Examination and Diagnosis Flashcards
You should start a Psych interview by asking what type of questions?
Open-Ended Questions
What kind of questions do you use to obtain the remaining pertinent info?
Closed-Ended Questions
The patient should feel that the psychiatrist is what three things?
Interested, nonjudgemental and compassionate
In psychiatry, what is the most important factor in making a dx and tx plan?
History
The History of Present Illness (HPI) should include info about the current episode including what 5 descriptions of the current episode?
Symptoms, Duration, context, stressors and impairment in fxn
How should the chief complaint be written?
In the patient’s own words, no matter how bizarre
Analogous to performing a physical exam in other areas of medicine
Mental Status Examination
The mental status exam assesses the following?
Appearance/behavior, speech, perception, sensorium/cognition, insight/judgement
The mental status exam tells only about the mental status @?
that moment! it can change every hour or every day, etc
When assessing physical appearance you should take specific notice of the following which may be clues for possible diagnoses: Pupil size Bruises in hidden areas Eroding of tooth enamel superficial cuts on arms
Pupil size: drug intoxication/withdrawl
Bruises in hidden areas: Increased suspicion for abuse
Eroding of tooth enamel: eating disorder
superficial cuts on arms: self-harm
The emotion that the patient tells you he feels or is conveyed nonverbally
Mood
an assessment of how the patient’s mood appears to the examiner, including the amount and range of emotional expression.
Affect
The patient’s form of thinking- how he or she uses language and puts ideas together
Thought Process
no logical connection from one thought to another
Loosening of associations
thoughts change abruptly from one idea to another, usually accompanied by rapid/pressured speech
Flight of ideas
made up words
Neologisms
Incoherent collection of words
Word Salad
Word connections due to phonetics rather than actual meaning. “My car is red. I’ve been in bed. It hurts my head”
Clang associations
Abrupt cessation of communication before the idea is finished
Thought blocking
Point of conversation never reached due to lack of goal directed assocations between ideas; responses usually in the ball park
Tangentiality
Point of conversation is eventually reached but with overinclusion of trivial or irrelevant details
Circumstantiality
Describes the types of ideas expressed by the patient
Thought Content
Too few versus too many ideas expressed
Poverty of thought versus overabundance
fixed, false beliefs that are not shared by the person’s culture and cannot be changed by reasoning. Classified as bizarre (impossible to be true) or nonbizarre (at least possible)
Delusions
Belief that one has special powers or is someone important (jesus, president, MJ, etc)
Delusions of Grandeur
belief that one is being persecuted
Paranoid
belief that some event is uniquely related to patient (TV show character is sending patient messages)
reference
belief that one’s thoughts can be heard by others
thought broadcasting
conventional beliefs exaggerated (eg Jesus talks to me)
Religious
false belief concerning body image (eg, I cannot swallow)
somatic
Repetitive behaviors (usually linked with obsessive thoughts)
Compulsions
Repetitive intrusive thoughts
Obsessions
Level of knowledge in the context of the patient’s culture and education (eg. who is the president? who was picasso?)
Fund of Knowledge
The patient’s level of awareness and understanding of his or her problem
insight
The patient’s ability to understand the outcome of his or her actions and use this awareness in decision making
Judgement
Tarasoff Rule
If the patient expresses imminent threats against friends, family or others, the doctor should notify potential victims and or protection agencies when appropriate
The most important predictor of future violence
prior history of violence
Axis I describes
all diagnoses of mental illness (including substance abuse and developmental disorders), not including personality disorders and mental retardation
Axis II describes
Developmental and personality disorders
Axis III describes
General medical conditions
Axis IV describes
Severity of psychosocial factors (eg, homelessness, divorce, etc)
Axis V provides
a global assessment of function (GAF) which rates overall level of daily functioning (social, occupational, psychological) on a scale of 0-100
Criterion for hospitalization is a Global Assessment of Function score of?
less then or equal to 30
