Fundamentals of psychiatry Flashcards
Impact of Mental Illness
NIMH reports 1 in 4 adults experience a mental health disorder in a given year
WHO reports 4 of 10 leading disabilities in US and other countries are from mental illness
Estimated in 2020 Major Depression will be leading cause of disability in the world
Economic estimate of untreated mental illness is more than 100 billion dollars per year in US
mental health and life
Depressed heart disease patients are much more likely to die after a heart attack than heart disease patients who are not depressed
Patients suffering from mental illness significantly access medical care at higher rates than patients without psychiatric issues
Children of mothers who suffer from chronic depression are more likely to have behavioral problems at school
The largest mental health system in LA county is the LA county jail system
depression and treatment stats
Suicide is the 8th leading cause of death in the US
Only 50% of patients diagnosed with depression receive treatment but only 20% of those receive appropriate treatment
Stigma continues to be prevalent
Treatment is highly effective
70 to 90 % will have significant decrease in symptoms and improvement in quality of life
Diagnosing Mental Illness
Clinical Observation Syndrome Based Response to treatment Future possibilities - Genome based - Biomarkers - Imaging studies
Diagnosis of Mental Illness DSM-5
Advantages:
- Reliability
- Objectivity
Disadvantages:
- False sense of certainty
- Cookbook medicine
Transference:
A set of expectations, beliefs, and emotional responses that a patient brings into the doctor patient relationship
CounterTransference:
Physicians unconscious or unspoken expectations and feelings about a patient
Multiaxial System
Axis I- Major Syndrome presenting
Axis II-arise in early life and persist i.e., personality disorders, MR
Axis III- medical conditions
Axis IV- psychosocial, environmental stressors
Axis V- global assessment of functioning
The Interview Setting
Safe location Adequate time Stance, eye contact Note taking Where’s the door Nurses Don’t need all the data from first meeting
Information Sources
History from the patient
Observation of the patient’s behavior, thoughts
Your interaction (reaction) to the patient
History from other sources: family, records
Physical Exam
Laboratory data
Mental Status Exam
Obstacles to the Psychiatric Interview
Voluntary vs. Involuntary Treatment Confidentiality Embarrassment Potential ramification on career, family, finances Altered mental status Aggression Stigma
The Psychiatric Exam
History and Physical Mental Status Exam Neurologic Exam Laboratory Data Imaging Studies
Medical History
- Substance History
- – Illicit and prescription drugs
Developmental History - Prenatal and Birth History - Motor and Verbal - Milestones - Family structure - Parental Relationship, Abuse
Sexual History
Social History
- Education
- Relationships
- Employment
- Legal
Mental Status Exam
Appearance Attitude Motor Activity Thought Content Thought Process Speech Orientation Perceptions (visual, auditory, tactile) Calculations Attention Abstraction Judgment Insight
Delusion
fixed belief that isn’t true
Biological Assessment
Plasma drug levels CBC Electrolytes Creatinine Liver function tests Thyroid UA Pregnancy Toxicology Screen Neuroimaging EEG
Medical Conditions with Depression
Hypothyroidism Diabetes Mellitus Cushing’s syndrome Systemic lupus erythematosis (SLE) Pancreatic carcinoma Parkinson’s disease Multiple sclerosis Dementia
Medical Conditions with Mania
Hyperthyroidism
Head injury
Complex partial seizures
Huntington’s disease
Medical Conditions with Psychosis
Hyperthyroidism Brain Tumor Seizure disorder CNS infection Drug withdrawal/intoxication
Medical Conditions with Anxiety
Hyperthyroidism Coronary artery disease Pulmonary diseases Hypoglycemia Mitral valve prolapse Hypoxia Substance Induced
Neuropsychological Testing
Intellectual functioning
- Weschler intelligence scales
Attention and Concentration
- Digit span forward, backward
Memory
- Weschler memory scale
Language
Visual spatial
- Clock drawing
Executive Functioning
- Wisconsin card sorting test
Origin of Mental Illness“Biopsychosocial Model”
Psychoanalytic Theory
Biological Theory
- Neuroanatomy
- Neurochemical
Genetic Theory
Social Theory
Treatment of Mental Illness
Psychotherapy Pharmacotherapy Family Therapy Substance Abuse Treatment Group Therapy Structured Living Environment Vocational Rehabilitation Light Therapy ECT Magnetic Stimulation
Obstacles to Treatment
Voluntary vs. Involuntary Non-adherance Stigma Cost Polypharmacy Side effects Impaired judgment, cognition, insight, altered MS Cultural issues Ineffective treatment Substance use Alteration of family dynamics Poor access to care
Psychiatric Sub-Specialities
Adult Psychiatry Child/adolescent Psychiatry Geriatric Psychiatry Addiction Psychiatry Forensic Psychiatry Consultation/Liasion Psychiatry Administrative Psychiatry Outpatient vs. Inpatient Psychiatry NeuroBehavioral Psychiatry
Ethics in Psychiatry
Competency
- Legal issue
- Courts
- Diagnosis tells you little
- Refusal of care
Confidentiality
Duty to Warn
Boundaries
