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Human Behavior > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Which state would you go to to study mental Illness?

A

Utah (22.4% living with mental illness; 5.2% reports of serious mental illness), Oklahoma (5.2% reports of serious mental illness) , West Virginia (5.5% reports of serious mental illness)

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2
Q

What disorders are the most likely to see in the US?

A
  • Anxiety (panic, OCD, PTSD, GAD, phobias): 42 million people, 18.1% - Major Depression: 14.8 million people, 6.7% - Bipolar disorder: 6.1 million people, 2.6% - Schizophrenia: 2.5 million, 1.1%
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3
Q

Psychoanalytic Theory (Sigmund Freud)

A

Focuses on personality development and unconscious motivations as the cause of behaviors (Oral, Anal, Phallic, Latency, Genital) If an individual receive to ouch or too little gratification in one of the states, they will becomes fixated in that particular development stage.

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4
Q

Attachment Theory

A

Focuses on the role of the early care giver and child relations. Secure infants/children have more self-esteem and self-reliance as they becomes adults and function better

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5
Q

Diathesis-stress Model

A

examines the interaction of non-biological or genetic traits (diathesis) and environmental influences (stressors) to produce disorders (e.g. depression, anxiety, schizophrenia)

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6
Q

Axis I (Old)

A

Clinical Disorders/Affective Disorders: - Schizophrenia - Major depression - Bipolar disorder

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7
Q

Axis II (Old)

A

Disorders that appeared early in life and persisted: - Personality disorders - Intellectual disabilities, previously called mental retardation

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8
Q

Axis III (Old)

A

General Medical Conditions: - Diabetes - Hypertension - Epilepsy

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9
Q

Axis IV (Old)

A

Psychosocial and Environmental Problems - Problems with primary support groups - Problems related to the social environment - Educational Problems - Occupational problems - Housing problems - Economic problems - Problems with access to healthcare services - Problems with related to interaction with the legal system/crime - Other

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10
Q

Axis V (Old)

A

Global Assessment of Functioning (GAF) –> Old Now use: World Health Organization Disability Assessment Schedule (WHODAS)

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11
Q

Major Types of Classficiations

A

MAPPSSC Mood Anxiety Psychosis Personality Substances/Addiction Somatic Cognitive

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12
Q

Top 12 Tips on Psych Interview Techniques

A
  1. Establish rapport early – start with non-threatening questions, and when possible some common topics.
  2. Allow the patient to talk freely without interruption (at least 3-4 minutes)
  3. Determine the patient’s chief complaint – It may not be clear.
  4. Use open and closed ended questions
  5. Develop provisional differential diagnosis (DDX).
  6. Use more focused questions to clarify differential DDx
  7. Depending on the patient, initially you may not want to try reasoning with them.
  8. Gradually move to the tougher questions, (drugs, sexual, and criminal behavior, etc.)
  9. Follow-up on vague responses.
  10. Always ask about suicidal and homicidal ideations.
  11. Provide adequate time for the patient to ask questions.
  12. Convey confidence and hope.
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13
Q

Psych Review of Symptoms (ROS)

A

MAPPSS-CEETO

Mood – Describe your mood

Anxiety – Do you worry a lot? Is it hard for you to control the worrying?

Psychosis – Do you see things that others don’t

Personality – Any patterns that have caused you problems throughout your life?

Substance/Addiction – How often do you use substances, gamble, etc.?

Somatic – Do you worry about your physical health?

Cognitive/Dissociation –do you often forget things?

Eating/feeding – Do you have concerns with your weight or eating habits? Restrict foods?

Elimination – regularly soil clothing?

Trauma – ever suffered an event you believed threatened your safety/life.

Obsessions/compulsions – Experience unwanted urges, thoughts, repetitive acts?

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14
Q

Past Psych Hx

A
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15
Q

Family History

A
  • Age and occupation of parents and age of siblings
  • Document the family hx of mental disorders as well as their course and outcome.
  • Document alcohol and drug use, criminal history, severe depression, suicide, etc., in blood relatives.
  • Social, cultural, educational background
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16
Q

Social History = Life History

A
  • Include personal history/demographics
  • Birth place, childhood area
  • Developmental and social adjustments
  • Childhood behavioral concerns (temper tantrums, phobias, cruelty concerns)
  • Adolescence: family, peer, and authority relationships, school performance, drug use
  • Legal issues

Adulthood:

  • Sexual history: sexual development
  • Marital and family relationships
  • Religious and cultural attitudes
  • Education, employment, military service, financial situation, current social/living situation, and support systems
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17
Q

Medical History

A

Very brief Medical Hx:

  • Allergies, hospitalizations
  • Chronic diseases, current medications
  • History of neurologic disorders or head trauma
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18
Q

Components of MSE

A
  • General Appearance & Attitude
  • Motor Activity/behavior
  • Levels of Consciousness/orientation
  • Speech and language
  • Mood and Affect
  • Thought form/content
  • Perception
  • Memory and cognition
  • Judgment and Insight
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19
Q

Alert

A

patient is able to open eyes, look at you, responds fully and appropriately

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20
Q

Lethargic

A

sluggish, drowsy, but can open eyes, and respond. Falls back to sleep easily

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21
Q

Obtunded

A

lessened interest in the environment, slowed response to stimulation, sleeps a lot.

