Module 10

Question 1

Components of a Mental Status Exam

Answer 1

exam used to observe and describe patient’s psychological functions by using different domains

appearance
attitude/rapport
behaviour (gait, abnormal movements, tremors, hyperactivity)
mood and affect (mood is pts own words, affect is the nonverbal behaviour)
speech
thought process (rate of flow, form, logical etc)
thought content (suicide, delusions, obsessions, phobias)
perceptions (sensory experience, hallucination)
cognition
insight
judgment

Question 2

What is a mini mental exam and when is it used in primary care?

Answer 2

screening device or cognitive impairment 
consists of orientation to time, place
attention/calculation
registration (repeating with prompts)
recall
language
repetition
complex commands

similar to a MOCA but less detailed

Question 3

Name a screening tool for someone who may have suffered a trauma.

Answer 3

Primary Care-PTSD Screen and Checklist

Question 4

Name a screening tool for OCD

Answer 4

Yale-Brown Obsessive-Compulsive Scale

Question 5

What is the GAD-7 screening tool for?

Answer 5

anxiety

Question 6

What is the primary care toolkit for?

Answer 6

Transcare

Question 7

WHat is the first line medication for treating anxiety?

Answer 7

Antidepressants- SSRIs, SNRIs are effective for GAD, panic disorder, PTSD, social anxiety and OCD

Question 8

When is buspirone used?

Answer 8

GAD

Question 9

WHen would you use atypical antipsychotics?

Answer 9

refractory anxiety symptoms.

Question 10

Name two non-pharm therapies for treating anxiety.

Answer 10

CBT and exercise

Question 11

What is the first line treatment for depression?

Answer 11

SSRI’s and SNRI’s

Question 12

SSRI’s and SNRI’s are equally effective as MOAI’s and TCA … why would we choose SSRI’s over the MOAI and TCA?

Answer 12

Because they offer a lower side effect profile, fewer drug interactions, and are less likely to be lethal in overdose

Question 13

What risk do TCA’s have?

Answer 13

arrythmia, are lethal in overdose, and are highly anticholoinergic

Question 14

What are some non-pharm approaches to managing depression?

Answer 14

Good nutrition has a role in mood improvement
Bright light therapy- for seasonal or sleep disorders
ECT
Exercise
New research for transcranial magnetic stimulation for resistant MDD to psychotropic medications

Question 15

In a mental health situation…When would you refer someone IMMEDIATELY to the ED?

Answer 15

patients who are at risk of harming themselves or others.

pts with unexplained fevers, delirium, overdose, severe sedative withdrawal, vital signs instability, severe headaches, chest pain, abd pain, head injury, active suicidality, GI bleeding

Question 16

In regard to mental health…When would you urgently refer someone (urgently meaning in 1 week)

Answer 16

when the patient is at risk for S.I. but is currently safe
OR
Other comorbidities are present, including substance use disorders, there is an indication for CBT

Question 17

In regard to mental health…When is f/u in 1 mo appropriate?

Answer 17

when recurrent symptoms are not responding to treatment provided in primary care setting complications with medication management require frequent f/u
Dementia is also present
Pts may benefit from psychotherapy, family education, or group support

Question 18

How is Elder Abuse addressed at the individual level?

Answer 18

In the home it is reported to state adult protective services, or police if immediate risk.

Elders can report it themselves or the state long term care ombudsman (Whatever the heck that means)… I think in Canada its just the Ministry of Justice. Im going off the section in the textbook.

Question 19

At the community level what should friends, family, or community organizations fo if the patient is not able to advocate for themselves?

Answer 19

Textbook- State adult protective services.

Canada- Seniors Abuse and Information Line (SAIL)

Question 20

What is vicarious trauma?

Answer 20

“It is believed that counselors working with trauma survivors experience vicarious trauma because of the work they do. Vicarious trauma is the emotional residue of exposure that counselors have from working with people as they are hearing their trauma stories and become witnesses to the pain, fear, and terror that trauma survivors have endured.”

Question 21

What are cognitive changes associated with aging?

Answer 21

normal loss in brain size
information processing slows, speed of processing is greatly affected; maintain the ability to be able to complete tasks but much slower
dementia, delirium at greater risk with increased age

Question 22

What is the PHQ9 used for?

Answer 22

screening for depressive disorder

Question 23

What are some common mental health conditions seen in primary care?

Answer 23

anxiety
depression
bipolar disorder
substance use disorder
PTSD

Question 24

Discuss how you manage a patient in primary care with anxiety

Answer 24

non pharm: psychotherapy including counselling, meditation, CBT
healthy lifestyle modifications- exercise, sleep, diet

pharm: antidepressants (first line), SSRIs, SNRIs
remember to discuss low mood/suicidality in first few weeks of treatment

Question 25

What are the typical clinical manifestations of a patient presenting with anxiety?

Answer 25

Restlessness/feeling on edge
Easy fatiguability
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance 
Subjective worry, fears, anxiety

Question 26

What is major depressive disorder and who is at risk?

Answer 26

most common of depressive disorders, longer-term persistent presentation of depressed mood or affect, prominent for most days

can affect any age given circumstances, women > men, genetic predisposition to depression

Question 27

What are the clinical manifestations of a person with depressive disorder?

Answer 27

vague somatic concerns, irritability, loss of interest in previously enjoyable events, social withdrawal, decreased appetite, insomnia, fatigue, perseverence on personal guilt, suicide

Question 28

What are some non-pharmaceutical options in managing someone who has depressive disorder?

Answer 28

psychotherapy
complementary agents 
nutrition
bright light therapy (in those with seasonal affective disorder) 
ECT

Question 29

What is the diagnostic criteria for bipolar disorder?

Answer 29

Bipolar I: Individual has at least 1 manic episode
Bipolar II: Individual has hypomania without frank mania and at least one major depressive episode

Episodic mood shifts between mania, major depression, hypomania, and mixed mood states

Question 30

What are the clinical manifestations of a patient with bipolar disorder?

Answer 30

varied clinical symptoms dependent on their current mood state

hypomania- elevated mood, increased energy
mania - psychotic thought and perception, delusions, hallucinations, racing thoughts, tangential speech

Question 31

Describe the management of someone with bipolar disorder

Answer 31

non pharm: psychotherapy, most likely need to include a pharmaceutical

pharm: Lithium as first choice
Watch for signs and symptoms of toxicity
Ataxia
Tremor
Sedation or agitation
Diarrhea
Vomiting

Question 32

What is schizophrenia and who is at risk?

Answer 32

chronic, disabling, brain disorder that interrupts a person’a capacity to accurately perceive reality
difficulty communicating and relating to others
onset of symptoms between 16-30 years of age, men experience earlier onset compared to women

most common is paranoid schizophrenia

Question 33

What are the clinical manifestations of a patient with schizophrenia?

Answer 33

prodromal period >50 weeks before psychotic presentation, can be vague like poor sleep, mood changes, reduced concentration or motivation

three categories of symptoms:
positive (auditory, visual hallucinations and delusions)
negative (alogia, blunted affect, asocial, anhedonia)
cognitive (lack of focus and sustaining attention, impaired verbal fluency)