Interview & Assessment Flashcards
Purpose of interview
establish rapport & gather info
Three main steps in the interview
- formulate an impression of diagnosis
- develop a treatment plan
- produce a written document for patient’s medical record
Two main components of the interview
- History
2. Mental Status Exam (cognition and emotion status in interview)
what does the report start with?
identifying information like name, race, gender, reliability of informant
next section of report is the chief complaint
observes verbal/non-verbal
evaluate certain areas
important to use the words the patient uses - gives insight to what the patient thinks
next section is history of presenting problems
how did they function before the episode (aka PREMORBID FUNCTION = very important)
asking about vegetative state (sleeping & eating)
Premorbid function helps
establish a baseline, predictive, many disorders are similar with basic symptoms
after looking at history of presenting problems you look at
past psychiatric history
after psychiatric history you look at personal history
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)
after personal history you look at family history
variable degrees of heritability with some mental illness, provides context into patients developmental history
after family history you look at social history
what is currently happening in your life: residence, marital status, occupation/income, social supports, interests
after social history you look at medical history
a focus on anything that will predispose a patient to mental illness, chronic pain, trauma, car crash, abuse, head injury’s seizures, HIV
After the medical history you look at the second component
Mental Status Exam - symptoms observed at the interview. How they think, perceive, emotions, behavior
Main things looked at in the mental status exam: appearance
physical (grooming/dress)
behavior (cooperative/oppositional)
manner relating to examiner
movement
Main things looked at in the mental status exam: speech
volume (normal, loud, soft) rate (pressured, slowed) spontaneity syntax vocab
Main things looked at in the mental status exam: thinking
thought form - how ideas are linked (goal directed, circumstantial, tangential, loose associations, flight of ideas)
thought content:
delusions, ideas of reference, obsessions
thought content: delusions
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
thought content: ideas of reference
belief that everyday occurrences carry specific unique personal significance
thought content: obsessions
unwanted intrusive thoughts beyond patient’s control
Main things looked at in the mental status exam: perception
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
Main things looked at in the mental status exam: mood
internal
depressed, anxious, euphoric
Main things looked at in the mental status exam: affect
external
labile, appropriate/inappropriate, fat, euthymic (range variation)
Main things looked at in the mental status exam: insight and judgment
insight: patients awareness of his illness
judgement: active demonstration of insight
Main things looked at in the mental status exam: cognition
alertness, orientation, concentration, memory, general knowledge
definition psychosis
beliefs and perceptual experiences that reidosynmratic, not experienced by others
includes delusions, hallucinations
positive symptoms of psychosis
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
manic symptoms
euphoric mood increased activity racing thoughts/flight of ideas inflated self esteem decreased need for sleep distractibility poor judgement
depressive symptoms
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
anxiety symptoms
excessive uncontrollable worry and fear associated with feelings of tension and physical arousal
panic attacks, agoraphobia, social phobia, specific phobia, obsessions, compulsions
mental status exam
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
Speech
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
thought process
defined as how a patient organizes his/her thoughts
though content
describes a patient’s ideas. Abnormalities of content include delusions, ideas of reference and obsessions
delusions
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
Types of delusions
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
ideas of reference
belief that everyday occurrences carry specific, unique and personal significance
obsessions
unwanted intrusive thoughts beyond patients control
mood
internal, subjective aspect of the patient’s emotional state
terms to convey mood
depressed - low or sad
anxious - distress of unease, fears of misfortune or harm
euphoric - elevated, distorted levels of happiness
affect
external, objective aspect of the patients emotional state
terms to describe affect
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
perception
abnormalities include hallucinationa nd illusions
hallucinations
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
illusions
originate with true sensory stimuli, which are then misprocessed or misinterpreted
positive symptoms of psychosis
extra feelings or behaviors that are usually not present such as delusions, hallucinations, disorganized speech, disorganized behavior
negative symptoms of psychosis
reflect a decrease in or a loss of normal functions. Represents a reduction of emotional responsiveness, motivation, socialization, speech and movement
manic symptoms include
euphoric mood increased activity racing thoughts/flight of ideas inflated self-esteem decreased need for sleep distractibility poor judgment
depressive symptoms include
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
anxiety is characterized by
excessive, uncontrollable worry and fear associated with feelings of tension and physical arousal