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22
Q

Stuporous

A

Wakens only with painful stimuli. Verbal responses slow or absent. Falls back into unresponsive state when stimuli ceases

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23
Q

Comatose

A

unarousable to any stimuli

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24
Q

Mood

A

emotional attitude that is relatively persistent; and usually reported by the patient.

Depressed, euphoric, anxious, irritable, apathetic, anhedonic, bored, “sad/happy

To assess mood, you need to ask the patients how they are feeling:

  • “How are your spirits these days?”
  • Labile mood?
  • Intensity of mood?
  • Is the patient suicidal?
  • Is the mood appropriate to the patient’s situation?
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25
Q

Affect

A

Inferred from the patient’s emotional response. It is what you see or observe (objective). Full range, inappropriate, labile, flat or blunted.

The external expression of emotion visible to the clinician:

  • Are the pts responses and body language devoid of emotion?
  • Are their responses hyper-emotional?
  • Do their responses change dramatically through the interview?
  • Are the responses appropriate to the patient’s situation or what they are saying?
26
Q

Patterns of Speech: Derailment or loose associations

A
27
Q

Pattern of Speech: Tangentiality

A

only partially relevant or irrelevant responses to questions that don’t answer the question. Totally digress…

28
Q

Pattern of Speech: Circumstantiality

A
29
Q

Speech Patterns: Word salad/Incoherence

A

speech makes no sense at all. Words joined don’t convey a message, i.e., Wernicke’s aphasia…. Need to rule out stroke.

30
Q

Speech Pattern: Pressured speech

A

Fast and difficult to interrupt/understand; seen in bipolar-mania.

31
Q

Speech Pattern: Flight of ideas

A

rapid, continuous, shift of ideas either unrelated or based upon minimal associations, distractions, play on words; (seen in mania).

32
Q

Patterns of Speech: Distractible speech

A

During the course of a discussion, pt changes subject in response to something unrelated in the environment.

33
Q

Patterns of Speech: Perseveration

A

persistent repetition of specific words or ideas; in absence of stimuli

34
Q

Pattern of Speech: Clanging

A

word choice don’t make sense. Words are chosen based on the sound they make (often rhyming), not their meaning.

35
Q

Thought Content: Preoccupations

A

obsessive, phobic, suicidal, homicidal, paranoia/suspicious

36
Q

Thought Content: Delusions

A

False, fixed personal beliefs that are not shared by others in the pts community. (Occur in psychotic d/o).

  • Persecution
  • Grandiosity
  • Delusion of being controlled externally
  • Somatic delusions
  • Jealousy, Religious
  • Ideas and delusions of reference
  • Thought insertion/withdrawal/broadcasting
37
Q
A
38
Q

Alogia

A

Poverty of thought, no depth, minimal responses, very concrete (vs. abstract). Often seen in schizophrenia.

Manifests as:

  • Non-fluent empty speech (poverty of speech)= few spontaneous words, very concrete
  • Fluent empty speech (poverty of content of speech) = conveys little information, overly abstract or concrete.
39
Q

Preception: Illusions

A

misperception of real external stimuli

40
Q

Preceptions: Hallucinations

A

Abnormal perceptions. Pt hears, sees, smells or feels something others cannot.

  • Visual
  • Auditory – One voice or more? Conversing?
  • Tactile, olfactory, gustatory
41
Q

Preceptions: Derealization

A

is the sense that the world around the person is somehow not real

42
Q

Preceptions: Depersonalization

A

is the sense that the person is somehow not real

43
Q

Memory: Registration

A

Can pt. learn something new and immediately repeat it back?

44
Q

Memory: Recent/short term memory

A

Can the patient correctly remember things that happened today?

45
Q

Memory: Remote/long-term memory

A

Can the patient correctly remember things that happened or information from long ago?

46
Q

Attention

A

Can the patient focus enough to be able to perform tasks?

  • Attentive
    hypervigilant
  • distractible
  • difficulty following conversation
47
Q

Cognition

A

Assess patient’s apparent cognition/intelligence by assessing the degree to which they are informed, can problem solve, capacity for abstract thinking, simple math, complexity of their vocabulary, etc.

