Ch 6 Mental health Flashcards
What does concurrent disorder refer to?
mental health disorder AND substance use disorder
-includes gambling
What are the 5 areas of cognitive function tested by the MMSE?
Max score:
Score of ___ indicates cognitive impairment
- orientation
- registration
- attention and calculation
- recall
- language
Max score of 30
Score of 23 and lower = cognitive impairment
MoCA is sensitive for detecting ______
Score of ___ or higher is normal
mild cognitive impairment
26+ is normal
Mental status exam
What are the 3 components of BEHAVIOUR?
Mood: sustained emotion (inward subjective description of how someone feels)
Affect: outward objective expression of feelings/state of mind
Speech
Mental status exam
What are the 5 components of COGNITION?
Consciousness Orientation Memory (immediate vs recent vs remote) Attention + Concentration Comprehension + Abstract Reasoning
Mental status exam
What are the 5 components of THINKING?
Perception (sensory awareness) Content (ideas, beliefs) Process (the logical way someone thinks) Insight (awareness of reality) Judgment (the ability to choose logical decision)
Detailed mental status exam
What are the 4 components of APPEARANCE?
- posture
- body movements
- dress (appropriate for season, setting)
- grooming/hygiene
Detailed mental status exam
What are the 4 components of BEHAVIOUR
- level of consciousness
- facial expression (flat)
- speech
- mood and affect (labile vs congruent)
Detailed mental status exam
What are the components of COGNITIVE FUNCTIONS?
- orientation
- attention
- memory (immediate vs recent vs remote)
- new learning (4 unrelated words)
How would you test:
- immediate memory
- recent memory
- remote memory
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?)
How would you screen for new learning (ie ability to make new memories)?
-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
How do you define INSIGHT?
What questions would you ask to assess insight?
Insight is impaired in……
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
How do you define JUDGEMENT?
How would you assess for judgement?
Judgement is impaired in….
- 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
How would you assess THOUGHT PROCESS?
how would you describe normal thought process
does what they’re saying make sense?
-logical, goal directed, coherent, relevant
How would you assess THOUGHT CONTENT?
- obsessions (intrusive thoughts, ideas, fears - )
- compulsions (unwanted repetitive action to neutralize/prevent discomfort)
- delusions (fixed false beliefs)
What are some different types of delusions?
- 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)
How would you assess for perception?
- illusions (misinterpretation of true sensation eg brown sock = mouse)
- hallucinations (perceptions when pt is awake/conscious, absence of external stimuli)
SADPERSONAS for suicide risk assessment
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
What is blocking?
-sudden interruption in train of thought related to strong emotion
eg unable to complete a sentence, “forgot what I was going to say”
What is confabulation?
-fabricating events to fill memory gaps
What is neologism?
-coining a new word with no meaning
eg “I have to turn on my thinkilator”
What is circumlocution?
-roundabout expression
eg “that thing you open a door with”
What is circumstantiality?
-excessive unnecessary detail
ie tangential
What is loosening associations?
-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”
What is flight of ideas?
-abrupt change, rapid skipping from topic, accelerated speech, play on words
eg “that pill is blue, I feel blue, she wore blue velvet”
What is word salad?
incoherent mix of words and phrases
illogical, disconnected
(makes no sense)
eg beauty, red based five, pigeon, street corner, sort of”
What is perseveration?
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”
What is echolalia?
-imitation, repeating others words in a mumbling/mocking tone
What is clanging?
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”
Schizophrenia:
symptoms must be present for at least ____ months including at least __ month of active symptoms (less if treated)
at least 6 months with 1 month of active symptoms
- affects social and occupational functioning
- not attributable to another condition
Major depressive disorder
-symptoms present for at least _____(duration)
depressed mood PLUS 4 additional symptoms
2 weeks
Fatigue
Sleep (too little or too much)
Worthlessness
Weight (gain or loss)
How is hypomania different from mania?
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
Schizophrenia affects a person’s _____, ____ and _____
Cognition
Perception
Affect
-delusions, hallucinations, disorganized speech, negative symptoms (social withdrawal, anhedonia, lethargy, blunted responses, apathy)
