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Psychosocial Medicine > Lecture 1: Intro to psychiatry > Flashcards

Lecture 1: Intro to psychiatry Flashcards

1
Q

Mental Disorder (4 pts.)

A

deviation from normal range of functioning

  • not disease-no pathopyhsiology that we know of
  • set sufferers apart from their culture
  • treatments based on cultural knowledge of the time
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2
Q

Modern Era (3 points)

A

included in scientific advances of 19th and 20th centuries

advances in psychology and development

medicalization of psychiatry

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3
Q

Biopsyschosocial model (3 disciplines)

A

mental disorders involve a web of causation

  1. Biological factors- anatomy, genetics, cell bio, neurochemistry
  2. pshycological factors- development, coping skills, belief systems
  3. social factors- cultural, political, financial, economic
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4
Q

Psychiatric interview (3 pts)

A

interaction with a patient to assess their mental state at a given time and place

includes conversation, inquiry, and observation

approaches “from the outside in”

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5
Q

Stages of psychiatric interview (4)

A
  1. inception
  2. reconnaissance
  3. detailed inquiry
  4. conclusion

see slides 8-9

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6
Q

elements of hx (9)

A

chief complaint-what, when, why, why now?

  1. hx of present illness (HPI)
  2. psychiatric hx
  3. familiy medical and psychiatric hx
  4. social hx
  5. educational hx
  6. occupational hx
  7. military hx (if applicable)
  8. chemical dependence
  9. legal
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7
Q

chief complaint

A

chief complaint-what, when, why, why now?

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8
Q

hx of present illness (HPI)

A

duration, precipating factors, specific symptoms, intesity of symptoms, any associated phsycial changes or illnesss (ex. pancreatic cancer and hyperthyroidism causes depression)

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9
Q

psychiatric hx

A

prior episodes of similar symptoms, other types of psychiatris ilness, prior treatments and outcomes

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10
Q

family medical and psychiatric hx

A

familiy medical and psychiatric hx-mental disorders, chemical dependence, medical problems

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11
Q

Social hx

A

family composition, parent’s hx, family live, cultural milieu, signifcant or traumatic events during development

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12
Q

educational hx

A

academic achievement, attitudes toward school, likes/dislikes, socialization in school

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13
Q

Occupational hx

A

1st job, duration of employments, changes in career, significant episodes of disability or unemployment

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14
Q

military hx

A

affiliation, duration, deployments, experience during combat

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15
Q

Chemical dependence

A

use patterns, legal involvements, treatment episodes

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16
Q

legal hx

A

arrests or convictions, lawsuits, bankruptcy

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17
Q

Mental status examination

A

psychiatric equivalent of the physical examination

intended to describe patient’s mental state during the interview

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18
Q

elements of mental status exam (8)

A
  1. appearance and behavior
  2. relationships to the intreviewer
  3. mood and affect
  4. cognition and memory
  5. language
  6. disorder of thought
  7. phsyiologic function
  8. insight and judgement
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19
Q

Appearance and behavior

appearance points
behaviors (4)

A

describes physcial aspects of patient

should include pertient positives or negatives

detailed but not judgemental

stereotypical behaviors

  1. catanoia- minmal or no movement
  2. akathesia-difficulty staying still
  3. waxy flexibility-action figure posin
  4. mannerisms- picking slapping, tapping hands
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20
Q

Relation to interviewer

A

patients attidue, eye contact/body posture/facial expressions

note changes during interview and possible motivations for change

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21
Q

Catanonia

A

minimal or no movement

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22
Q

akaethesia

A

difficulty staying still

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23
Q

waxy flexibility

A

action figure positioning

24
Q

mannerisms

A

picking, tapping hands, slapping

25
Q

mood and affect

mood-def.

affect-def.

demeanor- def.

A

mood-sustained emotional quality

affect-variable demonstration of patient’s internal state

demeanor- patient’s projection of a specific state, possibly not their true state

26
Q

Mood (6)

A

sustained emotional state that is frequenly, but not always, associated with certain affect

depressed, anxious, irritable, euphoric (extreme elation), labile (rapid mood changes), apathetic

27
Q

affect (7)

A

moment to moment expression of emotions

demonstrate patient’s feeling about themselves, others, and situations

mood states have typical affects but patients still maintain affective range

  1. euthymic- normal mood (not depressed not euphoric)
  2. dysphoric- sad, emotionally numb
  3. histrionic- rapidly changing, superficial
  4. labile- suddenly changing without obvious provocation
  5. flat- little expression of emotoin, monotonous
  6. angry- signs of hostility
  7. incongruent- not consisten with statements or expressed mood
28
Q

Cognition (4)

A

describes quality of mental functions

alertness, orientation, memory, attention, concentration

29
Q

Alertness (4)

