lect 3

Question 1

what is homicidal ideation?

Answer 1

complex relationship btw violence and mental illness

Question 2

the mentally ill are most often victims of violence

Question 3

patients who exhibit psychotic and paranoid sx at increase risk of ?

Answer 3

-commit violence

Question 4

homicidal risk factors

Answer 4

-males
-hx of criminal
-ACE
-physical or sexual abuse
-setting fires or abusing animals

Question 5

homocidal ideation specifics

mania–>
Schizo–>
conduct–>
antisocial personality disorders–>

Answer 5

mania–> hallucinations
Schizo–> agitation
conduct–>hostility
antisocial personality disorders–> suspiciousness

Question 6

if pt is threat to themselves or others, what is the next step?

Answer 6

INVOLUNTARY commit

Question 7

for homicidal ideation, what must the provider do?

Answer 7

-documentation is UR BFF

-documentation needs to prove the pt is not capable of MAKING decisions due to mental illness

-explain why they are AT RISK to others
-suicidal

Question 8

Pts with mental health issues frequently present w medical complaints and sx…

fyi

Question 9

Present illness:

does not always mean mental issue so OBTAIN HX

Question 10

precipitation of illness and relevant stressors:

if ONSET

Answer 10

• determine the physical and psychosocial stressor at the time

Question 11

types of questions for PREVIOUS ILLNESSES AND BEHAVIORAL PROBLEMS?

Answer 11

-similiar behavior in the past?
-what caused them to act like this?
-other emotional disorders or sx related to tension?

-any physical or neuro dx that contributes to present problem?

-personal habits that cause or complicate problem (substance abuse)

Question 12

PREVIOUS PSYCH TX and mental health intervention?s

Answer 12

-have your recieved inpt or out pt setting?

-received psychiatric care?

-medications for mental issues?

-counseling or psychotherapy?

Question 13

when interviewing for psychiatric/ mental health, what should obtain?

Answer 13

MEDICAL RECORDS

Question 14

predisposition and potentials?s

inventory required of pts physical , intellectual or emotional deficiencies

Answer 14

-what was the pt like before they became ill?

-strengths and weakness to pt breakdown?

• personal strengths, resources, apparent at this time?

-what does the pt has going for them now or hold them back?

-expect to function ;ike before?

Question 15

why is an inventory required of pts physical ?

Answer 15

crucial to the designed of an individualized plan of management

Question 15

HIPPA allows:

exception to

Answer 15

providers to share health information for tx purposes W/OUT pt authorization for pt health reasons

EXCEPT psychotherapy notes

Question 16

presentation ?s

Answer 16

why does the pt seek help now?

did pt come in their own or did someone else persuade them?

did others bring pt in for tx?
why?

Question 17

insight, judgement, motivation for tx?

Answer 17

does pt think their unwell?

referred appropriately?

do they recognize their own disturbance or have any idea of it ?

realistic? what help do they seek ?

Question 18

family hx questions is subtle bc pts refuse to disclose family problems?

so say, all families have emotional problems, tell me about

Question 19

family hx ?

Answer 19

• psychiatric illness for atleast 2 GENERATIONS

Question 20

social history?

Answer 20

expand on medical social history

-tell me about the relationship w children, spouse, parents?

Question 21

why is social history information important?

Answer 21

• informs provider of social, cultural, and family structural influences that CONTRIBUTED to pts personality/values.

Question 22

purpose of educational and occupational hx?

Answer 22

give developmental hx extending through the second decade of life and intellectual and social capacity.

interruptions of timelines?
-any signs of emerging psychopatho or setback crisis

Question 23

occupational hx informs provider of pt inability to work for periods

Answer 23

-episodes of depression, mania, psychosis, explosive behavior

Question 24

military service hx important:

Answer 24

• stress in training
  -rigid hierarchy
  -type of discharge: medical or dishonorable

Question 25

making a diff dx you need:

INFO
old records
current mental state

Question 26

Mental Status examination:

Answer 26

-presented to the ED, Crisis Unit, Psych unit

->40 yrs old
-hx of any disorder in the brain

-personal habits, memory deteriorated

-physical signs of brain dysfxn

-referral to establish mental compet or legal sanity

Question 27

mental status examination 8 sections are?

Answer 27

-appearance and behavior
-relationship to interviewr
- affect/mood
-cognition and memory
-lang
-disorders of thought
-physio fxn
-insight and judgement

Question 28

appearance and behavior?

?s and when is this done

Answer 28

assessment of appearance and behavior begins DURING the interview before MSE

-describe what you see

-physique? habits? weight gain/loss ? any disfiguration/marks?

DESCRIBE PTS FACE/HAIR

Question 29

appearance and behavior?

Answer 29

-how do they look, expression in eyes and mouth, in tune w surroundings, are they clean, dressed, ,appropriate or peculiar?

speech, tone, volume?

behavior:
tics, tremors, fidgeting

Question 30

pts who present with … are

organized, repetitive mov’t, speech:

rituals:

catatonia:

Answer 30

SCHIZO

rituals: OCD

CAT: sx lack movt and communication and include agitation, confusion and restlessness

Question 31

relationship to the interviewer?

ex. pt was inpatient and rude to examiner

Answer 31

• is inferred by the pts behavior and speech toward provider?

-cooperative or not?
-threatening, pleasant
-engaged or distant

Question 32

mood vs affect

Answer 32

M: inner state that persist for some time

A: feeling or emotion

Question 33

types of affect:

broad:
restricted/limited:
blunted:
flat:
labile:

outward signs of emotion: body lang, facial express, tone of voice

Answer 33

broad: healthy
R: limited outward signs of emotions

Blunt: SIGNIFICANT limited outward signs of emotions’

flat: no signs of emotions

labile: unstable / out of proportion emotion

Question 34

whats coma?

Answer 34

state of unawareness pt cant be aroused

Question 35

cognition and memory:

Answer 35

level of consciousness and awareness

Question 36

stupor?

Answer 36

unawareness but TEMPORARILY AROUSED

Question 37

torpor?

Answer 37

awareness is NARROWED and restricted w psychomotor retardation

Question 38

delirium?

Answer 38

worse at night

emotional lability , visual illusions

Question 39

dissociative fugue state?

Answer 39

-found in a daze , umaware of name or addy