introduction to MH assessment Flashcards
Many patients with depression and anxiety present with what?
Many patients with depression and anxiety present with physical symptoms
Presentation with physical symptoms means that psychological concerns are going to be what?
Presentation with physical symptoms means that psychological concerns are less likely to be recognises and appropriately addressed
Failure to detect disorders such as depression and anxiety leads to what?
Failure to detect disorders such as depression and anxiety leads to chronicity, with cascading losses and escalation of disability
What kind of factors are affecting the failure to diagnose depression and anxiety on the Patients side?
Fear of appearing weak or ungrateful; stigma and shame; belief that nothing can be done; the doctor is too busy or not interested; follow the lead of the doctor (i.e. Biomedical focus)
What kind of factors are affecting the failure to diagnose depression and anxiety on the Doctor side?
Failure to appreciate that psychological distress can be expressed in physical terms; Doctors traditionally view illness as physical or psychological, with the latter often only a “Diagnosis of exclusion); Belief that if the patient has concerns they will raise them; lack of time; “Not my Job” mentality’ “cant fix the problem anyway” mentality
attention to psychosocial concerns is integral to quality of care for who?
attention to psychosocial concerns is integral to quality of care for all patients not just the overtly distressed ones
It is important to realise that psychosocial and physical issues are NOT what?
psychosocial and physical issues are NOT mutually exclusive (the patient can present with both physical and mental disorders
What does attention to the psychosocial dimensions of illness improve?
Emotional adjustment; the capacity to cope with disease burden; patient satisfaction; burden on the health system
What are some basic communication skills that can improve patient doctor interactions?
Good eye contact; clarification of patients concerns; Responding to cues that re suggestive of emotional distress; asking questions about patients’ feelings; enquiring about the situation at home; making supportive comments; handling interruptions well
What are some basic things you as a doctor can do before the consultation to improve the communication?
Allow adequate time; ensure privacy; prevent interruptions; never assume that you and the patient share the same mind-set about the starting point or aims of the interview
When get the interview started what are some simple things you can do as a doctor to improve communication?
State the purpose of the interview; Establish good rapport (good eye contact; appropriate proximity and body language; active listening; empathic comments); Treat the patient with dignity and respect; treat psychosocial issues as mainstream
Adolescents have rapid development of what abilities
Abstract thought; capacity to appreciate things from anothers perspective; recognition of ambiguity; concept of time; increased ability to reason and make decisions;
an adolescents normal tendency will be to regress to?
The normal tendency of an adolescent is to regress to less mature processing in situation of stress, conflict and illness
You cannot assume that the ability to grasp one concept will mean what?
You cannot assume that the ability to grasp one concept will mean universal understanding of other concepts
In Adolescents what is usually in short supply
Self-esteem
while dealing with an adolescent it is easy to be self-reflective which can lead to being critical or judgmental what are some strategies to avoid this?
Resist comparing the behaviours of others with you own; remember that what you see includes a response to the problems; if you feel frustrated or angry that may in fact be a clue about how the patient feels; challenge your own desires/needs to fix everything
in a mental health assessment what is the question you are trying to answer
“Why is this person with these problems presenting at this time”
What are some general strategies that you can use to preserve the patients self esteem during the interview?
Don?t focus exclusively on the difficult things allow the patient to talk about what is going well in their life; allow ways out (“this might not apply to you but I think”); Give some context that will make them see that they are not the only ones with these difficulties
in a mental health assessment what should you be looking for in past psychiatric history?
any diagnosis or admissions; treatment and responses to treatment; adherence to treatment; parental history
This some reasons why it is important to get some past medical and surgical history?
Medical problems may mimic psychiatric problems; medical treatments affect mood; medical conditions may limit psychiatric treatment; psychological status may be influenced by medical conditions;
What are some import family history points to consider in a mental health assessment?
Quality of family relationships (supportive and nurturing or over-involved and over protective); mental illness and psychiatric treatment of family; personality characteristics (Antisocial obsessional and anxious traits have links to genetics)
what are some things to consider while in the substance abuse part of the mental health assessment?
Build an index of suspicion; ask for details and examples; ask about impact;
what are some considerations of developmental history in a mental health assessment?
capacity to learn trust; Relationships and support; patterns of coping and response to stress and adversity; strengths and weaknesses; occupational and social functioning
once you have finished the interview what are some things you should consider other than what the patient said?
You should include your observation about appearance general behaviour speech and mood
