Mental Health Flashcards
The ability to focus or concentrate over time on one task or activity—an inattentive or distractible person with impaired consciousness has difficulty giving a history or responding to questions
Attention
The process of registering or recording information, tested by asking for immediate repetition of material, followed by storage or retention of information
Memory
Awareness of personal identity, place, and time, requires both memory and attention
Orientation
Sensory awareness of objects in the environment and their interrelationships (external stimuli), also refers to internal stimuli such as dreams or hallucinations
Perception
The logic, coherence, and relevance of the patient’s thought as it leads to selected goals, or how people think
Thought process
What the patient thinks about, including level of insight and judgment
Thought content
Awareness that symptoms or disturbed behaviors are normal or abnormal
Insight
Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms
Judgment
An observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor
Affect
A more sustained emotion that may color a person’s view of the world
Mood
A complex symbolic system for expressing, receiving, and comprehending words, as with consciousness, attention ad memory, language is essential for assessing other mental functions
Language
Assessed by vocabulary, amount of information, abstract thinking, calculations, and construction of objects that have two or three dimensions
Higher cognitive functions
when obtain HPI it is important to obtain pre-morbid personality
- Social relationships
- Mood
- Attitudes toward work or responsibilities
- Typical response to criticism or praise
- Leisure activities and hobbies
Mental status examination consists of six components:
- appearance and behavior
- speech and language
- mood
- thoughts and perceptions
- insight and judgment
- cognitive function
speech & language deficit evaluation technique
patients who struggle with naming emotions
alexithymia ( helpful to list some emotions for them to choose from)
lack of goal directedness, incorporating tedious and unnecessary details, with
difficulty in arriving at an end point.
Thought process-
Circumstantiality
digresses from the subject, introducing thoughts that seem unrelated, oblique, and
irrelevant.
Thought process-
Tangentiality
sudden cessation in the middle of a sentence at which point a patient cannot
recover what has been said
Thought process-
Thought blocking
jumping from one topic to another with no apparent connection between the
topics
Thought process-
Loose associations
Speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection
Thought process-
Circumstantiality
Sudden interruption of speech in midsentence or before the idea is completed, attributed to “losing the thought”; can occur in normal people
Thought process-
Blocking
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next.
Thought process-
Flight of ideas
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory
Thought process-
Confabulation
Speech that is incomprehensible and illogic, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use.
Thought process-
Incoherence
Tangential” speech with shifting topics that are loosely connected or unrelated. Patient is unaware of lack of association
Thought process-
Derailment
Invented or distorted words, or words with new and highly idiosyncratic meanings
Thought process-
Neologisms
Persistent repetition of words or ideas
Thought process-
Perseveration
Repetition of the words and phrases of others
Thought process-
Echolalia
Speech with choice of words based on sound rather than meaning, as in rhyming and punning
Thought process- Clanging
Perceptual disturbances
repetitive, unwelcome, irrational thoughts that
impose themselves on the patient’s consciousness over which he or she has no apparent control. Accompanied by feelings of anxious dread and are ego alien, unacceptable, and undesirable. Often resisted by the patient.
Thought& perception- Obsessions
repetitive stereotyped behaviors that the
patient feels impelled to perform ritualistically, even though he or she recognizes the irrationality and absurdity of the behaviors. Although no pleasure is derived from performing the act, there is a temporary sense of relief of tension when it is completed. Usually associated with obsession.
Thought& perception- Compulsions
patient’s absorption with his or her own
thoughts to such a degree that the patient loses contact with external reality. Can range from mere absentmindedness to suicidal or homicidal ideation and the autistic thinking of the
Thought& perception- Preoccupations
morbid fears that are reflected by morbid anxiety.
