Intro To Behavior Health

Question 1

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.

Answer 1

Mental Disorder

Question 2

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

Answer 2

22 Major Categories of Psychiatric Illness

Question 3

Schizophrenia Spectrum and other Psychotic disorders have defined abnormalities in:

Answer 3

1. Delusions
   
   2. Hallucinations
   3. Disorganized thinking/speech
   4. Grossly disorganized or abnormal behavior
   5. Negative/Positive Symptoms

Question 4

Defined by “Manic episodes” and “Depressive episodes”.

Answer 4

Bipolar and Related Disorders

Question 5

Defined by presence of sad, or empty, or irritable mood.
Accompanied by somatic and cognitive changes.
Significantly affects the individual’s capacity to function.

Answer 5

Depressive disorders

Question 6

the emotional response to real or perceived imminent threat

Answer 6

Fear

Question 7

Anticipation of future threat

Answer 7

Anxiety

Question 8

recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted

Answer 8

Obsessions

Question 9

repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession

Answer 9

Compulsions

Question 10

Defined by requisite exposure to trauma or stressful event.

Symptoms may be quite variable – anxiety, anhedonia, dysphoria, externalized anger, aggressiveness, dissociativeness.

Answer 10

Trauma - and Stressor-Related Disorders

Question 11

Defined by the prominence of somatic symptoms associated with significant distress and impairment (abnormal thoughts, feelings, and behaviors in response to the symptoms)

Answer 11

Somatic Symptom and Related Disorders

Question 12

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.

Answer 12

Feeding/Eating Disorders

Question 13

10 Classes of drugs in substance-related disorders

Answer 13

1. alcohol
   
   2. caffeine
   3. cannabis
   4. hallucinogens
   5. inhalants
   6. opioids
   7. sedatives, hypnotics, & anxiolytics
   8. stimulants
   9. tobacco
   10. Other (or unknown)

Question 14

-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

Answer 14

Personality Disorder

Question 15

loss of reality testing with delusions & hallucinations

Answer 15

Psychotic

Question 16

No loss of reality testing: based on mainly intrapsychic conflicts or life events that cause anxiety; symptoms include obsession, phobia, and compulsion.

Answer 16

Neurotic

Question 17

No known structural damage or clear-cut biological cause to account for the impairment

Answer 17

Functional

Question 18

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)

Answer 18

Organic

Question 19

No known cause, AKA idiopathic

Answer 19

Primary

Question 20

known to be a symptomatic manifestation of a systemic, medical, or cerebral disorder (like delirium from a fever)

Answer 20

Secondary

Question 21

Oblique, digressive, or even irrelevant manner of speech in which the central idea is never communicated

Answer 21

Tangentially

Question 22

i.e. - The patient is asked to explain how she was injured, but looses her train of thought and goes on to other subjects.

Answer 22

Tangentially example

Question 23

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

Answer 23

Circumstantiality

Question 24

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

Answer 24

Circumstantiality example

Question 25

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

Answer 25

Thought Blocking

Question 26

i.e. - In the middle of talking about his childhood, the patient abruptly pauses, after which he can’t remember what he was saying

Answer 26

Thought Blocking Example

Question 27

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

Answer 27

Loosening of the associations

Question 28

i.e. - “He went to the ballpark and brought Frank’s beer belly home in a bag of grass seed.”

Answer 28

Loosening of the associations example

Question 29

Rapid succession of fragmentary thoughts or speech in which content changes abruptly and speech may be incoherent. Seen in mania

Answer 29

Flight of Ideas

Question 30

i.e. - A man starts talking about his business, but quickly shifts to discussing the economy, the government, and other countries

Answer 30

Flight of Ideas example

Question 31

Incoherent, essentially incomprehensible, mixture of words and phrases commonly see in far-advanced cases of schizophrenia

Answer 31

Word Salad

Question 32

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!”

Answer 32

Word Salad example

Question 33

False sensory perception occurring in the absence of any relevant external stimulation of the sensory modality involved

Answer 33

Hallucinations

Question 34

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

Answer 34

Hallucinations Example

Question 35

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

Answer 35

Delusions

Question 36

i.e. – “I believe that someone is following me and taking my picture.”

Answer 36

Delusions Example

Question 37

State of awareness of oneself and one’s surroundings in terms of Person, Place, Time & Situation (Ox4)

Answer 37

Orientation

Question 38

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?

Answer 38

Orientation Example

Question 39

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

Answer 39

Insight

Question 40

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

Answer 40

Insight Example

Question 41

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

Answer 41

Judgment

Question 42

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.”

Answer 42

Judgment Example

Question 43

Two Sections of the psychiatric exam

Answer 43

1. Complete medical history; pertinent PE | 2. Psychiatric history

Question 44

Components of a Psychiatric History

Answer 44

``` ID, CC/HPI Past medical/surgical hx Past psych hx Medications Substance use Family hx Social hx Personal hx ```

Question 45

8 Parts of the Mental Status Exam

Answer 45

- Appearance and behavior - Speech - Mood (anxiety/risk -assessment) - Thoughts (both content and process) - Perception - Cognition - Insight - Judgment

Question 46

MSE: Appearance & Behavior

Answer 46

- Hygiene/grooming - Appropriate clothing - Unusual mannerisms

Question 47

MSE: Speech

Answer 47

``` Not language abilities Dysphasia Volume Amount Speed ```

Question 48

- Overall emotional state during interview - Include subjective expressions by patient - Sad, depressed down, happy, euphoric, anxious, tense, nervous, worried

Answer 48

Mood

Question 49

- Variable emotions during interview - Objective elements - Intensity, appropriate, lability

Answer 49

Affect

Question 50

MSE: Thought Content

Answer 50

Delusions: firmly held false beliefs that are not culturally bound Suicidal ideations Obsessions Poverty of content

Question 51

MSE: Thought Process

Answer 51

-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

Question 52

MSE: Perception

Answer 52

-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

Question 53

MSE: Cognition

Answer 53

-Orientation: time, place, person -Attention/concentration: Serial 7s test -Memory ~Short term, recent, remote

Question 54

MSE: Judgment/ insight

Answer 54

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

Question 55

Ordering of Thyroid Function Tests

Answer 55

-Depression w hypothyroidism -Lithium therapy can cause hypothyroidism Sub-clinical hypothyroidism can cause depression Order thyrotropin-releasing hormone (TRH)

Question 56

Dexamethasone-Suppression Test

Answer 56

-Used to confirm major depressive disorder

Question 57

Catecholamines

Answer 57

``` Elevated (urine) w/carcinoid tumors +/- when on phenothiazines (urine) In CSF low in suicidal depressed patients ↓ 5-HIAA in all violent behavior ↑ in PTSD ```

Question 58

Lab Tests Related to Lithium

Answer 58

- plasma level - Thyroid - lytes - WBC - Renal Function

Question 59

Lab Tests related to Clozapine (Clozaril)

Answer 59

WBC 2° to risk of agranulocytosis

Question 60

Lab Tests related to tricyclic/tetracyclic drugs

Answer 60

- EGC-looking for conduction delays | - Blood levels for therapeutic range