Deck 4 Flashcards
What’s the purpose of making a therapeutic rapport
Patient feels accepted, less anxious.
The rapport is a building block for change.
What are the key skills for making a therapeutic rapport
Empathy
Warmth
Professionalism
Respect
Gathering data is to get a complete picture of the problem, and also to understand the patient as a
person
In addition to guiding the actual care, the treatment plan
instills hope
reduces anxiety
provides education such that the patient wants to follow-up
Come back to page 88
come back
Clues that point to a medical cause
Later age of onset Known underlying medical condition Atypical presentation of psychiatric condition No personal or family history of mental illness Poor response to usual treatment Substance/medication use Waxing and waning mental status Abnormal vital signs
Medical disorders that can cause psychiatric symptoms: Neurologic
Stroke Tumor MS Dementia Meningitits Encephalitis Head injury Seizure disorder Parkinsons
Medical disorders that can cause psychiatric symptoms: Endocrine
Hypo/hyperthyroid
Adrenal disorder
Liver disorder
Vitamin deficiency
Medical disorders that can cause psychiatric symptoms: Substance
Corticosteroids, antidepressants, drugs of abuse
Medical disorders that can cause psychiatric symptoms: Infectious
HIV, pneumonia, UTI, syphilis
Medical disorders that can cause psychiatric symptoms: Cardiopulmonary
MI, hypercarbia/hypoxia
In the mental status exam, what are some answers you’d put for “Attitude or approach to the interview”
Cooperative
Agitated
Disinhibited
Disinterested
In the mental status exam, thought blocking goes under which category
Speech
In the mental status exam, for thought content you could put answers like
Ruminative
Obsessional
Delusions
Flight of ideas
Rapidly moving from one thought to another, but logically connected
Circumstantial
includes details not directly relevant but eventually returns to address the subject or question
Tangential
Begins OK but the patient never returns to the original question and thoughts are seen as irrelevant or related in only a minor way
Loose associations
Difficult or impossible to see thee connections between content
Perseveration
unable to move to other topics despite attempts to change the subject
Thought blocking
patient appears unable to complete a thought, stops in mid-sentence
Neologisms
new work or combination of several words
Word salad
Confused language with no apparent meaning
Perceptual disturbances include hallucinations, delusions, and
depersonalization and derealization
derealization
one’s environment has changed in a strange way that is difficult to describe
insight
the patient’s understanding of how they are feeling, presenting, and functioning as well as potential causes of their distress
Judgement
A person’s ability to make good decisions and act on them
Presumed competency
All adults are presumed to be competent and able to make decisions about their health
Informed consent is required for everyone unless
they are deemed incompetent by a judge
Procedural protections
Any individual facing involuntary commitment has a right to procedural protections defined by the state and typically include:
A judicial hearing with at least one mental health professional present
An independent mental health evaluation
The right to be represented by competent counsel
Right to be free from psychiatric boarding in hospital emergency rooms
According to the Americans with disabilities act, employers must (in general)
provide reasonable accommodations to qualified people with disabilities
According to the Americans with disabilities act, environmental modifications can include
minimizing/removing distractions adding room dividers private work spaces work space away from noisy equipment increased lighting listening to headphones to block out distractions
According to the Americans with disabilities act, equipment accommodations can include
use of audio recorder white noise machines electronic organizers computer access from remote locations software that minimizes distractions (pop up blockers)
According to the Americans with disabilities act, accommodations of job duties can be
minimizing non-essential job duties
Division of large job assignments into smaller tasks
Additional assistance and/or time for training
Addition training and modified training materials
According to the Americans with disabilities act, accommodation of management and supervision can include
Flexible and supportive supervision style; positive reinforcement and feedback
Communication tailored to employee’s preferred learning style
Regularly scheduled meetings to discuss workplace issues and productivity
Written work agreements with short and long term goals
Relevant training for all employees
According to the Americans with disabilities act, Frequently used accommodation include
Flexible work place (WFH) Flexible scheduling Leave of absence Breaks when needed Allowing eating at the work site
What does FMLA provide
up to 12 weeks of unpaid, job-protected leave per year while maintaining group health benefits
Which employers are required to adhere to FMLA
All public agencies
All public and private elementary and secondary school, and companies with at least 50 employees
Employees are eligible if they have worked for the employer for at least one year or 1250 hours of the past year
What reasons can be used for unpaid leave
Birth and care of a newborn child
Placement with the employee of a child for adoption or foster care
To care for an immediate family member (spouse, child, parent) with a serious medical condition
To take medical leave when the employee is unable to work because of a serious health condition
FMLA in mental health
Consider FMLA if patient can no longer perform essential job functions to normal standards but a leave can help patient get to a point where the patient can again perform those functions
If patient is permanently unable to do the job, can consider requesting a reassignment to a job that can be done, if possible, as a reasonable accommodation
