Clinical Psychiatry & Psych Assessment Flashcards
1
Q
Definition of Mental Disorder
(DSM‐5)
A
- A mental disorder is a syndrome characterized by significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in psychological, biological, or developmental processes underlying mental functioning.
- Mental Disorders are associated with significant distress or disability in social, occupational, or other important activities.
- Goal: Psychiatric Diagnosis
2
Q
Diagnostic and Statistical Manual of Mental Disorders (DSM)
Features
A
- Descriptive Approach: Atheoretical
- Diagnostic Criteria: Operationalized
- Systematic Description: Associated Features
3
Q
General Approach of the DSM
A
-
Medical Illness can have a psychiatric presentation
- Hypothyroidism presenting as Depression
- Frontal lobe tumor presenting as Mania
- Infections presenting as Psychosis
-
Substance Abuse disorders also have psychiatric presentations
- Amphetamines presenting with Psychosis
- ETOH with Depression
- Always need to exclude that the presentation of a patient is not due to a medical illness or substance use
4
Q
Psychiatric Diagnosis
Conclusions
A
- Psychiatric diagnosis is not just based on symptom checklist
- Diagnostic criteria are offered as guidelines
- Clinical judgement has to be exercised in assessing the presence and severity of each symptom
- Recognize the combination of predisposing, precipitating, perpetuating and protective factors that have resulted in a particular condition
- Use diagnostic and contextual information to develop an evidence-based treatment plan
5
Q
Psychiatric History Taking
A
- Identifying information
- Presenting complaints
- History of present illness
- Past medical / surgical history
- Past psychiatric history
- Alcohol and substance use
- Family psychiatric history
- Personal and Social History
6
Q
Psychiatric Interview
A
- Begin with open ended questions
- Let the patient tell his/her story
- Clarify
- Anxiety and depression mean different things to different people
- Patient’s primary concerns may not be the physician’s main concerns
- Suicide, homicide, domestic violence, and abuse should not be omitted from a review of the current situation
- Avoid checklist questions
- The key ingredient: Doctor Patient Relationship
7
Q
Substance Abuse History
A
- What
- How much (Quantity /$$$)
- For how long
- How
- What if not used (Withdrawal symptoms)
- Treatment History
- Complications from use
8
Q
Trauma History
A
Essential component of the HPI and should always be assessed
- Childhood Trauma
- Intimate Partner Violence
- Combat Trauma
- Elder Abuse
9
Q
Personal and Social History
A
- Where the person grew up; what family life was like
- How far the person advanced in school; what subjects the person preferred
- Hobbies and interests
- Marital and relationship history
- Work /Occupation
- Spiritual orientation and practice
- Legal History
10
Q
Collateral History
A
- Family (need consent from pt)
- In case of children there are more sources: Teachers, Wrap around workers, Foster parents…
- Other caregivers
- Primary Care Physician
- Others (Insurance / Probation Officers….)
11
Q
The Physical Exam
A
- Weight and Height
- Trauma
- Track marks
- Neuro exam
- Movement disorders
12
Q
Mental Status Exam (MSE)
Components
A
-
General appearance and behavior
- Appearance
- Behavior
- Psychomotor activity
- Attitude
-
Mood and Affectivity
- Mood
- Affect
- Appropriateness
- Range
- Mobility
- Reactivity
- Speech characteristics
-
Thought
- Thought process: Formal Thought Disorder
- Thought content: Delusions
- Depressive cognitions, Anxiety, Phobias, Obsessions, SI
-
Perception
- Hallucinations
- Illusions
-
Sensorium and Cognition
- Level of consciousness
- Attention and concentration
- Orientation and memory
- Language, reading, writing
- Visuospatial ability
- Abstraction
- General fund of information
-
Judgment and insight
- Test judgment / Social Judgment / Clinical judgment
- Grades of insight
13
Q
Mood and Affect
A
- Affect: An immediately expressed and observed emotion
- Mood: emotional experience over a more prolonged period of time
-
Observed Disturbance of Affect:
- Blunted: reduction of expression
- Flat: absent expression
- Inappropriate: discordance between expression and content of speech
- Labile: abnormal variability with rapid shifts
14
Q
Formal Thought Disorders
A
An impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language.
Indicates a disturbance of the organization and expression of thought.
-
Incoherence
- Only the word structure is preserved but there are no discernible connections between words
- “Word salad”
-
Tangentiality
- Moves from thought to thought but never seems to get to the main point
-
Derailment or Loose Associations
- Severely disordered thinking
- Thoughts lose almost all connections with one another and become disconnected and disjointed
-
Circumstantiality
- Person talks in circles, providing excessive and unnecessary detail before getting to the point
-
Flight of ideas
- Continuous, rapid speech that changes focus from moment to moment based on association, distractions, or plays on words
15
Q
Delusions
A
A firm and fixed false belief that is held with firm conviction in spite of evidence of the contrary and not in keeping with the persons religious and / or cultural beliefs.
Types of Delusions:
- (Bizarre)
- Delusional jealousy
- Erotomanic
- Grandiose
- Persecutory
- Somatic
- Thought insertion
- Thought broadcast
