Intro Flashcards
Define the biopsychosocial model
Bio, psycho & social factors that merge together forming a trifecta of importance to a patient’s perceptions, beliefs, relationships, and social situations.
3 overlapping factors of biopsychosocial model
- Bio-Medical (Risk factors): physical, genetic, biomechanical
- Psycho: Mental status, emotions, personality, behavior
- Social: Culture, socioeconomics, family, ethics, values
What is the difference between a counselor and a therapist
- counselors give advise
- therapist help the patient come up with solutions
Education for MFT?
grad degree + internship
Licensed alcohol & drug abuse counselor: training
master’s degree + 2 years field work
Substance Abuse Counselor: education
bachelors in social science
Social work: credentialing
LCSW (MSW, DSW, PhD)
Psychiatris: education
DO or MD
Psychologist: education
PhD, PsyD, EdD
Examples of social influence on Behavior
- Socioeconomic Factor
- Work environment
- Family relationships and social support
- Access to care (some can’t wait 2 mo. for appt)
- Personnel Resources
Behaviors influenced by psychosocial factors
- Stress Management
- Risk factor management / lifestyle change
- Compliance with treatment
- Treatment response
- Help seeking or help rejecting behaviors
What is the purpose of the DSM-5?
- Communication between clinicians
- Predict outcome of disorders
- Monitor treatment
- Litigation
Define mental disorder
A syndrome characterized by a significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes that regulate mental function. Usually these are associated w/ a significant distress or disability in social, occupational or other important activities. The behavior deviancy must be unexpected to one’s culture and social deviance is not necessarily a MD unless if results from the individual.
(TQ!!!)
Psychiatric illness: what info supports diagnosis?
- Symptoms
- Genetics
- Course of illness (onset, cycling)
- Response to tx
(meds are non-specific and may work on healthy pts, that doesn’t mean that they need it.)
Psych Exam: Differences from H & P
- Focus on psychiatric symptoms
- Focus on psychiatric and developmental history
- Mental status exam fully described
What are the identifying information in an evaluation?
- age/sex/race
- setting
- reason
- consent
HPI: what questions should you ask about sleep?
- increased/decreased
- restorative/nonrestorative
- initial/terminal insomnia
- periods of decreased sleep needs
HPI: questions about apetite (2)
- increased/decreaased
- weight gain/loss
HPI: questions to ask about concentration?
- impairment
- racing thoughts
- distracted
- difficulty in decision making
HPI: questions to ask about memory?
deficits in long or short term
HPI: questions to ask about energy?
- fatigue
- hyper
HPI: questions to ask about interest/motivation?
have gained or lost interest in hobbies
HPI: questions to ask about suicidal ideation (5)
- thoughts
- plans
- intent
- means
- self-control or urges
HPI: questions to ask about homicidal ideation (7)
- target
- thoughts
- intent
- plans
- means
- control
- urges
HPI: thoughts to ask about hallucinations (8)?
- auditory
- visual
- tactile
- olfactory
- nature
- frequency
- reality testing
- command hallucinations
HPI: delution types
- grandiose
- paranoid
- erotomanic
- bizarre
HPI: self-destructive behaviors (5)
- self-cutting
- self-induced emesis
- binging
- skin-picking
- hair-pulling
HPI: anger problems
- verbal or physical
- duration
HPI: reckless behavior
- overspending
- promiscuity (libido)
- substance use
HPI: questions to ask about mood
- depression
- anxiety
- mood swings
HPI: questions to ask about pain (2)
- does it interfere w/their life
- what would life be like if you didn’t have pain
HPI: questions to ask about life circumstances (3)
- guilt
- stressors
- self-confidence/self-esteem
HPI: for all symptoms that are positive you should also assess _____ (6).
- severity
- duration
- importance to pts well-being
- degree of disabiltiy
- palliative
- provocative
Past psych Hx (PPH) (4)
- past hospitalizations
- past suicides
- past psychotherapy trials and response
- past medications (therapy and side effects)
HPI: questions to ask about substance use (8)
- 1st use age
- periods of abstinence
- Illicit drugs that are not associated in a tox screen
- amounts and frequency
- blackouts - associated w/abnormal use
- Siezures
- Withdrawl
- Legal problems
HPI: past medical Hx (3)
- OLDCARTS
- Hx of head injury
- Allergies
Lab tests for psych eval
- Brain imaging
- EEG
- Sleep study
- MD labs: CMP, CBC, TSH, Lipid panel, B12, folate (B9)
Fam Hx for psych eval
- marital status
- children
- family w/conditions
- who do they live with
What questions should you ask about the patient’s family of origin?
- parents: marital status & occupation
- siblings
- family hx of pscy illness
- Hx of abuse
Social Hx questions
- Occupation: how long, satisfaction, dream as a tenn
- Education: how far, academic prowess, problems at school (hyper, trouble, distractibility)
- Military
- Legal
- Rec activities
- Support system
Military Hx questions
- exposure to combat
- type of discharge
- rank at discharge
Pros & cons to DSM5
- Pros: improves reliabiltiy of dx, clarifies dx process & hx taking
- Cons: increases dx precisions may give false certainty, may sacrifice validity for reliability, depersonalize the dx process
When does a patient meet inpatient criteria?
- danger to self or others
- unable to care for self
- medical detox
- failure to improve in outpatient
(Usually the most popular in rural centers due to lack of psychiatrists and specialists of any type in the areas)
Partial Hospital Program Criteria
Need for intensive Tx w/o dangerousness
(Typically meets for 6 hours a day/ 5x a week)
Intensive Outpatient Program Criteria
- Able to care for self
- Stable levels of dangerousness
- Need for active support
(Typically meets 3 hours a day/ 3-5x a week)
Outpatient psychiatric care (30
- Most common type of Tx
- Typically meets 1/week
- Periodic medical management to maintain patient stability.