A

fully alert- no impairment

coma- non responsive to stimuli

stupor- briefly rousable by stimuli

torpor- restricted responses to sitmuli

twilight- brief sense of confusion and disorientation

30
Q

Derlium

A

waxing and waning consciousness

lack of awareness of surroundings, agitation, hallucinations, restlessness, insomnia, combative, visual illusions, labile affect

frequent in ICU and post-op settings

caused by metabolic illness, infections, medication, reactions, strokes, many other medical conditions

caused by something else-always a result of something*

31
Q

Orientation (4)

A

person-rarely impaired except in dissociative states

time-day, date, month, hear, hour

place-building, city, state

situation-clinic, hospital, home

32
Q

Memory levels (3)

A
  1. immediate- initial registration by the brain
  2. short term-maintained in hippocampus for several minutes
  3. long term-memory traces in temporal and parietal lobes
33
Q

memory impairment (2)

A
  1. retrograde amnesia- loss of past memories after severe injury, metabolic illness, intoxication, psychosis, severe anxiety states, dissociative states
  2. anterograde- loss of ability to form new memories following head injury or ilness
34
Q

memory disorders (3)

A

falsification- making up new memories because your old ones suck

confabulation- false memories created to dill gaps caused by illness or demential

perservation- repeating the same information in response to different inquiries

35
Q

Memory screening

A

repeat three unrelated words to test immediate recall

ask patient to recall words a few minutes later to test short term memory

ask about remote events- names of schools, historical events, etc.

36
Q

concentration

A

ability to focus on a task

tests include serial 7 subtrations, spelling, simple words “world” backwards, note distractibility during interview

37
Q

Abstraction

A

ability to reason in abstract concepts rather than concrete concepts

proverbs test-ask what a proverb means to the patient, see if they answer literally

humor test-does the person get the joke?

38
Q

Language (3)

A

note language functions throughout interview

flow of speech-fluent, sparse, stilted, over inclusive

initiation of speech-spontaneous, latency

comprehension-patient’s understanding

39
Q

Speech disorders (5)

A
  1. apasia
  2. muteness
  3. echolalia
  4. clang speech
  5. word salad

~can be caused by damage to brocha’s or werkincke’s areas

40
Q

aphasia

A

difficulty repeating words or phrases

41
Q

muteness

A

lack of speech

42
Q

parolgia

A

approximately correct answers

43
Q

echolalia

A

answers echo questions

44
Q

clang speech

A

words chosen based on sound rather than meaning

45
Q

word salad

A

incoherent speech

46
Q

thought processes

A

inferred by patient’s speech and actions

assessed throughout interview through observation and inquiry

47
Q

Thought Tempo Abnormalities

A
  1. racing thoughts-rapid thoughts that patient cannot slow voluntarily. frequently accompanied by pressured speech
  2. retardation-slow, laborious thoughts with speech latency and sometimes loss of thread
48
Q

Thought Processes (4)

A
  1. goal-directed: patient is able to express coherent thoughts
  2. circumstantial: expresses excessive detail and “side trips” but able to reach goal
  3. flight of ideas: thoughts skip rapidly between topics with minimal connection to previous thought
  4. incoherent: thoughts essentially impossible to follow
49
Q

Thought Content (5)

A
  1. logical-no abnormal thoughts noted
  2. paranoid-illogical fears, suspicion
  3. ideas of reference- belief that benign stimuli refer to patient specifically
    ex. ) TV or video game giving personal messages to patient*
  4. thought insertion-belief that others implant thoughts in patient
  5. thought broadcasting-belief that others can hear the patient’s thought
50
Q

Abnormal perceptions (2)

A
  1. illusions- falsely interpreted sensory stimulation

2. hallucinations- false perception in the absence of sensory stimulation

51
Q

Illusions

A

shadow passing by, someone in the room, heard someone’s voice, heard someone’s voice, common in depression/anxiety/extreme stress/delirium

52
Q

Hallucinations (5)

A
  1. auditory-hearing voices, music, etc.
  2. visual- simple or complex forms
  3. tactile- formication, touching (ex.bugs crawling on them)
  4. olfactory and gustatory- smells and tastes
  5. somatic- physical symptoms appear to patient as stimulated by persectuion/technology
53
Q

physiologic

A

sleep functions

appetite and weight change

sexual changes

musculoskeletal changes-agitation, retardation, ambulation

54
Q

Insight and judgment

A
  1. insight- understanding the presence of an ilness and the risks and benefits of treatment
  2. judgement- subjective evaluation of the quality and appropriateness of a patient’s decision making capacity
55
Q

interview process (5)

A
  1. initiation-greet patient, establish purpose
  2. begin with open-ended questions
  3. allow free-form answer then begin detailed inquiry
  4. focus on clinical and diagnostic symptoms
  5. use judgement on when to re-direct interview

Psychosocial Medicine (19 decks)

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