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Fall 2024 > Intro to Behavior med > Flashcards

Intro to Behavior med Flashcards

1
Q

What are some of the potential etiologies of mental illness?

A

Inflammatory
Trauma
Gut microbiome/diet
biological
family history
psychosocial
neuro
Overall, it is multofactorial

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2
Q

What are the codes for commitment in Pennsylvania

A

201 - voluntary
302 - involuntary

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3
Q

What are the indications for hospitalizing someone due to mental illness?

A

Danger to themselves or others:
Suicidal/homicidal ideations
Psychosis with potential to harm themselves or others
impaired judgement/inability for self-care

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4
Q

What are some factors that influences psychological responses from a patient?

A

Nature/severity of illness
Meaning that the illness has to the patient
Personality style/coping mechanisms of the patient
Past experiences of the patient, friends, family, doctors, etc.
Response of the providers to the patient

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5
Q

How does psychosis effect patient assessment?

A

Difficulty thinking and reasoning; frightened and guarded

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6
Q

How does depression effect patient assessment?

A

Difficulty concentrating and speaking spontaneously; must ask about suicide

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7
Q

How does a patient’s agitation/violence effect their assessment?

A

impaired judgement, increased impulsivity, possibly paranoid; approach calmly, never turn your back on the patient, stay between the patient and the door;

May have another staff member come with you if you are worried

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8
Q

What should be done before diagnosing/treating a psychiatric patient?

A

Perform a routine medical evaluation to screen for concurrent disease, rule out differentials, and establish baseline values

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9
Q

How many psychiatric patients have co-existing medical illnesses?

A

43-60%

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10
Q

Why is it important to identify underlying medical illnesses?

A

Some medical illnesses cause psychiatric symptoms that need to be identified

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11
Q

What are the most important components of patient assessment?

A

History
Mental status exam
Physical exam
Diagnostic testing

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12
Q

How should you write the chief complaint?

A

In the patient’s own words

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13
Q

How could you write the quality of the illness in HPI

A

What aren’t you capable of doing?

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14
Q

What should be asked specifically in past medical history?

A

Any past psychiatric history
Medical illnesses
Drug and alcohol history, current or past

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15
Q

What 4 elements should be included in personal history?

A

Developmental
Childhood
Adolescence
Adulthood

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16
Q

What should be asked about developmental history?

A

Situation pt was born into
Mother’s use of drugs/alc during pregnancy
Developmental disabilities/milestones

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17
Q

What should be asked about childhood history?

A

Discipline in the home
School history
Social relationships

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18
Q

What should be asked about adolescent history

A

Puberty
Academics
Activities/interests
Romantic/sexual relationships

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19
Q

What should be asked about adult history?

A

Work history
Marriages/relationships
Military
Educational history
Religion
Social activities
Current living situation
Legal history
Sexual history

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20
Q

What other history must be asked?

A

Family history
Review of systems

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21
Q

What should be noted about physical exam for psychiatric patient assessment?

A

May have to defer it is patient is not in a position for an exam, just document why

Determine the extent of the exam by the patient’s presentation

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22
Q

What is the purpose of diagnostic tests for a psychiatric patient?

A

No test confirms mental illness - it just helps rule out underlying disorders such as:
-systemic infections
-CVD
-endocrine
-neuro
-etc.

Establishes normal - ex: baseline kidney and liver function

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23
Q

What are some standard lab tests to order on psychiatric patients?

A

CBC w/ diff
Blood glucose
Blood chemistries (electrolytes, renal, liver)
Thyroid function
Syphilis (RPR, then FTA if +)
Urinalysis
Tox screen
Drug levels
HIV testing

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24
Q

What are some non-invasive studies that could be performed on a psychiatric patients?

A

CXR
EKG
EEG
Brain imaging:
-CT scan
-MRI
-PET (cerebral blood flow)

