Diagnosis of Psychiatric Disorders & MSE

Question 1

What is leading non-infectious cause of disability in the world?

Answer 1

Depression

Question 2

What percentage of pxs w/ depression also have anxiety?

What percentage of pxs w/ anxiety also have depression?

Answer 2

50%

25%

Question 3

By when do most people w/ psychiatric disorders show signs?

Answer 3

Age 30

Question 4

Components of the Psychiatric Interview (7)

Answer 4

Px identification / CC
HPI
Past psych history
Past medical history
Medications / substances
Family history
Social history including psychosocial situation, developmental history, and habits

Question 5

Main parts of the MSE (10)

Answer 5

Appearance
Behavior
Speech
Mood
Affect
Thought Process
Thought Content
Cognition
Insight
Judgment

Question 6

Dyskinesia

Answer 6

Slow, writhing movements of the lips, tongue, jaw, or trunk

Question 7

Waxy Flexibility

Answer 7

Px is not responsive and maintains posture into which she has been placed

Question 8

Posturing

Answer 8

Assuming an inappropriate / bizarre posture

Question 9

Stereotypy

Answer 9

Purposeless, repetitive movements

Question 10

Alexithymia

Common w/ which disorder?

Answer 10

Inability to describe one’s emotional state

Common in depression

Question 11

Different types of affect content

Answer 11

Euthymic, dysphoric, anxious, irritable, angry, elated, euphoric

Question 12

5 components of affect

Answer 12

content, congruency, range, intensity, consistency

Question 13

Tangentiality

Answer 13

Type of thought process. Px replies to question in oblique way that moves further and further away from question.

Question 14

Circumstantiality

Answer 14

Type of thought process. Px’s responses are indirect and delayed in reaching goal, but eventually gets there.

Question 15

2 main types of loosening of associations

Which disorders are these associated with?

Answer 15

• 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)

Question 16

Perseveration

Which disorders?

Answer 16

Type of thought process. Px repeats particular phrases or questions. Common in dementia / psychosis.

Question 17

Which disorders are associated w/ thought poverty?

Answer 17

Depression, psychosis, and dementia

Question 18

What disorders involve visual hallucinations?

Answer 18

More common in dementia, delirium, and substance intoxication / withdrawal, but can happen in psychosis

Question 19

Hypnopompic / hyponogogic hallucinations

Answer 19

Hypnopompic (occur upon awakening) or hypnogogic (occur upon falling asleep) hallucinations are not pathological

Question 20

Which disorders involve persecutory / paranoid delusions?

Answer 20

Most common w/ schizo, but can occur w/ depression w/ psychotic features and dementia

Question 21

Which disorders involve grandiose delusions?

Answer 21

Schizo and mania

Question 22

What 4 delusions are specific to schizophrenia?

Answer 22

• 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

Question 23

7 characteristics of cognition

Answer 23

Memory, orientation to time / place / situation, attention span, sensory perception, alertness, language, executive function

Question 24

Insight

Answer 24

How well do you understand what’s going on? Includes awareness of having a psychiatric disorder.

Question 25

Judgment

Answer 25

How do you act based on your insight?

Question 26

Cultural Formation

Answer 26

Clarifies key aspects of the presenting clinical problem from the point of view of the individual and other members of their social network.

Question 27

Psychiatric diff diagnosis for depression

Answer 27

Bipolar, adjustment disorder, bereavement

Question 28

How does bereavement differ from MDD?

Answer 28

Positive emotions / humor are relatively preserved, dysphoria decreases over time, self-esteem is intact, and thoughts of death focus on the deceased.

Question 29

Medical diff diagnosis for depression

Answer 29

Hypothyroidism, cancer, CHF, Addison’s disease

Question 30

Substance-related diff diagnosis for depression

Answer 30

Alcohol abuse, stimulant withdrawal, or use of steroid meds