History, MSE, Dx (Ch 2) Flashcards
The 4 Ps
Pt’s psychosocial and environmental conditions Predisposing to, Precipitating, Perpetuating, and Protecting against the current episode
Neurovegetative symptoms
quality of sleep, appetite, energy, psychomotor retardation/activation, concentration
Importance of asking about caffeine/nicotine use
nicotine withdrawal may cause anxiety and agitation
NSAID effect on lithium
NSAID decreases Lithium excretion which increases lithium concentrations.
Exceptions may be sulindac and aspirin
Psychomotor retardation
slowness of voluntary and involuntary movements
aka hypokinesia or bradykinesia
Akinesia: absence of movement
Automatisms
spontaneous, involuntary movements during an altered state of consciousness
range from purposeful to disorganized
Pressured speech
usually uninterruptible
patient compelled to continue speaking
Assess patient’s intellectual functioning
Proverb interpretation: assess if patient has difficulty with abstraction
Vocabulary strategies: define a particular vocabulary word correctly and appropriately use in sentence reflects intellectual capacity
example of labile affect
laughing one second, crying the next
Affect
assessment of how the patient’s mood appears to the examiner - amount and range of emotional expression
Circumstantiality
point of the conversation is eventually reached but with over inclusion of trivial or irrelevant details
Tangentiality
point of conversation never reached, responses usually in ballpark
Loosening of associations
no logical connection from one thought to another
Flight of ideas
thoughts change abruptly from one idea to another, usually accompanied by rapid/pressured speech
Neologisms
made up words
Word salad
incoherent collection of words
Clang associations
word connections due to phonetics rather than actual meaning
“my car is red. I’ve been in bed. It hurts my head.”
Though blocking
Abrupt cessation of communication before the idea of finished
Grandeur delusions
belief that one has special powers or is someone important (Jesus, President)
Paranoid delusions
belief that one is being persecuted
Reference delusions
belief that some event is uniquely related to patient (e.g. TV show character is sending patient messages)
Thought broadcasting delusions
belief that one’s thoughts can be heard by others
Religious delusions
conventional beliefs exaggerated (e.g. Jesus talks to me)
Somatic delusions
false belief concerning body image (e.g. I have cancer)
Poverty of thought vs overabundance
Too few versions too many ideas expressed
Delusions
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 non bizarre (at least possible)
Phobias
persistent, irrational fears
Obsessions
repetitive, intrusive thoughts
Compulsions
Repetitive behaviors (usually linked with obsessive thoughts)
Hallucinations
Sensory perceptions in absence of actual stimulus
Auditory (most common), visual, taste, olfactory, or tactile
Types of auditory hallucinations
ringing, humming, whispers, or voices speaking clear words
Command auditory hallucinations
voices instruct the patient to do something
Hypnagogic hallucination
hallucinations only before falling asleep
Hypnopompic hallucination
hallucinations only upon awakening
Illusions
Inaccurate perception of existing sensory stimuli (wall appears to be moving)
Derealization/Depersonalization
feeling detached to one’s surroundings/mental processes
Alcoholic hallucination
auditory (usually), visual and tactile hallucinations occurring during or after period of heavy alcohol consumption
Patient aware they are hallucinations, not real
DTs - no clouding of sensorium and VS are normal
Consciousness
Pt’s level of awareness
Alert, drowsy, lethargic, stuporous, coma
Orientation
to person, place, and time
Calculation
ability to add/subtract
Immediate memory (registration)
dependent on attention/concentration and can be tested by asking a patient to repeat several digits or words
Recent (short term) memory
Events w/in past few minutes, hours or days
Remote memory
long term
Fund of knowledge
Level of knowledge in context of the patient’s culture and education
Who is president? Who was Picasso?
Attention/Concentration
Ability to subtract serial 7s from 100 or to spell “world” backwards
Reading/writing
simple sentences (must make sure patient is literate first)
Abstract concepts
Ability to explain similarities between objects and understand the meaning of simple proverbs
Insight
level of awareness and understanding of problem
full, partial/limited or none
Problems with insight example related to illness
complete denial of illness or blaming it on something else
Judgment
ability to understand outcome of actions and use awareness in decision making
excellent, good, fair, or poor
Tarasoff rule
If a patient expresses imminent threats against friends, family, or others, the doctor should notify potential victims and/or protection agencies when appropriate