Abstract Thinking:

  • Proverbs: Ask the patient to interpret a commonly used proverb
  • Similarities: Ask the patient to tell you how two things are alike
48
Q
A
49
Q

Judgement

A

Judgment is the ability to evaluate a situation and make a reasoned decision. Two ways to assess:

  • Ask patients to propose a solution to their current problems: “How will you get follow up care after you leave here today?”
  • Ask patients to propose a solution to a hypothetical problem: “What would you do if you found a stamped, addressed letter on the ground?”
50
Q

Insight

A

Insight is the ability of patients to understand and acknowledge factors that influence a situation (such as their illness).

Patients with mental disorders or have dementia often lack insight and may deny their illness. They may also refuse to take medications for their illness or engage in needed therapy

51
Q

SIG E CAPS

A

Sleep

Interest

Guilt

Energy

Concentration

Appetite

Psychomotor

Suicidal thoughts

52
Q

Major Depression: 5 of 9 criteria, most of every day for two weeks, with impairment

A

Sad, empty, hopeless (need one of these)

OR

Lost of interest or pleasure (apathy, anhedonia)

Weight change

Insomnia or hypersomnia

Psychomotor slowing or agitation

Fatigue

Worthlessness, guilt

Decreased concentration

Thoughts of death or suicide

53
Q

How to believe a DSM diagnosis

(Not in DSM but the smart thing)

A

Right patient: female of reproductive age

Right Symptoms: meets criteria

Right backstory: social stressors, current and past

Right family history: alcoholic father but not clear

Right prior treatment response: yes, sort of

54
Q

Screening Questions

A

” Have you ever been treated for depression in the past?”

“In the past two weeks have you been feeling sad, down, or depressed most days?”

“In the past two weeks have you noted loss of interest or that you can’t enjoy things as much as usual?”

55
Q

Use Medicine to help you answer questions

A

Thyroid

Vitamin D

General chemistries, CBC

Age appropriate for specific symptoms or unusual presentation (age, gender, context)

Fatigue: cardiovascular, autoimmune, metabolic

Sleep: Sleep apnea

Weight loss: abdominal cancer

Presence of serious medical condition doesn’t rule out depression as a co factor requiring treatment

***SUBSTANCE ABUSE!***

56
Q

Helps calculate suicidal Risk

“SAD PERSONS”

A

S – Sex: 1 if male; 0 if female; (more females attempt, more males succeed)
A – Age: 1 if < 20 or > 44
D – Depression: 1 if depression is present*
P – Previous attempt: 1 if present
E –Ethanol abuse: 1 if present*
R – Rational thinking loss: 1 if present*
S – Social Supports Lacking: 1 if present*
O – Organized Plan: 1 if plan is made and lethal
N – No Spouse: 1 if divorced, widowed, separated, or single
S – Sickness: 1 if chronic, debilitating, and severe*
*=modifiable

Total points

Proposed clinical action

0 to 2

Send home with follow-up

3 to 4

Close follow-up; consider hospitalization

5 to 6

Strongly consider hospitalization, depending on confidence in the follow-up arrangement

7 to 10

Hospitalize or commit

57
Q

Suicide risk: Clinical

A

Addicted or chronically ill

Prior attempts

Planning

Hopelessness a critical predictor

Anxiety or agitation; panic while depressed

Anxiety induced by antidepressants (esp adolescents)

Psychotic symptoms

58
Q

Suicide Assessment Five-Step

“SAFE-T”

A

IDENTIFY RISK FACTORS
Note those that can be
modified to reduce risk
2
IDENTIFY PROTECTIVE FACTORS
Note those that can be enhanced
3
CONDUCT SUICIDE INQUIRY
Suicidal thoughts, plans
behavior and intent
4
DETERMINE RISK LEVEL/INTERVENTION
Determine risk. Choose appropriate
intervention to address and reduce risk
5
DOCUMENT
Assessment of risk, rationale,
intervention and follow-up
eAssessment SAFE-T
NATIONAL SUICIDE PREVENTION LIFELINE
1.800.273.TALK (8255)

59
Q

Integration Care

A
  • Start with one medication, used in appropriate doses, follow with measures (Like PHQ9)(Implement “disease management” if available)
  • Switch within class or to another class/enlist mental health practitioner

PA: may continue to manage medication while psychotherapy provided by MSW, PHD

60
Q

Clinically Participating in their care

A

SAD PERSONS: Low sensitivity (19%) and minimal positive predictive value

Single question: Do you wish to be dead?

Instill hope

Impulsive suicide (esp, psychosis, personality disorders, dementia) is much harder to predict (people who can’t plan)

Access to means (GUNS)

Active preparation

61
Q

Treat or Refer?

A

TREAT

Prior treatment response

Medically complicated

Pain and MUPS

Preference for medication

PMDD

Seasonal disorder (“atypical” : hypersomnic, weight gain, not densely anhedonic) (use light)

REFER

Moderate or mild: wants or open to psychotherapy

Severe, Bipolar, psychotic sx

Wish to be dead/ history of suicide attempts

Treatment non responsive

Intolerance to side effects or meds

Human Behavior (1 decks)

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