Intro To Behavior Health Flashcards
An illness with psychological or behavioral manifestations associated with significant distress and impaired functioning caused by a biological, social, psychological, genetic, physical, or chemical disturbance.
Mental Disorder
Neurodevelopmental Disorders.
Schizophrenia Spectrum and other Psychotic disorders*
Bipolar and Related Disorders*
Depressive Disorders*
Anxiety Disorders*
Obsessive-Compulsive and Related Disorders*
Trauma- and Stressor-Related Disorders*
Dissociative Disorders
Somatic Symptom and Related Disorders*
Feeding and Eating Disorders*
Elimination Disorders
Sleep-Wake Disorders
Sexual Dysfunctions
Gender Dysphoria
Disruptive, Impulse-Control, and Conduct Disorders
Substance-Related and Addictive Disorders*
Neurocognitive Disorders
Personality Disorders*
Paraphilic Disorders
Other Mental Disorders
Medication-Induced Movement Disorders and Other Adverse Effects of Medications
Other conditions that may be a focus of clinical attention
22 Major Categories of Psychiatric Illness
Schizophrenia Spectrum and other Psychotic disorders have defined abnormalities in:
- Delusions
- Hallucinations
- Disorganized thinking/speech
- Grossly disorganized or abnormal behavior
- Negative/Positive Symptoms
Defined by “Manic episodes” and “Depressive episodes”.
Bipolar and Related Disorders
Defined by presence of sad, or empty, or irritable mood.
Accompanied by somatic and cognitive changes.
Significantly affects the individual’s capacity to function.
Depressive disorders
the emotional response to real or perceived imminent threat
Fear
Anticipation of future threat
Anxiety
recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted
Obsessions
repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession
Compulsions
Defined by requisite exposure to trauma or stressful event.
Symptoms may be quite variable – anxiety, anhedonia, dysphoria, externalized anger, aggressiveness, dissociativeness.
Trauma - and Stressor-Related Disorders
Defined by the prominence of somatic symptoms associated with significant distress and impairment (abnormal thoughts, feelings, and behaviors in response to the symptoms)
Somatic Symptom and Related Disorders
Characterized by a persistent disturbance of eating or eating-related behavior that results in the consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.
Feeding/Eating Disorders
10 Classes of drugs in substance-related disorders
- alcohol
- caffeine
- cannabis
- hallucinogens
- inhalants
- opioids
- sedatives, hypnotics, & anxiolytics
- stimulants
- tobacco
- Other (or unknown)
-an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
-is pervasive and inflexible
-has an onset in adolescence or early adulthood
-is stable over time
and leads to distress or impairment
Personality Disorder
loss of reality testing with delusions & hallucinations
Psychotic
No loss of reality testing: based on mainly intrapsychic conflicts or life events that cause anxiety; symptoms include obsession, phobia, and compulsion.
Neurotic
No known structural damage or clear-cut biological cause to account for the impairment
Functional
Illness caused by a specific agent producing structural changes in the brain; usually associated with cognitive impairment, delirium, or dementia (NOT USED IN DSM-V)
Organic
No known cause, AKA idiopathic
Primary
known to be a symptomatic manifestation of a systemic, medical, or cerebral disorder (like delirium from a fever)
Secondary
Oblique, digressive, or even irrelevant manner of speech in which the central idea is never communicated
Tangentially
i.e. - The patient is asked to explain how she was injured, but looses her train of thought and goes on to other subjects.
Tangentially example
Disturbance in the associative thought and speech process in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea. Seen in schizophrenia, obsessional disturbances, and certain cases of dementia
Circumstantiality
i.e. - When asked about a bruise on her arm, the patient recounts everything else that happened that same day before explaining how she was injured
Circumstantiality example
Abrupt interruption in train of thinking before a thought or idea is finished; after a brief pause, the patient indicates no recall of what was being said or was going to be said. Often indicates the presence of a mental illness such as schizophrenia
Thought Blocking
i.e. - In the middle of talking about his childhood, the patient abruptly pauses, after which he can’t remember what he was saying
Thought Blocking Example
Thinking or speech disturbance involving a disorder in the logical progression of thoughts, manifested as a failure to communicate verbally adequately; unrelated and unconnected ideas shift from one subject to another
Loosening of the associations
i.e. - “He went to the ballpark and brought Frank’s beer belly home in a bag of grass seed.”
Loosening of the associations example
Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Seen in mania
Flight of Ideas
i.e. - A man starts talking about his business, but quickly shifts to discussing the economy, the government, and other countries
Flight of Ideas example
Incoherent, essentially incomprehensible, mixture of words and phrases commonly see in far-advanced cases of schizophrenia
Word Salad
i.e. - “It was shockingly not of the best quality I have known all such evildoers coming out of doors with the best of intentions!”
