Lecture 1: Intro to psychiatry Flashcards
Mental Disorder (4 pts.)
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
Modern Era (3 points)
included in scientific advances of 19th and 20th centuries
advances in psychology and development
medicalization of psychiatry
Biopsyschosocial model (3 disciplines)
mental disorders involve a web of causation
- Biological factors- anatomy, genetics, cell bio, neurochemistry
- pshycological factors- development, coping skills, belief systems
- social factors- cultural, political, financial, economic
Psychiatric interview (3 pts)
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”
Stages of psychiatric interview (4)
- inception
- reconnaissance
- detailed inquiry
- conclusion
see slides 8-9
elements of hx (9)
chief complaint-what, when, why, why now?
- hx of present illness (HPI)
- psychiatric hx
- familiy medical and psychiatric hx
- social hx
- educational hx
- occupational hx
- military hx (if applicable)
- chemical dependence
- legal
chief complaint
chief complaint-what, when, why, why now?
hx of present illness (HPI)
duration, precipating factors, specific symptoms, intesity of symptoms, any associated phsycial changes or illnesss (ex. pancreatic cancer and hyperthyroidism causes depression)
psychiatric hx
prior episodes of similar symptoms, other types of psychiatris ilness, prior treatments and outcomes
family medical and psychiatric hx
familiy medical and psychiatric hx-mental disorders, chemical dependence, medical problems
Social hx
family composition, parent’s hx, family live, cultural milieu, signifcant or traumatic events during development
educational hx
academic achievement, attitudes toward school, likes/dislikes, socialization in school
Occupational hx
1st job, duration of employments, changes in career, significant episodes of disability or unemployment
military hx
affiliation, duration, deployments, experience during combat
Chemical dependence
use patterns, legal involvements, treatment episodes
legal hx
arrests or convictions, lawsuits, bankruptcy
Mental status examination
psychiatric equivalent of the physical examination
intended to describe patient’s mental state during the interview
elements of mental status exam (8)
- appearance and behavior
- relationships to the intreviewer
- mood and affect
- cognition and memory
- language
- disorder of thought
- phsyiologic function
- insight and judgement
Appearance and behavior
appearance points
behaviors (4)
describes physcial aspects of patient
should include pertient positives or negatives
detailed but not judgemental
stereotypical behaviors
- catanoia- minmal or no movement
- akathesia-difficulty staying still
- waxy flexibility-action figure posin
- mannerisms- picking slapping, tapping hands
Relation to interviewer
patients attidue, eye contact/body posture/facial expressions
note changes during interview and possible motivations for change
Catanonia
minimal or no movement
akaethesia
difficulty staying still
waxy flexibility
action figure positioning
mannerisms
picking, tapping hands, slapping
mood and affect
mood-def.
affect-def.
demeanor- def.
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
Mood (6)
sustained emotional state that is frequenly, but not always, associated with certain affect
depressed, anxious, irritable, euphoric (extreme elation), labile (rapid mood changes), apathetic
affect (7)
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
- euthymic- normal mood (not depressed not euphoric)
- dysphoric- sad, emotionally numb
- histrionic- rapidly changing, superficial
- labile- suddenly changing without obvious provocation
- flat- little expression of emotoin, monotonous
- angry- signs of hostility
- incongruent- not consisten with statements or expressed mood
Cognition (4)
describes quality of mental functions
alertness, orientation, memory, attention, concentration
Alertness (4)
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
Derlium
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*
Orientation (4)
person-rarely impaired except in dissociative states
time-day, date, month, hear, hour
place-building, city, state
situation-clinic, hospital, home
Memory levels (3)
- immediate- initial registration by the brain
- short term-maintained in hippocampus for several minutes
- long term-memory traces in temporal and parietal lobes
memory impairment (2)
- retrograde amnesia- loss of past memories after severe injury, metabolic illness, intoxication, psychosis, severe anxiety states, dissociative states
- anterograde- loss of ability to form new memories following head injury or ilness
memory disorders (3)
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
Memory screening
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.
concentration
ability to focus on a task
tests include serial 7 subtrations, spelling, simple words “world” backwards, note distractibility during interview
Abstraction
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?
Language (3)
note language functions throughout interview
flow of speech-fluent, sparse, stilted, over inclusive
initiation of speech-spontaneous, latency
comprehension-patient’s understanding
Speech disorders (5)
- apasia
- muteness
- echolalia
- clang speech
- word salad
~can be caused by damage to brocha’s or werkincke’s areas
aphasia
difficulty repeating words or phrases
muteness
lack of speech
parolgia
approximately correct answers
echolalia
answers echo questions
clang speech
words chosen based on sound rather than meaning
word salad
incoherent speech
thought processes
inferred by patient’s speech and actions
assessed throughout interview through observation and inquiry
Thought Tempo Abnormalities
- racing thoughts-rapid thoughts that patient cannot slow voluntarily. frequently accompanied by pressured speech
- retardation-slow, laborious thoughts with speech latency and sometimes loss of thread
Thought Processes (4)
- goal-directed: patient is able to express coherent thoughts
- circumstantial: expresses excessive detail and “side trips” but able to reach goal
- flight of ideas: thoughts skip rapidly between topics with minimal connection to previous thought
- incoherent: thoughts essentially impossible to follow
Thought Content (5)
- logical-no abnormal thoughts noted
- paranoid-illogical fears, suspicion
- ideas of reference- belief that benign stimuli refer to patient specifically
ex. ) TV or video game giving personal messages to patient* - thought insertion-belief that others implant thoughts in patient
- thought broadcasting-belief that others can hear the patient’s thought
Abnormal perceptions (2)
- illusions- falsely interpreted sensory stimulation
2. hallucinations- false perception in the absence of sensory stimulation
Illusions
shadow passing by, someone in the room, heard someone’s voice, heard someone’s voice, common in depression/anxiety/extreme stress/delirium
Hallucinations (5)
- auditory-hearing voices, music, etc.
- visual- simple or complex forms
- tactile- formication, touching (ex.bugs crawling on them)
- olfactory and gustatory- smells and tastes
- somatic- physical symptoms appear to patient as stimulated by persectuion/technology
physiologic
sleep functions
appetite and weight change
sexual changes
musculoskeletal changes-agitation, retardation, ambulation
Insight and judgment
- insight- understanding the presence of an ilness and the risks and benefits of treatment
- judgement- subjective evaluation of the quality and appropriateness of a patient’s decision making capacity
interview process (5)
- initiation-greet patient, establish purpose
- begin with open-ended questions
- allow free-form answer then begin detailed inquiry
- focus on clinical and diagnostic symptoms
- use judgement on when to re-direct interview