Often not spontaneously conveyed in the interview
Thought& perception- Phobias
Cognitive function
Birthdays, anniversaries, SSN,
names of schools attended, jobs held, past historical events
Remote memory
Events of the day, weather,
today’s appointment time, laboratory tests taken during the day
Recent memory
New learning ability
Higher cognitive function
Depression
Suicide risk
Substance use disorder
Memory loss- alarm symptoms
Alarm symptoms can be classified into 2 types: • Symptoms reflecting the seriousness of the underlying cause of memory loss
• Abrupt onset, gait abnormalities, altered mental status, psychosis, disruptive behavior,
new seizures
• Memory loss in patients with chronic diseases signaling a serious complication of their
disease:
• HIV/AIDS, Autoimmune diseases, Cancer, Anemia, Thyroid disease
Memory loss- narrowing differential diagnosis
For all others, neurocognitive screening tests can be done to evaluate the
severity of the memory and functional impairments.
• Patients that screen positive for more serious impairment will require referral to a neurologist to further evaluate for the type of underlying disorder may be causing the memory loss.
Vascular dementia
Dementia temporally related to a stroke or due to chronic cerebral ischemia. Classically, the dementia progresses in a stepwise manner, but it may be steadily progressive. It may be difficult to distinguish from Alzheimer’s disease. In the early stages, subcortical signs (eg, depression, subtle gait disturbances) and language difficulties often outweigh memory impairment, in contrast to early Alzheimer’s disease, in which memory loss typically predominates.
Alzheimer’s disease
Dementia that has an insidious onset and progresses steadily in the absence of focal neurologic signs or other identifiable causes. Autopsy reveals characteristic cortical degeneration with amyloid plaques and neurofibrillary tangles.
Mild Cognitive Impairment
Depending on the definition used, between 5% and 16% per year will progress to dementia.
Diffuse Lewy body disease (DLBD)
The early coexistence of dementia and Parkinson’s disease. Unlike Parkinson’s disease, the dementia of DLBD either precedes or occurs within 12 months of the onset of extrapyramidal symptoms. The cognitive impairment often fluctuates, and psychiatric symptoms (commonly visual hallucinations) occur early in the course of the illness.
Frontotemporal dementia
A progressive dementia in which personality changes (eg, apathy, self-neglect, perseveration, hyperorality) and speech impairment typically exceed memory loss during the early stages.6
Anxiety- alarm symptoms
• Look for physical manifestations of serious illness to differentiate anxiety
driven symptoms from symptom driven anxiety.
• Hypoxia, hypoglycemia, heart rhythm
• Assess for substance use, intoxication and suicidal ideation.
Anxiety - Narrowing differential
(Sudden onset with no obvious trigger)
Panic disorder
Anxiety - Narrowing differential
(Social anxiety or phobia )
Social anxiety
Anxiety - Narrowing differential
(Confined spaces)
Agrophobia
Anxiety - Narrowing differential
(Trigger recalls a past trauma)
PTSD
Anxiety - Narrowing differential ( Intrusive thoughts with repetitive need to perform specific acts )
OCD
Anxiety - Narrowing differential (Multiple triggers that are persistent)
generalized anxiety disorder
Depressed mood - alarm symptoms
The major alarm symptom here is suicidality.
• Because patients rarely volunteer thoughts of suicide, it is important to ask directly about
suicidality.
• The topic may be introduced by asking, “Have you been feeling that life is not worth living or
that you would be better off dead?”
• Another approach is to ask, “Sometimes when a person feels down or depressed, they might
think about dying. Have you been having any thoughts like that?”
If a patient reports suicidal ideation, it is important to further assess if the patient has immediate plans and the overall risk level. Screening tools to assess immediate risk should be utilized.
• High risk patients need immediate intervention and hospitalization.
Depressed Mood - differential diagnosis (experiencing five or more
symptoms during the same 2-week period
and at least one of the symptoms should be
either depressed mood or loss of interest or
pleasure.)
Major depression
Depressed Mood - differential diagnosis (Seasonally occurring depressed mood)
Seasonally effective disorder
Depressed Mood - differential diagnosis (Occurs prior to menstruation)
Premenstrual
dysphoric disorder
Depressed Mood - differential diagnosis (Episodes of major depression alternating
with episodes of mania)
Bipolar disorder
Depressed Mood - differential diagnosis (Depressed mood with hallucinations or
delusions)
Psychosis
Depressed Mood - differential diagnosis
(Persistent depressive disorder for 2 years is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities)
Dysthymic disorder
