Interview & Assessment

Question 1

Purpose of interview

Answer 1

establish rapport & gather info

Question 2

Three main steps in the interview

Answer 2

1. formulate an impression of diagnosis
2. develop a treatment plan
3. produce a written document for patient’s medical record

Question 3

Two main components of the interview

Answer 3

1. History

2. Mental Status Exam (cognition and emotion status in interview)

Question 4

what does the report start with?

Answer 4

identifying information like name, race, gender, reliability of informant

Question 5

next section of report is the chief complaint

Answer 5

observes verbal/non-verbal
evaluate certain areas
important to use the words the patient uses - gives insight to what the patient thinks

Question 6

next section is history of presenting problems

Answer 6

how did they function before the episode (aka PREMORBID FUNCTION = very important)
asking about vegetative state (sleeping & eating)

Question 7

Premorbid function helps

Answer 7

establish a baseline, predictive, many disorders are similar with basic symptoms

Question 8

after looking at history of presenting problems you look at

Answer 8

past psychiatric history

Question 9

after psychiatric history you look at personal history

Answer 9

intent is to get as much about the person’s life
importance of early life cues: quality of bond with family, eye contact, what happened during toddler years (toilet training/separation anxiety)
adolescence, what important things happen)

Question 10

after personal history you look at family history

Answer 10

variable degrees of heritability with some mental illness, provides context into patients developmental history

Question 11

after family history you look at social history

Answer 11

what is currently happening in your life: residence, marital status, occupation/income, social supports, interests

Question 12

after social history you look at medical history

Answer 12

a focus on anything that will predispose a patient to mental illness, chronic pain, trauma, car crash, abuse, head injury’s seizures, HIV

Question 13

After the medical history you look at the second component

Answer 13

Mental Status Exam - symptoms observed at the interview. How they think, perceive, emotions, behavior

Question 14

Main things looked at in the mental status exam: appearance

Answer 14

physical (grooming/dress)
behavior (cooperative/oppositional)
manner relating to examiner
movement

Question 15

Main things looked at in the mental status exam: speech

Answer 15

volume (normal, loud, soft)
rate (pressured, slowed)
spontaneity
syntax
vocab

Question 16

Main things looked at in the mental status exam: thinking

Answer 16

thought form - how ideas are linked (goal directed, circumstantial, tangential, loose associations, flight of ideas)
thought content:
delusions, ideas of reference, obsessions

Question 17

thought content: delusions

Answer 17

fixed beliefs odd, strange or eccentric and outside the realm of real possibility. associated mainly with schizophrenia
Types:
passivity - being controlled by something or someone else
grandiosity - elevated importance
jealousy - belief that spouse is unfaithful
persecutory - belief that been conspired against, prosecuted
religious - beliefs about second coming, possession by the devil
somatic - belief that body is diseased, abnormal or changed

Question 18

thought content: ideas of reference

Answer 18

belief that everyday occurrences carry specific unique personal significance

Question 19

thought content: obsessions

Answer 19

unwanted intrusive thoughts beyond patient’s control

Question 20

Main things looked at in the mental status exam: perception

Answer 20

hallucinations: a sensory perception not experienced by others. Associated with schizophrenia, bipolar disorder, depression, delirium and substance abuse (auditory, olfactory and visual)
Illusions: fixed false beliefs

Question 21

Main things looked at in the mental status exam: mood

Answer 21

internal

depressed, anxious, euphoric

Question 22

Main things looked at in the mental status exam: affect

Answer 22

external

labile, appropriate/inappropriate, fat, euthymic (range variation)

Question 23

Main things looked at in the mental status exam: insight and judgment

Answer 23

insight: patients awareness of his illness
judgement: active demonstration of insight

Question 24

Main things looked at in the mental status exam: cognition

Answer 24

alertness, orientation, concentration, memory, general knowledge

Question 25

definition psychosis

Answer 25

beliefs and perceptual experiences that reidosynmratic, not experienced by others includes delusions, hallucinations

