Final Exam Flashcards
Elements of a Good Goal
Goal is stated in a POSITIVE manner Goal is SPECIFIC Goal is MANAGEABLE Goal is in the pt's OWN language Goal is MEASURABLE Goal is within pt's CONTROL
What Major things are we Assessing in a Mental Health Interview?
Ruling out risk
Assessing function
Determining symptoms of distress
Hypothesizing diagnoses, spectrum disorders and developing a working formulation of the patient.
Seven Variable of Psychiatric Interviewing
1) physiological
2) psychological
3) dyadic system (interpersonal),
4) ,Family system,
5) Group system
6) Societal system
7) Existential (Framework for meaning; core beliefs –self, other, world) (variation of biopsychosocial model)
Intentions of the Interview
Establish a relationship – rapport/engagement
Obtain information/data - descriptive
Understand patient concerns (stages of change)
Identifying risk
Assess for mental disorders and addictions
Generating hypotheses - suspected
Provide feedback
Goal Development/Treatment Plan
Instill hope and ensure patient return
Empathetic Responses in the Interview
Empathic responses – basic (sounds like) and complex (you’re feeling…) or (it is…e.g. frightening to lose someone in that way)
Use intermittently to strengthen engagement Statements vary in degree of implied certainty, quality attribution and intimacy
Guarded patients – stay basic or avoid empathic statements
Trusting patients – complex statements may be more useful
Successful empathic statements increase patient responsiveness.
Empathy conveyed verbally and non verbally
Rapport can be developed even when the interviewer is more directive in their questioning.
Types of Q’s to be aware of
Double Barrelled Questions: Have you had trouble eating and sleeping?
Multiple Choice: Do you have trouble falling asleep, staying asleep or waking up in the morning?
Echo question: “I’m afraid everyone will leave me.” Therapist: Everyone?
Be aware of transference. If the clinician notices a change in affect in the patient the clinician can ask “How are you feeling right now?”.
Mood – Suicidality and Homocidality
Do you have or have you had thoughts of harming (killing) yourself?
Do you have specific ideas or plans?
What keeps you alive?
Do you have thoughts of harming anyone else?
Do you think that there are people you love who would be better off dead?
Anxiety Related Q’s
Social Anxiety (SAS)
Do you worry that people are judging you?
Does this inhibit you from engaging in social activities?
GAD (GAD-7)
Do you worry a lot of the time? What about?
Do you think you worry more than most people?
Do you have any associated physical sensations? What are they?
Panic (ANSQ-5)
Have you ever experienced (heart palpitations, racing, shortness of breath, sense of doom) that has lasted a half hour or less?
Did you think you were having a heart attack?
If yes, how often has this happened?
OCD (Y-BOCS)
Do you engage in activities you can’t help (e.g. excessive checking, hand washing, cleaning)? Are these activities associated with anxiety?
Do you have thoughts that are intrusive and unwanted? What are these about? Are these thoughts associated with anxiety?
Psychosis
Psychosis fluctuates, gains momentum and may evolve over time: hard and soft signs
Hard: delusions, hallucinations, formal thought disorder, gross disorientation, bizarre mannerisms/body language
Soft: intense, inappropriate, agitated, or angry affect, guarded, suspicious, vague, mild thought disorder, pre-occupation with a distant incident, expectation of familiarity from interviewer, inappropriate eye contact, long latency before responding
Delerium vs Psychosis
Delerium – need to do complete medical evaluation – many organic causes (e.g. anemia, electrolytes, glucose, calcium, B1 def., infections, neurological disorders, substance withdrawal, intoxication)
Psychosis – Psychosis secondary to a medical condition can present like any other psychosis- “think organic” when evaluating the onset of psychotic symptoms
R/O organic causes if no prior diagnosis. Corroborative reporting from others close to the family is invaluable if you can obtain it
Questions if Psychosis Suspected
Do you ever have thoughts that thoughts are being inserted into your mind? Withdrawn?
Do you ever think the TV has special messages for you?
Do you ever think your thoughts are being controlled?
Do you think you have a special purpose for which you have been singled out?
Do you have beliefs that others would not agree with or believe in?
Do you ever think that others are out to harm you or are persecuting you? If yes, who?
Do you ever hear things or voices that other people wouldn’t believe in?
Do you ever experience voices commanding you to harm others or yourself?
