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Bipolar Disorder - DSM IV TR Criteria
a period of abnormally & persistently elevated, expansive or irritable mood lasting ≥ 1 wk or any duration if hosp. is necessary.
≥3 present during mood disturbance to a significant degree. DIGFAST
Screening clock for dementia
3 points for # 12 in correct position 1 point for all 12 #s 1 point for 2 distinct hands ALWAYS ask the pt to place hands at eleven ten 1 point for correct designated time score of < 4 is + for impairment.
Hamilton Depression Rating Scale
>23 = very severe depression 19-22 = severe depression 14-18 = moderate depression 8-13 = mild depression 0-7 = no depression
Other common screening tools
BPRS = Brief Psychiatric Rating Scale - assess psychosis
PANSS = Positive & Negative Syndrome Scale - assesses schizophrenia
Mood disorder questionnaire screens for bipolar
PHQ-9 Patient Health Questionnaire; screens for depression in primary care & populations w/ co-morbid medical illness (Endorsed by APA)
GAF & Scoring
Global Assessment Functioning.
0-40 or 50 = require hospitalization
71-80 minimal psychopathology
depending ≥40 can be opt.
AIMS & Scoring
Abnormal Involuntary Movement Scale
1-4 oral facial movements
5-6 extremity movements
7 trunk movement
8-10 global judgement related to sx present
11-12 dental & denture status that may influence score.
Lithium labs
Thyroid indices Creatinine Clearance Sodium Lithium levels 0.6 - 1.2 Tx acute mania 0.8 - 1.0 Maintenance Tx
Neuro-imaging
PET scan - primarily experimental brain mapping
MRI - Gross structure of the brain, new onset psychosis or dementia, delineate gray & white matter. Structural, metabolic & functional imaging
EEG - measures electrical activity of the brain. New onset of seizures, esp. in children, evaluate brain tumors & abscesses, subdural hematomas, CVA’s, intracranial hemorrhage
CT - Brain Mapping, specific or minute brain abnormalities are enhanced, areas of ischemia, areas in states of dementia, tumors. Used for migraines, trauma, vertigo & dizziness.
Cranial Nerves CNI
Cranial Nerve I - S
olfactory - smell test
CNII
Cranial Nerve II - S
Optic - Visual Acuity, confrontation method to assess visual fields
CNIII
Cranial Nerve III - M
Oculomotor
eye movement, six eye positions individually
CNIV
Cranial Nerve IV - M
Trochlear
eye movement, same tests as oculomotor
CNV
Cranial Nerve V
Trigeminal - B
superficial & deep structures of head & face
corneal reflex, show teeth
CNVI
Cranial Nerve VI - M
Abducens
Specific eye movements, same as oculomotor
CNVII
Cranial Nerve VII
Facial - B
Facial movements - corneal reflex, raise eyebrows, puff cheeks