lect 3 Flashcards
what is homicidal ideation?
complex relationship btw violence and mental illness
the mentally ill are most often victims of violence
patients who exhibit psychotic and paranoid sx at increase risk of ?
-commit violence
homicidal risk factors
-males
-hx of criminal
-ACE
-physical or sexual abuse
-setting fires or abusing animals
homocidal ideation specifics
mania–>
Schizo–>
conduct–>
antisocial personality disorders–>
mania–> hallucinations
Schizo–> agitation
conduct–>hostility
antisocial personality disorders–> suspiciousness
if pt is threat to themselves or others, what is the next step?
INVOLUNTARY commit
for homicidal ideation, what must the provider do?
-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
Pts with mental health issues frequently present w medical complaints and sx…
fyi
Present illness:
does not always mean mental issue so OBTAIN HX
precipitation of illness and relevant stressors:
if ONSET
- determine the physical and psychosocial stressor at the time
types of questions for PREVIOUS ILLNESSES AND BEHAVIORAL PROBLEMS?
-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)
PREVIOUS PSYCH TX and mental health intervention?s
-have your recieved inpt or out pt setting?
-received psychiatric care?
-medications for mental issues?
-counseling or psychotherapy?
when interviewing for psychiatric/ mental health, what should obtain?
MEDICAL RECORDS
predisposition and potentials?s
inventory required of pts physical , intellectual or emotional deficiencies
-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?
why is an inventory required of pts physical ?
crucial to the designed of an individualized plan of management
HIPPA allows:
exception to
providers to share health information for tx purposes W/OUT pt authorization for pt health reasons
EXCEPT psychotherapy notes
presentation ?s
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?
insight, judgement, motivation for tx?
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 ?
family hx questions is subtle bc pts refuse to disclose family problems?
so say, all families have emotional problems, tell me about
family hx ?
- psychiatric illness for atleast 2 GENERATIONS
social history?
expand on medical social history
-tell me about the relationship w children, spouse, parents?
why is social history information important?
- informs provider of social, cultural, and family structural influences that CONTRIBUTED to pts personality/values.
purpose of educational and occupational hx?
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
occupational hx informs provider of pt inability to work for periods
-episodes of depression, mania, psychosis, explosive behavior
military service hx important:
- stress in training
-rigid hierarchy
-type of discharge: medical or dishonorable
making a diff dx you need:
INFO
old records
current mental state
Mental Status examination:
-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
mental status examination 8 sections are?
-appearance and behavior
-relationship to interviewr
- affect/mood
-cognition and memory
-lang
-disorders of thought
-physio fxn
-insight and judgement
appearance and behavior?
?s and when is this done
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
appearance and behavior?
-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
pts who present with … are
organized, repetitive mov’t, speech:
rituals:
catatonia:
SCHIZO
rituals: OCD
CAT: sx lack movt and communication and include agitation, confusion and restlessness
relationship to the interviewer?
ex. pt was inpatient and rude to examiner
- is inferred by the pts behavior and speech toward provider?
-cooperative or not?
-threatening, pleasant
-engaged or distant
mood vs affect
M: inner state that persist for some time
A: feeling or emotion
types of affect:
broad:
restricted/limited:
blunted:
flat:
labile:
outward signs of emotion: body lang, facial express, tone of voice
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
whats coma?
state of unawareness pt cant be aroused
cognition and memory:
level of consciousness and awareness
stupor?
unawareness but TEMPORARILY AROUSED
torpor?
awareness is NARROWED and restricted w psychomotor retardation
delirium?
worse at night
emotional lability , visual illusions
dissociative fugue state?
-found in a daze , umaware of name or addy
