Clin Med - Psych Assessment Flashcards
State the prevalence of mental illness defined by SAMHSA
- Any mental, behavioral, or emotional disorder (excluding developmental and substance use disorders).
- Diagnosable currently or within the past year.
- Of sufficient duration to meet diagnostic criteria.
State the prevalence of serious mental illness defined by SAMHSA
- A mental, behavioral, or emotional disorder (excluding developmental and substance abuse disorders).
- Diagnosable currently or within the past year.
- Of sufficient duration to meet diagnostic criteria specified within the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
- Results in serious functional impairment which substantially interferes with or limits one or more major life activities.
What differentiates mental illness vs. serious mental illness?
Results in serious functional impairment which substantially interferes with or limits one or more major life activities.
Identify the rank of neuropsychiatric illnesses in contribution to U.S. disability adjusted life years.
Neuropsychiatric illnesses are #1!
Neurological vs. psychiatric disorders
- Neurological disorders are most often identifiable by the presence of structural, genetic, physiological, or biochemical disorders.
- Psychiatric disorders are most notable for the absence of more definitive disorders.
What are the definitive disorders for psych disorders?
o Many psychiatric conditions show genetic predispositions and respond to medications that alter brain function.
o Psychiatric disorders, although representing disorders of brain function, will be recognized by their clinical signs with abnormalities of thought, mood, affect, and behavior rather than specific tests of brain structure and clinical laboratory testing.
What are psych disorder diagnoses based on?
the interview and exclusion of medical illnesses; often a collateral informant is needed.
What is the DSM-5 definition of mental disorder?
-4 parts, in upcoming cards
A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
Mental disorders are usually associated with…
-DSM-5 definition
significant distress or disability in social, occupational, or other important activities.
Expected or culturally approved responses…
-DSM-5 definition
to a common stressor or loss, such as the death of a loved one, is not a mental disorder.
Are socially deviant behavior a mental disorder?
-DSM-5 definition
Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.
Describe the meaning of “praecox feeling” in psych interview and role in psych diagnosis
- Term coined by psychiatrist who “claimed that the diagnosis of schizophrenia was sometimes bolstered by a seemingly ineffable intuition, probably based on a fundamental inaccessibility of the patient.”
- Similar terms include “diagnostic par pénétration,” “diagnosis through intuition,” or “atmospheric diagnosis. “
•Today, psychiatric diagnoses are made through psychiatric evaluation to establish DSM V diagnostic criteria, but often when interviewing a patient, one may have an odd sensation of speaking with one who is not reacting normally
State the areas to assess when interviewing a psychiatric patient
•Appearance •Movement --Disturbances of activity --Abnormal movements •Mood and Affect •Delusions and Hallucinations •Thought and Speech •Judgment and Insight
Appearance of patient with schizophrenia
- Patient appears bizarre, disheveled, unkempt
- Colors and patterns are mismatched
- Ornaments and bits of jewelry may be oddly placed
- May wear aluminum foil
- May wear ear plugs or put cotton in ears
Appearance of patient with depression
- Patient appears “not done”
- Shoulders sag, posture slumped, and head may be hung
- Skin may become deeply lined and lack turgor; hair may not be done
- Appears lifeless and dull; eyes lack any vibrancy
Appearance of patient with mania
- Patient appears over-vitalized
- Dresses colorfully
- Excessive and overly gaudy jewelry
- Additions to hair (extensions, beads, etc.)
Define anhedonia
lack of interest
Define anergia
lack of energy
Define ambivalence
can “paralyze” a patient into inactivity (e.g., inability to choose between a spoon or fork causing a patient not to eat at all)
Define psychomotor retardation
slowed speech, decreased movement, and impaired cognitive function (depression
Define psychomotor agitation
movements that are caused by psychiatric conditions (anxiety) rather than by external sources (caffeine or cocaine)
Define annihilation of the will
no capacity to conceive of a purpose and follow it; cannot move towards purposeful activity (e.g., spending hours gathering bits of dust or lying in bed)
Define excited catatonia
hyperactivity seems senseless and bizarre with no purpose, for example, touching all doorknobs, jumping around, marching frantically
*can turn violent
Define manic excitation
purposeful agitation with an extreme abundance of energy but activities may not be completed; also can see hyperactivity and hyper-sexuality
Disorders characterized by impulsivity (6)
- mania
- schizophrenia
- alcoholism and drug abuse
- borderline personality
- dementia or mental retardation
- attention-deficity/hyperactivity disorder
Impulsivity in mania
- One after another, impulses override whatever steadying forces still exist in the patient
- No interference is tolerated
- No obstacle is too great – if anyone tries to block the patient’s impulse, they may encounter abuse
Impulsivity in schizophrenia
without warning or provocation, a catatonic patient may leap up and smash furniture, etc., and then go into a state of catatonic stupor
Impulsivity in alcoholism and drug abuse
irritability and any harbored fierce resentments can easily overwhelm whatever restraint and good judgment are left
Impulsivity in borderline personality
patients often lack restraint and good judgment, leading to self-destructive impulses
Impulsivity in dementia or mental retardation
- These patients never fully acquire self-restraint
* Like normal 2-year-olds, everything in view belongs (or should) to them
Impulsivity in attention-deficit/hyperactivity disorder
may be marked by impulsivity (e.g., a child blurts out whatever comes to mind or acts on whatever impulse arises)
Define tics
- repetitive rapid involuntary movements that look similar to purposeful behavior, e.g., eye blinking or grimacing or vocalizations.
- these usually involve only a limited number of muscle groups.
Define coprolalia
a complex vocal tic where the patient involuntarily utters obscenities
Define chorea
•“dance-like” rapid purposeless movements occurring randomly both in time and in spatial location on the body •may be caused by: o Huntington’s disease o Tardive dyskinesia o Sydenham’s chorea o Medications (e.g., phenytoin, oral contraceptives, and stimulants) o Hyperthyroidism o Lupus
Define asterixis
AKA flapping tremor; an involuntary jerking movement, especially in the hands
Define akathisia
state of inner sense of the need to be in constant movement; motor restlessness
Define tardive dyskinesia
repetitive, involuntary movements associated with use of antipsychotic drugs given for psychiatric disorders; manifests as grimacing, tongue protrusion, lip smacking, puckering, rapid eye blinking, etc.
Define dystonia
involuntary increase in muscle tone that causes torsions or contractions of muscles, commonly due to antipsychotic medications.
Define torticollis
contraction of the neck muscles
Define catalepsy (a catatonia)
a patient maintains whatever position they are placed in for up to several hours and then slowly resumes a normal position
Define waxy flexibility (a catatonia)
the examiner meets with a peculiar stiffness upon attempting to move patient’s limb, as if bending soft wax
Define posturing (a catatonia)
a patient spontaneously assumes a bizarre posture for varying periods of time
Define negativism (a catatonia)
tendency to do or say the opposite of what is asked or what is appropriate to the situation; common in catatonic schizophrenia