Word Salad example
False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved
Hallucinations
i.e. - The patient complains of an overwhelming chemical smell in and around his room; no one else smells it, although he insists it’s still there and says he feels faint
Hallucinations Example
A false belief, based on incorrect inference about external reality, that is held firmly despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief
Delusions
i.e. – “I believe that someone is following me and taking my picture.”
Delusions Example
State of awareness of oneself and one’s surroundings in terms of Person, Place, Time & Situation (Ox4)
Orientation
i. e. - A 42 y/o alcoholic man in delirium tremens was examined in a local hospital, 2010. When he was asked date and where he was he replied: I’m Jesus Christ standing on a street corner in Tennessee; it’s 2008 and I’m minding my own
business. Why don’t you do the same?
Orientation Example
Conscious recognition of one’s own condition. In psychiatry, it refers to the conscious awareness and understanding of one’s own psychodynamics and symptoms of maladaptive behavior; highly important in effecting changes in the personality and behavior of a person
Insight
i.e. - A 25 y/o man was seen in the ED stating he was controlled by a computer on an Enterprise-like starship, similar to the one on Star Trek. He was convinced all of his thoughts, actions, and feelings were being programmed onboard the starship, which was located light-years away and, therefore, could never be detected by anyone else
Insight Example
Mental act of comparing or evaluating choices within the framework of a given set of values for the purpose of electing a course of action. If the course of action is consonant with reality or with mature adult standards of behavior, judgment is said to be intact or normal; judgment is to be impaired if the chosen course of action is frankly maladaptive, results from impulsive decisions based on the need for immediate gratification, or is otherwise not consistent with reality as measured by mature adult standards
Judgment
i.e. – burning oneself purposely AND when asked what she would do if she found a stamped addressed envelope in the street the patient replied, “Well, I would open it of course and read what it said. Maybe there would be money in it.”
Judgment Example
Two Sections of the psychiatric exam
- Complete medical history; pertinent PE
2. Psychiatric history
Components of a Psychiatric History
ID, CC/HPI Past medical/surgical hx Past psych hx Medications Substance use Family hx Social hx Personal hx
8 Parts of the Mental Status Exam
- Appearance and behavior
- Speech
- Mood (anxiety/risk -assessment)
- Thoughts (both content and process)
- Perception
- Cognition
- Insight
- Judgment
MSE: Appearance & Behavior
- Hygiene/grooming
- Appropriate clothing
- Unusual mannerisms
MSE: Speech
Not language abilities Dysphasia Volume Amount Speed
- Overall emotional state during interview
- Include subjective expressions by patient
- Sad, depressed down, happy, euphoric, anxious, tense, nervous, worried
Mood
- Variable emotions during interview
- Objective elements
- Intensity, appropriate, lability
Affect
MSE: Thought Content
Delusions: firmly held false beliefs that are not culturally bound
Suicidal ideations
Obsessions
Poverty of content
MSE: Thought Process
-Concern with flow of patient’s ideas and how well they connect with one another
-Normal: logical, goal –directed, well-organized
-Abnormal
~Tangentiality
~Circumstantiality
~Thought blocking
~Loose associations
~Flight of ideas
~Word salad
MSE: Perception
-Hallucinations: abnormal sensory perception
~Auditory most common: “do you ever hear things other people don’t hear?
~Visual
~Olfactory
~Tactile
~Gustatory
~Illusions: Gross distortions of real sensory input
MSE: Cognition
-Orientation: time, place, person
-Attention/concentration: Serial 7s test
-Memory
~Short term,
recent, remote
MSE: Judgment/ insight
Judgment: ability to plan/act in established cultural norms
“What would you do if you smelled smoke in a movie theater?”
Insight: depth, accuracy of understanding a situation
Ordering of Thyroid Function Tests
-Depression w hypothyroidism
-Lithium therapy can cause hypothyroidism
Sub-clinical hypothyroidism can cause depression
Order thyrotropin-releasing hormone (TRH)
Dexamethasone-Suppression Test
-Used to confirm major depressive disorder
Catecholamines
Elevated (urine) w/carcinoid tumors \+/- when on phenothiazines (urine) In CSF low in suicidal depressed patients ↓ 5-HIAA in all violent behavior ↑ in PTSD
Lab Tests Related to Lithium
- plasma level
- Thyroid
- lytes
- WBC
- Renal Function
Lab Tests related to Clozapine (Clozaril)
WBC 2° to risk of agranulocytosis
Lab Tests related to tricyclic/tetracyclic drugs
- EGC-looking for conduction delays
- Blood levels for therapeutic range
