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
Define automatic obedience (a catatonia) and echopraxia
- patients do or say whatever is asked of them, regardless of consequences
- Echopraxia: patient mirrors behavior done by examiner without being prompted to do so
Define mood
a patient’s sustained, relatively long-lasting emotional tone (e.g., depressed, elated, angry)
Define affect
refers to the emotional “look” or expression of a patient (e.g., facial expressions, gestures, and postures)
Mood vs. affect
mood is more constant, but affect can change from moment to moment
What are the 4 common disturbances in depressed mood?
- pervasive pessimism
- hopelessness
- anergia
- anhedonia
Pervasive pessimism in depressed mood
“their glass is 2/3 empty”
- only remembers bad things in past; cannot recognize successes
- only sees failure in the future
Hopelessness in depressed mood
patients see only that they do not measure up and are burdened with guilt, shame, and sense of utter helplessness
Anergia in depressed mood
patient feels tired and lifeless
Anhedonia in depressed mood
loss of interest in doing things (inability to experience pleasure)
What are the 5 common disturbances in mania?
- euphoria
- irritability
- increased energy level
- hyperactivity
- flight of ideas
Euphoria in mania
- bursting with amusement and good cheer
- having feelings of grandeur
- feeling that things are wonderful, satisfying, and beyond contentment
- beaming with confidence and good will
- projecting “infectious” enthusiasm and good humor
- having intense self-satisfaction or optimism
Irritability in mania
- may be extreme and possibly violent
- patients are overbearing, insistent, quick to take offense, and are constantly pressing their own opinion and plans
Increased energy level in mania
energy levels seem inexhaustible, and patients often need little or no sleep
Hyperactivity in mania
patient demonstrate lots of movement and activity, but very little is accomplished or has purpose
Flight of ideas in mania
words and sentences are maintained, and the connection between ideas is apparent, but there are rapid and frequent shifts in topics
Define labile affect
- affects come and go rapidly; there are abrupt changes in emotional feeling and tone
- labile affect is normal in children
- seen with mania, histrionic personality disorder, delirium, and dementia
- changes may occur for no apparent reason (not in response to external stimuli) every few seconds (mania) or have a precipitant that is fairly minor resulting in dramatic and disproportionate reaction (histrionic)
Define inappropriate affect
Patient’s affective expressions are inappropriate to what they claim to be feeling
- speaking of a great grief with a smile on the face
- laughing at a funeral
- talking about a new child with no smile or expressionless
Define flat affect
- The patient becomes devoid of all feeling and of all emotional expression
- The patient is not necessarily depressed but is unmoved by events around him
- The patient’s voice is monotonous, and face is immobile
Define delusion
- a cardinal symptom indicating serious mental illness, such as schizophrenia, severe depression, or mania.
- -a delusion is a patient’s false belief that:
- -is inconsistent with cultural norms
- -is inappropriate for the patient’s level of education
- -preoccupies the thoughts of the patient
- -does not share fundamental beliefs and practices with the people around the patient
Mood-congruent vs. non-mood-congruent delusions
Mood-congruent
•these delusions are fairly common in depression and mania and are usually congruent with the patient’s mood, (e.g., a depressed patient is full of self-loathing and feels she has committed unpardonable sins)
Non-mood-congruent
•a delusion that is not related to patient’s mood (e.g., a delusion that one’s thoughts are extracted and sucked into telephone lines as observed in those with schizophrenia)
Define somatic delusions
-give example
- Patients believe that they have many diseases and health problems.
- Example: a rumbling in the belly indicates a tumor
Define delusions of poverty
- Patients are convinced that their resources are depleted and that they have lost all
- Displaying a healthy bank statement does not help
Define Nihilistic delusions
-give example
- Patients believe that everything has become dead, lifeless and inanimate
- Example: figures are walking around but are not alive
Define delusions of sin
- Patients survey their lives, see many sins, and are guilt-ridden
- Some patients will go to authorities and demand they be arrested.
Define delusions of persecution
patients believe that they are being harmed, watched, ridiculed, manipulated, discriminated against, or plotted against, by another individual or group.
Define delusions of grandeur
-give example
•Patients believe that they possess special wealth, powers, skill, influence, or destiny.
•These are often accompanied by delusions of persecution.
o Example: Patient states they are a millionaire or famous artist.
Define delusions of reference
-give example
- Everything with meaning pertains to the patient
- Patients believe that chance events and encounters in some way or other refer or pertain to them
- Example: If someone in the room claps, this pertains to the patient.
Define bizarre delusions
fantastic beliefs that resist any clear classification except that of being bizarre
Define erotomanic delusions
patients believe that someone else, often someone of much higher social stature, has fallen in love with them, but for one compelling reason or another is unable to openly profess that love (e.g., patients who are star stalkers)
Define pseudomemories
patients will report as memories events and experiences that either did not or could not have occurred
What are the 4 Schneiderian delusions?
*these are delusions of the “first rank” that, when present, indicate that the diagnosis of schizophrenia is most likely
- delusions of thought insertion
- delusions of thought withdrawal
- delusions of influence
- delusions of thought broadcasting
Define delusions of thought insertion (Schneiderian delusion)
thoughts, which are not the patient’s own, are placed or somehow inserted directly into their heads
Define delusions of thought withdrawal (Schneiderian delusion)
thoughts are being sucked out or somehow withdrawn from the patient by an outside force
Define delusions of influence (Schneiderian delusion)
patients believe that their thoughts, feelings, or actions are no longer under their own control but are in fact influenced and directed by some outside force or agency
Define delusions of thought broadcasting (Schneiderian delusion)
patients believe that their thoughts literally leave their heads whereupon they are picked up or read by others
Define hallucinations
-name the 5 types
hallucinations are perceptions that occur when there is no actual stimulus present.
