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Psychiatry > Examination and Diagnosis > Flashcards

Examination and Diagnosis Flashcards

1
Q

What are the components of a psychiatric history?

A
  • Identifying data
  • Chief complaint (patient’s own words)
  • History of present illness
  • Past psychiatric history
  • Past medical history
  • Medications
  • Allergies
  • Family history
  • Social history (occupation, education, living situation, substance abuse, etc.)
  • Mental status exam
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2
Q

What should the history of present illness include?

A
  • Information about the current episode
    • Why the patient came to the doctor
    • Description of current episode
    • Events leading up to current moment (precipitating events)
    • How work & relationships have been affected
    • The patient’s support system (who the patient lives with, distance & level of contact with friends & relatives)
    • Relationship btwn physical & psychological symptoms
    • Vegetative symptoms (insomnia, loss of appetite, problems with concentration)
  • Information about past episodes
    • Chronological account of past psychiatric problems/episodes
  • Establishing a baseline of mental health
    • Patient’s functioning when “well”
    • Developmental history: physical & intellectual ability at various stages of life (outpatient setting only)
    • Life values, goals (outpatient setting)
    • Evidence of secondary gain
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3
Q

What are the 8 things that the mental status examination assesses?

A
  • Appearance/Behavior
  • Mood/Affect
  • Speech
  • Perception
  • Thought process/Thought content
  • Sensorium/Cognition
  • Insight/Judgment
  • Suicidal/Homicidal ideation
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4
Q

True or False:

The mental status exam tells about a patient’s mental status all the time.

A

False

The mental status exam tells only about the mental status at that moment.

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5
Q

How is appearance assessed?

A
  • Physical appearance - clothing, hygiene, posture, grooming
  • Behavior - mannerisms, tics, eye contact
  • Attitude - cooperative, hostile, guarded, seductive, apathetic
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6
Q

How is speech assessed?

A
  • Rate - slow, average, rapid, pressured
    • Pressured speech is continuous, fast & uninterruptible
  • Volume - soft, average or loud
  • Articulation - well articulated versus lisp, stutter, mumbling
  • Tone - angry versus pleading, etc.
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7
Q

How is mood assessed?

A
  • The emotion that the patient tells you he feels or is conveyed nonverbally
  • “How are you feeling today”
  • Have patients rate their stated mood from 1-10
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8
Q

How is affect assessed?

A
  • An assessment of how the patient’s mood appears to the examiner (amt & range of emotional expression)
  • Quality - depth & range of feelings shown
    • Flat: none
    • Blunted: shallow
    • Constricted: limited
    • Full: average
    • Intense: more than normal
  • Motility - how quickly a person appears to shift emotional states
    • Sluggish vs supple vs labile
  • Appropriateness to content - whether the affect is congruent with the subject of conversation
    • Appropriate vs not appropriate
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9
Q

How is thought process assessed?

A
  • The patient’s form of thinking
  • How he or she uses language and puts ideas together
  • Describes whether the patient’s thoughts are logical, meaningful and goal-directed
  • It doesn’t comment on what the patient thinks, only how the patient expresses his or her thoughts
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10
Q

What are 8 examples of thought process disorders?

A
  • Loosening of associations
  • Flight of ideas
  • Neologisms
  • Word salad
  • Clang associations
  • Thought blocking
  • Tangentiality
  • Circumstantiality
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11
Q

Loosening of associations

A

No logical connection from one thought to another

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12
Q

Flight of ideas

A

a fast stream of very tangential thoughts

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13
Q

Neologisms

A

made-up words

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14
Q

Word salad

A

incoherent collection of words

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15
Q

Clang associations

A
  • Word connections due to phonetics rather than actual meaning
  • “My car is red. I’ve been in bed. It hurts my head”
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16
Q

Thought blocking

A

abrupt cessation of communication before the idea is finished

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17
Q

Tangentiality

A

point of conversation never reached due to lack of goal-directed associations between ideas

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18
Q

Circumstantiality

A

point of conversation is reached after circuitous path

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19
Q

How is thought content assessed?

A

the types of ideas expressed by the patient

20
Q

What are 6 examples of thought content disorders?

A
  • Poverty of thought vs overabundance
  • Delusions
  • Suicidal and homicidal thoughts
  • Phobias
  • Obsessions
  • Compulsions
21
Q

Poverty of thought vs overabundance

A

too few versus too many ideas expressed

22
Q

Delusions

A

fixed, false beliefs that are not shared by the person’s culture and cannot be changed by reasoning

23
Q

Suicidal and homicidal thoughts

A
  • Ask if the patient feels like harming him/herself or others
  • Identify if the plan is well formulated
  • Ask of the patient has intent (if released right now, would he go and kill himself or harm others?)
24
Q

Phobias

A

persistent, irrational fears

25
Q

Obsessions

A

repetitive, intrusive thoughts

26
Q

Compulsions

A

repetitive behaviors (usually linked with obsessive thoughts)

27
Q

How is perception assessed?

A
  • Hallucinations - sensory expereinces not based in reality (visual, auditory, tactile, gustatory, olfactory)
  • Illusions - inaccurate perception of existing sensory stimuli (ex: wall appears as if it’s moving)
28
Q

What are 5 examples of delusions?

