red based five, pigeon, street corner, sort of”

Question 27

What is perseveration?

Answer 27

Persistent repeating of verbal/motor response even with varied stimuli

eg “i’m going to lock the door, lock the door. I walk every day and I lock the door”

Question 28

What is echolalia?

Answer 28

-imitation, repeating others words in a mumbling/mocking tone

Question 29

What is clanging?

Answer 29

word choice based on sound instead of meaning (nonsense words and puns)

eg “my feet are cold, cold, bold, told. The bell tolled for me”

Question 30

Schizophrenia:

symptoms must be present for at least ____ months including at least __ month of active symptoms (less if treated)

Answer 30

at least 6 months with 1 month of active symptoms

• affects social and occupational functioning
• not attributable to another condition

Question 31

Major depressive disorder
-symptoms present for at least _____(duration)

depressed mood PLUS 4 additional symptoms

Answer 31

2 weeks

Fatigue
Sleep (too little or too much)
Worthlessness
Weight (gain or loss)

Question 32

How is hypomania different from mania?

Answer 32

Hypomania:

• at least 4 consecutive days of elevated/irritable/expansive mood AND increased energy/activity
• does not affect function
• does not have psychotic features

Mania:

• at least one week of elevated/irritable/expansive mood AND increased energy/activity
• affects social/occupational function OR
• needs hospitalization to prevent harm OR
• psychotic features

Hypomania and Mania have 3 or more:
GSTPAID
o Inflated self-esteem or grandiosity - G
o Decreased need for sleep - S
o More talkative/pressure speech - T
o Excessive engagement in activities with high potential for painful
consequences - P
o Increase in goal directed activity or psychomotor agitation - A
o Flight of ideas or subjective racing thoughts - I
o Objective or subjective distractibility - D

Question 33

Schizophrenia affects a person’s _____, ____ and _____

Answer 33

Cognition
Perception
Affect

-delusions, hallucinations, disorganized speech, negative symptoms (social withdrawal, anhedonia, lethargy, blunted responses, apathy)