- auditory
- visual
- tactile
- olfactory
- gustatory
Define auditory hallucinations
•These may be sounds, music, or voices
•Three types are considered “first rank” and are more common in schizophrenia:
–Voices talking to each other
–Voices commenting on what the patient is doing
–Voices that repeat or speak out loud the patient’s thoughts and are known as “audible thoughts” (most suggestive of schizophrenia)
Define visual hallucinations
- These range in complexity from simple flashes of light to detailed scenes
- When occurring with auditory hallucinations, they may suggest schizophrenia, mania, depression, dementia, and delirium
- When occurring without auditory hallucinations, they are suggestive of dementia, delirium, or secondary psychosis
Define tactile hallucinations
- Any imaginable tactile sensations
* Often seen in intoxications or in withdrawal states
Define olfactory hallucinations
- Hallucinations of smell
* Seen in schizophrenia and simple/complex seizures
Define gustatory hallucinations
- Altered sense of taste
* Seen with heavy metal poisoning
Which auditory hallucinations are considered “first rank” and are common in schizophrenia?
- Voices talking to each other
- Voices commenting on what the patient is doing
- Voices that repeat or speak out loud the patient’s thoughts and are known as “audible thoughts” (most suggestive of schizophrenia)
When are visual hallucinations most likely associated with organic illness and not a mental disorder?
when occurring without auditory hallucinations, they are suggestive of dementia, delirium, or secondary psychosis
Define circumstantiality
- This is speech that contains an excessive amount of detail but does finally reach the point.
- The key feature is that the point is finally made, or the question answered.
Example: politician at a press conference?
Define tangentiality
- The linkage between ideas is tight
- Sentence structure is maintained
- The detail does not address the point or answer the question
Define flight of ideas
- Words and sentences are maintained
- Connection between ideas is apparent
- Rapid and frequent shifts in topics
Define loose associations
- Words and sentences are maintained
- Phrases and sentences are still properly constructed
- The connection between ideas is not obvious
- This is seen as a “formal thought disorder” in schizophrenia, schizoaffective disorder, and delirious mania.
- The patient’s thought seems to lack goal-directedness with random words joined together almost by accident
Define fragmentation
- Words are intact, but phrases become disconnected from each other
- Speech lacks focus and consists mainly of phrases that are unrelated
- The patient still uses proper syntax and understandable words
Define verbigeration
repetition of words and phrases or sounds
Define jargon
- Syntax is intact, but speech becomes meaningless
* Speech has lost its communicative value altogether
Define word salad
- Words remain intact, but all syntax is lost
- Words have no connection to each other
- Speech is incomprehensible
Define incoherence
- Words are unintelligible
* Speech is garbled
Define clang associations
- Word selections are made on the basis of sound, not syntax or logical flow
- The words are similar in sound, but have no meaning and are not connected in any logical way
- Sometimes we see rhyming and puns
Define neologisms
- Words of phrases made up by patients that have meaning to them
- Formed by the improper use of word sounds
- Occur in syntactically correct place as if they are words you should know
Define thought blocking
- Syntax is intact, but speech suddenly stops
* The patient loses his train of thought
Define thought derailment
- Syntax is intact, but speech suddenly shifts
* Patient does not know what they were speaking about before the block and are unaware of the change in topic
Define echolalia
The patient repeats whatever is said by the examiner (seen in schizophrenia, catatonic type)
Define pressured speech
- A pouring forth of words
- The patient’s speech is rapid, often loud, and typically laced with rhymes, puns, and clang associations
- Others can barely get a word in edgewise (seen in mania)
Define poverty of speech
- The patient is restricted in the amount of speech used
* Replies are monosyllabic (seen in depression)
Define judgment
•The ability of a patient to assess new situations adequately and to chart appropriate responses to them
- -Absent in schizophrenia, dementia, and delirium
- -Ask a patient: “What would you do if you smelled smoke in a theater?”
Define insight
- The ability of a patient to recognize that parts of her experience of life are not normal.
- For example, some patients realize their hallucinations are not real and some do not.
Define partial insight
- The patient recognizes that there are problems but does not attribute them to an illness.
- The patient may understand that others see him as ill.
- The patient has variable ability to modify behavior and accept treatment.
Define impaired insight
- The patient denies having an illness or that there are problems.
- The patient has no capacity to understand the concerns of others.
- The patient has poor compliance with treatment.
Define obsessions
Are thoughts, impulses, or images that are:
- Recurrent and persistent
- Unwanted
- Not simply an exaggerated degree of concern over current problems
- Recognized as a product of the patient’s own mind
- Uncontrolled by the person’s will
- Recognized as absurd and irrational
- Resisted at least at some point and to some degree
Define compulsions
are irresistible urges to repetitively do something in response to an obsessive fear that something bad will happen should the compulsive act not be undertaken
Define phobia
- simple
- social
•Are marked and persistent fears of things or situations that the patient recognizes as unreasonable
- -Simple phobia – patients are fearful of specific things, such as snakes, heights, public speaking
- -Social phobia – patients are fearful of being humiliated or embarrassed in a specific situation
