Module 10 Flashcards
Components of a Mental Status Exam
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
What is a mini mental exam and when is it used in primary care?
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
Name a screening tool for someone who may have suffered a trauma.
Primary Care-PTSD Screen and Checklist
Name a screening tool for OCD
Yale-Brown Obsessive-Compulsive Scale
What is the GAD-7 screening tool for?
anxiety
What is the primary care toolkit for?
Transcare
WHat is the first line medication for treating anxiety?
Antidepressants- SSRIs, SNRIs are effective for GAD, panic disorder, PTSD, social anxiety and OCD
When is buspirone used?
GAD
WHen would you use atypical antipsychotics?
refractory anxiety symptoms.
Name two non-pharm therapies for treating anxiety.
CBT and exercise
What is the first line treatment for depression?
SSRI’s and SNRI’s
SSRI’s and SNRI’s are equally effective as MOAI’s and TCA … why would we choose SSRI’s over the MOAI and TCA?
Because they offer a lower side effect profile, fewer drug interactions, and are less likely to be lethal in overdose
What risk do TCA’s have?
arrythmia, are lethal in overdose, and are highly anticholoinergic
What are some non-pharm approaches to managing depression?
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
In a mental health situation…When would you refer someone IMMEDIATELY to the ED?
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
In regard to mental health…When would you urgently refer someone (urgently meaning in 1 week)
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
In regard to mental health…When is f/u in 1 mo appropriate?
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
How is Elder Abuse addressed at the individual level?
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.
At the community level what should friends, family, or community organizations fo if the patient is not able to advocate for themselves?
Textbook- State adult protective services.
Canada- Seniors Abuse and Information Line (SAIL)
What is vicarious trauma?
“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.”
What are cognitive changes associated with aging?
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
What is the PHQ9 used for?
screening for depressive disorder
What are some common mental health conditions seen in primary care?
anxiety depression bipolar disorder substance use disorder PTSD
Discuss how you manage a patient in primary care with anxiety
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
What are the typical clinical manifestations of a patient presenting with anxiety?
Restlessness/feeling on edge Easy fatiguability Difficulty concentrating Irritability Muscle tension Sleep disturbance Subjective worry, fears, anxiety
What is major depressive disorder and who is at risk?
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
What are the clinical manifestations of a person with depressive disorder?
vague somatic concerns, irritability, loss of interest in previously enjoyable events, social withdrawal, decreased appetite, insomnia, fatigue, perseverence on personal guilt, suicide
What are some non-pharmaceutical options in managing someone who has depressive disorder?
psychotherapy complementary agents nutrition bright light therapy (in those with seasonal affective disorder) ECT
What is the diagnostic criteria for bipolar disorder?
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
What are the clinical manifestations of a patient with bipolar disorder?
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
Describe the management of someone with bipolar disorder
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
What is schizophrenia and who is at risk?
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
What are the clinical manifestations of a patient with schizophrenia?
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)