Question 26

positive symptoms of psychosis

Answer 26

delusions: persecutory, referential, religious, somatic hallucinations: auditory, visual, olfactory disorganized speech: tangentially, incoherent, derailment, circumstantial, negative symptoms: decrease in normal functions, restriction in range of intensity of emotional expression, fluency and productivity of thought and speech, initiation of goal-directed behavior

Question 27

manic symptoms

Answer 27

``` euphoric mood increased activity racing thoughts/flight of ideas inflated self esteem decreased need for sleep distractibility poor judgement ```

Question 28

depressive symptoms

Answer 28

dysphonia mood change in appetite or weight insomnia or hypersomnia psychomotor agitation/retardation loss of interest/pleasure, energy, feeling worthlessness diminished ability to think or concentrate suicidal ideation

Question 29

anxiety symptoms

Answer 29

excessive uncontrollable worry and fear associated with feelings of tension and physical arousal panic attacks, agoraphobia, social phobia, specific phobia, obsessions, compulsions

Question 30

mental status exam

Answer 30

it is the equivalent of a physical exam, provides information about the persons thinking, emotions and behavior. This data combined with information from the history are the basis of formulating a differential diagnosis

Question 31

Speech

Answer 31

speech section of the mental status exam describes the physical production of speech, not the ideas being conveyed. Observations of speech may be made about volume, rate, spontaneity, syntax and vocabulary

Question 32

thought process

Answer 32

defined as how a patient organizes his/her thoughts

Question 33

though content

Answer 33

describes a patient's ideas. Abnormalities of content include delusions, ideas of reference and obsessions

Question 34

delusions

Answer 34

are fixed, false beliefs that are not shared by others as part of a religious or subcultural group. They are rigidly held regardless of evident to the contrary

Question 35

Types of delusions

Answer 35

grandiose: patient believes they have special powers religious: preoccupation with false beliefs of religious nature - possession by the devil somatic: belief that the body is diseased, abnormal or changed jealousy: belief that partner is cheating

Question 36

ideas of reference

Answer 36

belief that everyday occurrences carry specific, unique and personal significance

Question 37

obsessions

Answer 37

unwanted intrusive thoughts beyond patients control

Question 38

mood

Answer 38

internal, subjective aspect of the patient's emotional state

Question 39

terms to convey mood

Answer 39

depressed - low or sad anxious - distress of unease, fears of misfortune or harm euphoric - elevated, distorted levels of happiness

Question 40

affect

Answer 40

external, objective aspect of the patients emotional state

Question 41

terms to describe affect

Answer 41

labile - more affective states evident than expected during the interview with the changes occurring rapidly appropriate - affect matches described mood inappropriate - affect does not match mood euthymic - emotional range is evident restricted/constricted - emotional range is limited but not completely absent flat - no emotional range evident

Question 42

perception

Answer 42

abnormalities include hallucinationa nd illusions

Question 43

hallucinations

Answer 43

sensory perceptions generated whilly within the CNS in the absence of any external stimulus. They can occur in any sensory modality: auditory, visual, tactile, olfactory or gustatory

Question 44

illusions

Answer 44

originate with true sensory stimuli, which are then misprocessed or misinterpreted

Question 45

positive symptoms of psychosis

Answer 45

extra feelings or behaviors that are usually not present such as delusions, hallucinations, disorganized speech, disorganized behavior

Question 46

negative symptoms of psychosis

Answer 46

reflect a decrease in or a loss of normal functions. Represents a reduction of emotional responsiveness, motivation, socialization, speech and movement

Question 47

manic symptoms include

Answer 47

``` euphoric mood increased activity racing thoughts/flight of ideas inflated self-esteem decreased need for sleep distractibility poor judgment ```

Question 48

depressive symptoms include

Answer 48

``` dysphoric mood change in appetite or weight insomnia or hypersomnia psychomotor agitation/retardation loss of interest/pleasure, energy feelings of worthlessness diminished ability to think or concentrate suicidal ideation ```

Question 49

anxiety is characterized by

Answer 49

excessive, uncontrollable worry and fear associated with feelings of tension and physical arousal