Do you ever see things that other people wouldn’t believe in?
- If yes, what?
What is the DSM?
Diagnostic manual used by both psychologists and psychiatrists
Intended to be descriptive rather than theoretical
Intended to facilitate communication
Based on consensus interpretation o f available research and data
Alternative Resource is the ICD - but DSM is synchronized with ICD.
DSM Limitations
Not an exhaustive list of phenomena
No objective indicators
Overlap in disorder criteria
Epidemiology of Depression
Canada 1.2 million affected (2002)
Women >Men - in fact women are 70% more likely than men to experience depression during their lifetime.
Avg age of onset - 32 yrs
Course of Major Depressive Disorder (MDD)
1 episode ≥ 60% chance of a second.
2 episodes ≥ 70% chance of a third,
3 episodes ≥ 90% chance of a fourth
Mortality by suicide = 15%
MDD DSM Criteria (A)
5+ of the following symptoms;
(at least one of either (1) depressed mood or (2) loss of interest or pleasure)
1) depressed mood.
(2) markedly diminished interest or pleasure in all, or almost all, activities
(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite
(4) insomnia or hypersomnia
(5) psychomotor agitation or retardation (must be observable by others)
(6) fatigue or loss of energy
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
Minimum of 2 weeks in duration and is a deviation form ‘normal’
MDD DSM Criteria (B)
The symptoms do not meet criteria for a Mixed Episode.
MDD DSM Criteria (C)
Significant distress or impairment in functioning.
MDD DSM Exclusion Criteria
SX are NOT due to:
Substance Abuse
Bereavement
General medical Condition
Generalized Anxiety Disorder Epidemiology/Course
Women > Men
Comorbidity with MDD - 60%
Average age of onset 31 - from childhood to late adulthood.
Tends to be long lasting and recurrent
Moderate to severe impairment in occupational function: 38%
GAD DSM Criteria
A. Excessive anxiety and worry (apprehensive expectation), minimum 6 months, about a number of events or activities.
B. Difficult to control the worry
C. The anxiety associated with ≥ 3 of 6:
- restlessness or feeling keyed up or on edge
- being easily fatigued
- difficulty concentrating or mind going blank
- irritability
- muscle tension
- sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
D. The focus of the anxiety and worry is not focused on a particular domain – e.g. Worry about illness
E. Causes impairment in functioning.
F. Exclusions
effects of a substance
a general medical condition
exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.
Somatiform DIsorders
May be associated with a heightened awareness of normal bodily sensations.
Heightened awareness may be paired with a cognitive bias to interpret any physical symptom as indicative of medical illness.
Autonomic arousal is common.
Autonomic arousal may be associated with tachycardia, gastric hypermotility, muscle tension and pain associated with muscular hyperactivity (e.g., muscle tension headaches)
Somatitization vs Hypochondriasis
Hypochondriasis: Fear of having a specific dx, sx will be focused on one condition.
Somatization Not a specific disease rather the symptoms themselves and concern of multiple diseases and multiple parts of the body affected.
Both have similar ddx Q’s - both share a connection with higher rates of early life abuse.
Hypochondriasis
Fear of having a specific Dx.
DSM Criteria for Hypochondriasis
fear of having a serious disease for at least 6 months.
preoccupation persists despite appropriate evaluation and reassurance.
belief is not of delusional intensity
not restricted to a concern about appearance (as in persons with BDD).
causes clinically significant distress or impairment.
not explained better by a mood or anxiety disorder.
Normal rates: 10-20% of people who are healthy intermittent unfounded worries about illness.
When prolonged and persistent and not responsive to reassurance is when to consider hypochondriasis
Men=Women
Most common in early adulthood.
Comorbidity with Hypochondriasis
high rate of psychiatric comorbidity. generalized anxiety disorder major depression panic disorder benzodiazepine misuse
Course of Hypochondriasis
usually episodic,
but last from months to years and equally long quiescent periods.
one third of patients with hypochondriasis eventually improve significantly.
Mood Related Phenomenon
Altered sensation, experience, perception and expectation of the past, present and future states of the self and the world
Pervasive, persistent and minimally responsive to external events
Either in a POSITIVE or NEGATIVE direction
These ‘mood’ related ideas can affect all aspects of life.
Anxiety
Fear of demise
Self or others
The nature of the “demise” can be hidden by the other phenomena