A
  • Grandeur - belief that one has special powers or is someone important (Jesus, president)
  • Paranoid - belief that one is being persecuted
  • Reference - belief that some event is uniquely related to patient (TV show character sending patient messages)
  • Thought broadcasting - belief that one’s thoughts can be heard by others
  • Religious - conventional beliefs exaggerated (Jesus talks to me)
29
Q

How are sensorium & cognition assessed?

A
  • Consciousness - patient’s level of awareness; possible range includes: alert, drowsy, lethargic, stuporous, coma
  • Orientation - to person, place, time
  • Calculation - ability to add/subtract
  • Memory
    • Immediate - can repeat several digits are recall 3 words 5 min later
    • Recent - events within past few days
    • Recent past - events w/i past few mo
    • Remote - events from childhood
  • Fund of knowledge - level of knowledge in the context of the patient’s culture and education (who is the present? who was Picasso?)
  • Attention/Concentration - ability to subtract serial 7s from 100 or to spell “world” backwards
  • Reading/Writing - simple sentences (must make sure the patient is literate first!)
  • Abstract concepts - ability to explain similarities btwn objects and understand the meaning of simple proverbs
30
Q

How is insight assessed?

A
  • Patient’s level of awareness and understanding of his or her problem
  • Problems with insight include complete denial of illness or blaming it on something else
31
Q

How is judgment assessed?

A
  • Patient’s ability to understand the outcome of his or her actions and use this awareness in decision making
  • “What would you do if you smelled smoke in a crowded theater?”
32
Q

What are some ways to test ability to abstract?

A
  • Similarities
    • How are an apple and orange alike?
    • Normal answer: “they are fruits”
    • Concrete answer: “they are round”
  • Proverb testing
    • What is meant by “You can’t judge a book by it’s cover”?
    • Normal answer: “You can’t judge people by how they look”
    • Concrete answer: “Books have different covers”
33
Q

How do you approach a violent patient?

A
  • Avoid being alone with a violent patient
  • Ask “Do you feel like you want to hurt someone or that you might hurt someone?”
  • If the patient expresses imminent threats, the doctor should notify potential victims and/or protection agencies when appropriate
34
Q

How do you approach a delusional patient?

A
  • The psychiatrist should not directly challenge a delusion or insist that it is untrue, but he should not imply he believes it either
  • Simply acknowledge that you understand that the patient believes the delusion to be true
35
Q

How do you approach a depressed patient?

A
  • Important to offer reassurance that he or she can improve with appropriate therapy
  • Inquiring about suicidal thoughts is crucial
    • Feeling of hopelessness
    • Substance use
    • Hx prior suicide attempts (increased risk)
  • If patient is planning or contemplating suicide, he or she musst be hospitalized or otherwise protected
36
Q

Axis I of DSM IV

A
  • All diagnoses of mental illness
    • Substance abuse
    • Developmental disorders
  • Not including personality disorders and mental retardation
37
Q

Axis II of DSM IV

A
  • Personality disorders
  • Mental retardation
38
Q

Axis III of DSM IV

A
  • General medical conditions
39
Q

Axis IV of DSM IV

A
  • Psychosocial and environmental problems
  • ex: homelessness, divorce
40
Q

Axis V of DSM IV

A
  • Global Assessment of Function (GAF)
  • Rates overall level of daily functioning (social, occupational, psychological) on a scale of 0-100
  • Rate current GAF vs. high GAF during the past year
41
Q

Aspects of intelligence include…

A
  • Memory
  • Logical reasoning
  • Ability to assimilate factual knowledge
  • Understanding of abstract concepts
42
Q

What is the intelligence quotient?

A
  • Test of intelligence
    • Mean: 100
    • Standard deviation: 100
  • Scores adjusted for age and gender
  • IQ of 100
    • Mental age equals chronological age
    • Corresponds to the 50th %ile in intellectual ability for the general population
43
Q

What do intelligence tests assess?

What are two common tests?

A
  • Assess cognitive function by evaluating comprehension, fund of knowledge, math skills, vocabulary, picture assembly, and other verbal and performance skills
  • Wechsler Adult Intelligence Scale (WAIS)
    • Most common test for ages 16-75
    • Assesses overall intellectual functioning
    • 2 parts: verbal & visual-spatial
  • Stanford-Binet Test
    • Tests intellectual ability in patients ages 2-18
44
Q

IQ Chart

A
  • >130 - very superior
  • 120-129 - superior
  • 110-119 - high average
  • 90-109 - average
  • 80-89 - low average
  • 70-79 - borderline
  • 50-70 - mild mental retardation
  • 35-49 - moderate mental retardation
  • 25-34 - severe mental retardation
  • <25 - profound mental retardation
45
Q

What are objective personality assessment tests?

What is an example?

A
  • Questions with standardized-answer format that can be objectively scored
  • Minnesota Multiphasic Personality Inventory (MMPI-2)
    • Tests personality for different pathologies and behavioral patterns
    • Most commonly used
46
Q

What are projective (personality) assessment tests?

What are two examples?

A
  • No structured-response format
  • Often ask for interpretation of ambiguous stimuli
  • Thematic Apperception Test (TAT)
    • Test-taker creates stories based on pictures of people in various situations
    • Used to evaluate motivations behind behaviors
  • Rorschach Test
    • Interpretation of ink blots
    • Used to identify thought disorders and defense mechanisms

Psychiatry (18 decks)

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