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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
Q

Who typically does psychological evaluations?

A

Psychologists

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26
Q

Define psychological evaluations

A

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

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27
Q

What are the general categories of psychological tests that can be done?

A

Intelligence tests (IQ)
Personality/projective tests
Minnesota multiphasic personality inventory (MMPI)
Beck Depression Inventory
Thematic Apperception test (TAT)

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28
Q

What are the types of Intelligence Test (IQ)

A

Wechsler Adult Intelligence Scale (WAIS)
Weschler Intelligence Scale for Children (WISC)
Stanford-Binet

29
Q

What is the personality/projective test commonly used?

A

Rorschach (inkblot)

30
Q

Which test screens for depression?

A

Beck depression inventory

31
Q

What are the elements of the mental status exam?

A

General description
Mood and Affect
Speech
Perception
Thought
Sensorium and Cognition
Miscellaneous

32
Q

Describe the general description part of the MSE

A

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
Q

Describe the Mood and Affect section of the MSE

A

Mood is subjective - sad, depressed, happy, fine, etc.

Affect is objective - appropriate to mood, inappropriate, flat, blunted, labile, etc.

34
Q

Describe the speech section of the MSE

A

Volume (loud, soft, whispering, etc.)
Clarity (intoxicated, monotone, slurred, etc)
Pace (rapid/pressured - mania; slow - depressed)

35
Q

Describe the perception section of the MSE

A

Hallucinations - false perception NOT assoc. with real external stimuli

Illusions - misperception or misinterpretation of REAL external stimuli

36
Q

Describe auditory hallucinations?

A

Most common, usually a voice but can be any noise; may not admit to it but will show signs

37
Q

Describe visual hallucinations?

A

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
Q

Describe olfactory hallucinations?

A

Related to temporal lobe seizures and COVID

39
Q

Describe tactile hallucinations?

A

Feeling like things are on them (bugs for example)

Common withdrawal symptom

40
Q

Describe gustatory hallucinations?

A

Not as common, usually a medical condition

41
Q

How do you appropriately ask about hallucinations?

A

“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
Q

What should you do if you see patient showing signs of hallucinations but they deny it?

A

Document - “responding to internal stimuli”

43
Q

What are the two components of the Thought section of the MSE

A

Content: What the patient is talking/thinking about

Process: How ideas are produced or organized

44
Q

What are the elements of Thought Content assessed on MSE?

A

Delusions
Paranoia
Preoccupations
Obsessions
Compulsions
Phobias
Suicidal/homicidal ideations
Ideas of reference

45
Q

What is a delusion

A

The belief in something that is false;
ex) I am Jesus

46
Q

What is a preoccupation

A

Focusing on and idea and overdoing it;
ex) sexual or religious preoccupation

47
Q

What is an obsession

A

Recurrent or persistent thoughts, urges, or images that are intrusive/unwanted and cause marked anxiety or distress

48
Q

What are compulsions?

A

Repetitive behaviors or mental acts that the individual feels driven to perform in response to an obsession; if resisted, produces anxiety

49
Q

What should always be asked and documented?

A

Suicidal/homicidal ideations

50
Q

What are ideas of reference?

A

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
Q

What are the Thought Process components assessed on MSE?

A

Loosening of Associations
Flight of ideas
Racing thoughts
Tangentiality
Circumstantiality
Word salad
Neologisms
Clang Associations
Thought blocking

52
Q

What is loosening of associations/loose associations

A

Talking with no connection between the sentences

53
Q

What is flight of ideas

A

Saying many different things with some connections; can see how the patient is getting from one thing to another

54
Q

What are racing thoughts

A

subjective; often seen in mania/anxiety

55
Q

What is tangentiality

A

When you ask a question they go off on a tangent and DO NOT pull it back around to initial topic

56
Q

What is circumstantiality

A

Pull in a lot of unnecessary information but they DO end up pulling it back around in the end

57
Q

What is word salad

A

A mix of words that don’t make up a sentence or any sense

58
Q

What are neologisms

A

New words

59
Q

What are clang associations

A

Similar sounding words with no sentence (often rhyming)

60
Q

What is thought blocking

A

Often seen in depression; patient starts to talk then drops off and stops talking

*could be responding to internal stimuli

61
Q

What are the aspects of sensorium and cognition?

A

Consciousness
Orientation
Memory
Concentration
Reading and writing
Visuospatial ability
Abstract thought
Intellectual functioning

62
Q

Example of MSE consciousness

A

Alert, stuporous, lethargic, coma, etc.

63
Q

Orientation component of sensorium and cognition

A

Person, place, and time (A&O x 3)
Or X 4 if you include situation

64
Q

What are the aspects of memory you should ask

A

Immediate, recent, and remote

65
Q

How should concentration be assessed?

A

WORLD spelled backwards
Serial 7’s

66
Q

How is visuospatial ability assessed?

A

copy figures - pentagon, clock face

67
Q

How is abstract thought assessed?

A

proverbs, similarities; opposite of abstract is concrete

ex) what does “don’t cry over spilled milk” mean?

68
Q

How do you assess intellectual functioning

A

Counting change, distances, vocab, etc.

69
Q

What makes up the miscellaneous portion of the MSE?

A

Impulsivity
Judgement
Insight
Reliability

Fall 2024 (34 decks)

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