Diagnosis of Psychiatric Disorders & MSE Flashcards
What is leading non-infectious cause of disability in the world?
Depression
What percentage of pxs w/ depression also have anxiety?
What percentage of pxs w/ anxiety also have depression?
50%
25%
By when do most people w/ psychiatric disorders show signs?
Age 30
Components of the Psychiatric Interview (7)
Px identification / CC HPI Past psych history Past medical history Medications / substances Family history Social history including psychosocial situation, developmental history, and habits
Main parts of the MSE (10)
Appearance Behavior Speech Mood Affect Thought Process Thought Content Cognition Insight Judgment
Dyskinesia
Slow, writhing movements of the lips, tongue, jaw, or trunk
Waxy Flexibility
Px is not responsive and maintains posture into which she has been placed
Posturing
Assuming an inappropriate / bizarre posture
Stereotypy
Purposeless, repetitive movements
Alexithymia
Common w/ which disorder?
Inability to describe one’s emotional state
Common in depression
Different types of affect content
Euthymic, dysphoric, anxious, irritable, angry, elated, euphoric
5 components of affect
content, congruency, range, intensity, consistency
Tangentiality
Type of thought process. Px replies to question in oblique way that moves further and further away from question.
Circumstantiality
Type of thought process. Px’s responses are indirect and delayed in reaching goal, but eventually gets there.
2 main types of loosening of associations
Which disorders are these associated with?
- Flight of ideas – Loosened associations accompanied by pressured speech (often seen w/ mania)
- Thought blocking / derailment – Sudden disruption of thought processes, often midstream (common in pxs w/ psychosis)
Perseveration
Which disorders?
Type of thought process. Px repeats particular phrases or questions. Common in dementia / psychosis.
Which disorders are associated w/ thought poverty?
Depression, psychosis, and dementia
What disorders involve visual hallucinations?
More common in dementia, delirium, and substance intoxication / withdrawal, but can happen in psychosis
Hypnopompic / hyponogogic hallucinations
Hypnopompic (occur upon awakening) or hypnogogic (occur upon falling asleep) hallucinations are not pathological
Which disorders involve persecutory / paranoid delusions?
Most common w/ schizo, but can occur w/ depression w/ psychotic features and dementia
Which disorders involve grandiose delusions?
Schizo and mania
What 4 delusions are specific to schizophrenia?
- Idea of reference - belief that remarks, newspapers, radio/TV/internet, or other events refer specifically to the patient or are intended for the patient; e.g., “Do you hear those sirens? They’re coming to get me!”
- Thought broadcasting
- Thought insertion and withdrawal
- Delusion of passivity: the belief that one’s thoughts or actions are being controlled by someone else or something else
7 characteristics of cognition
Memory, orientation to time / place / situation, attention span, sensory perception, alertness, language, executive function
Insight
How well do you understand what’s going on? Includes awareness of having a psychiatric disorder.
Judgment
How do you act based on your insight?
Cultural Formation
Clarifies key aspects of the presenting clinical problem from the point of view of the individual and other members of their social network.
Psychiatric diff diagnosis for depression
Bipolar, adjustment disorder, bereavement
How does bereavement differ from MDD?
Positive emotions / humor are relatively preserved, dysphoria decreases over time, self-esteem is intact, and thoughts of death focus on the deceased.
Medical diff diagnosis for depression
Hypothyroidism, cancer, CHF, Addison’s disease
Substance-related diff diagnosis for depression
Alcohol abuse, stimulant withdrawal, or use of steroid meds