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25
Who typically does psychological evaluations?
Psychologists
26
Define psychological evaluations
Specialized diagnostic procedures/test that can identify and quantify the degree of psychopathology; provides objective data on a patient's psychological functioning and is a useful tool for clarifying confusing clinical presentations
27
What are the general categories of psychological tests that can be done?
Intelligence tests (IQ) Personality/projective tests Minnesota multiphasic personality inventory (MMPI) Beck Depression Inventory Thematic Apperception test (TAT)
28
What are the types of Intelligence Test (IQ)
Wechsler Adult Intelligence Scale (WAIS) Weschler Intelligence Scale for Children (WISC) Stanford-Binet
29
What is the personality/projective test commonly used?
Rorschach (inkblot)
30
Which test screens for depression?
Beck depression inventory
31
What are the elements of the mental status exam?
General description Mood and Affect Speech Perception Thought Sensorium and Cognition Miscellaneous
32
Describe the general description part of the MSE
Appearance (age, race, gender, and other descriptors) Behavior and Psychomotor activity (how are they moving, mannerisms, eye contact, etc.) Attitude (cooperative, hostile, defensive, irritable, etc.)
33
Describe the Mood and Affect section of the MSE
Mood is subjective - sad, depressed, happy, fine, etc. Affect is objective - appropriate to mood, inappropriate, flat, blunted, labile, etc.
34
Describe the speech section of the MSE
Volume (loud, soft, whispering, etc.) Clarity (intoxicated, monotone, slurred, etc) Pace (rapid/pressured - mania; slow - depressed)
35
Describe the perception section of the MSE
Hallucinations - false perception NOT assoc. with real external stimuli Illusions - misperception or misinterpretation of REAL external stimuli
36
Describe auditory hallucinations?
Most common, usually a voice but can be any noise; may not admit to it but will show signs
37
Describe visual hallucinations?
2nd most common, assoc. with dementia and delirium; can be real things or things that don't exist May not admit to it but could show signs
38
Describe olfactory hallucinations?
Related to temporal lobe seizures and COVID
39
Describe tactile hallucinations?
Feeling like things are on them (bugs for example) Common withdrawal symptom
40
Describe gustatory hallucinations?
Not as common, usually a medical condition
41
How do you appropriately ask about hallucinations?
"sometimes others that feel the way you do might hear voices or sounds that other people don't see. Has this happened to you?"
42
What should you do if you see patient showing signs of hallucinations but they deny it?
Document - "responding to internal stimuli"
43
What are the two components of the Thought section of the MSE
Content: What the patient is talking/thinking about Process: How ideas are produced or organized
44
What are the elements of Thought Content assessed on MSE?
Delusions Paranoia Preoccupations Obsessions Compulsions Phobias Suicidal/homicidal ideations Ideas of reference
45
What is a delusion
The belief in something that is false; ex) I am Jesus
46
What is a preoccupation
Focusing on and idea and overdoing it; ex) sexual or religious preoccupation
47
What is an obsession
Recurrent or persistent thoughts, urges, or images that are intrusive/unwanted and cause marked anxiety or distress
48
What are compulsions?
Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession; if resisted, produces anxiety
49
What should always be asked and documented?
Suicidal/homicidal ideations
50
What are ideas of reference?
Patients feel that other people, TV, radio, etc. are making reference to them, communicating with them ex) "hurry on down to X store" and patient literally hurries down to the store
51
What are the Thought Process components assessed on MSE?
Loosening of Associations Flight of ideas Racing thoughts Tangentiality Circumstantiality Word salad Neologisms Clang Associations Thought blocking
52
What is loosening of associations/loose associations
Talking with no connection between the sentences
53
What is flight of ideas
Saying many different things with some connections; can see how the patient is getting from one thing to another
54
What are racing thoughts
subjective; often seen in mania/anxiety
55
What is tangentiality
When you ask a question they go off on a tangent and DO NOT pull it back around to initial topic
56
What is circumstantiality
Pull in a lot of unnecessary information but they DO end up pulling it back around in the end
57
What is word salad
A mix of words that don't make up a sentence or any sense
58
What are neologisms
New words
59
What are clang associations
Similar sounding words with no sentence (often rhyming)
60
What is thought blocking
Often seen in depression; patient starts to talk then drops off and stops talking *could be responding to internal stimuli
61
What are the aspects of sensorium and cognition?
Consciousness Orientation Memory Concentration Reading and writing Visuospatial ability Abstract thought Intellectual functioning
62
Example of MSE consciousness
Alert, stuporous, lethargic, coma, etc.
63
Orientation component of sensorium and cognition
Person, place, and time (A&O x 3) Or X 4 if you include situation
64
What are the aspects of memory you should ask
Immediate, recent, and remote
65
How should concentration be assessed?
WORLD spelled backwards Serial 7's
66
How is visuospatial ability assessed?
copy figures - pentagon, clock face
67
How is abstract thought assessed?
proverbs, similarities; opposite of abstract is concrete ex) what does "don't cry over spilled milk" mean?
68
How do you assess intellectual functioning
Counting change, distances, vocab, etc.
69
What makes up the miscellaneous portion of the MSE?
Impulsivity Judgement Insight Reliability

Fall 2024 (34 decks)

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