Osteopathic Approach to Mood Disorders Flashcards
What does PROS stand for?
Psychiatric Review of Symptoms (not review of systems)
SIGECAPS
Sleep: insomnia or hypersomnia
Interest: reduced w/ loss of pleasure
Guilt
Energy: low, fatigue
Concentration: distracted
Appetite: increased or decreased
Psychomotor: retardation or agitation
Suicide: thoughts, plans
PHQ-2
patient health questionnaire screening for depression; if score is 3 or more followup with PHQ-9
PHQ-9
patient health questionnaire screening for depression; if question 9 then MUST complete the Columbia Suicide Severity Risk Scale (C-SSRS)
When is it indicated to complete the Columbia Suicide Severity Risk Scale (C-SSRS)?
if PHQ-9 is 20 or higher or if patient endorses item 9
What is the role of the behavioral health consultant (BHC)?
assists the physician to identify, diagnose and treat psychiatric problems
Some examples of PROS?
Sleep
Appetite
Substance
Cognition
Anxiety
Depression
Suicide
Mania
Recommendation for a patient with diabetes and a mood disorder?
must be evaluated and treated simultaneously; diabetes can contribute to mood and the mood can contribute to motivation and compliance
PE exam of someone who presents with a mood disorder?
Vitals, CN2-12, DTRs, strength, heart and lungs and remember:
Mental Status Exam (MSE) - at least 3 components
Thyroid exam
How many components must be included in a mental status exam (MSE)?
3 components
What some components of the mental status exam (MSE)?
Appearance, Behavior, Speech, Mood, Affect, Thought process, Thought content, Cognition, Perception, Insight/Judgement
The difference between mood and affect?
Mood is what the patient tells you they feel in quotes “fantastic” “depressed” “sad”
Affect is what you observe euthymic (normal mood), dysphoric (depressed) or euphoric (elated)
Congruency
if the affect matched the mood reported
Incongruency
if the affect does NOT match the mood reported
How do you determine passive vs active suicidal or homicidal ideation?
if they have the intent, plan and means
When should you immediately referral a patient to the ED?
if they have active suicidal ideation
What is the importance behind motivational interviewing?
helps the patient to explore and resolve ambivalence
What are labs that are routinely ordered for patients presenting with a mood disorder?
TSH
CBC
CMP
UA
What is a risk associated with benzodiazepine use?
cognitive dysfunction and dementia with long term use
A patient presents with symptoms of insomnia, loss of pleasure, excessive remorse, fatigue, distractibility, poor appetite, sluggish movements, and wishing to be dead. Which of the following mnemonics assists with quick identification of this disorder?
a. CAGE
b. IPRFDAMD
c. CSSRS
d. SIGECAPS
e. PHQGAD
d. SIGECAPS
Which of the following best describes the indication to perform the Columbia Suicide Severity Risk Scale?
a. the PHQ-2 is 6 or higher and the GAD-2 is 6 or higher
b. item 9 is endorsed on the PROS and the MSE score is 20
c. the patient endorses item 9 on the PHQ-9
d. the PHQ-9 score is 18 and the patient reports hallucinations
e. the MDQ-9 score is 23 and the patient is agitated
c. the patient endorses item 9 on the PHQ-9
Which of the following best describes the PROS?
a. Psychiatric review of systems that assess for risk factors
b. Part of the physical examination assessing for psychiatric symptoms
c. Assesses for psychosis risk, obsessions, and suicide
d. Assesses for perception, reasoning, observation and speech
e. A survey of psychiatric symptoms past and present
e. A survey of psychiatric symptoms past and present
In the integrated behavioral medicine model, which of the following best describes the function of the physical examination?
a. Serves to develop conflicting differential diagnosis
b. Can cause diagnostic confusion about co-morbid disorders
c. Enhances evaluation and management of interacting medical conditions
d. Often adds unnecessary complexity to the patient encounter
e. Determines which co-morbid condition can be disregarded
c. Enhances evaluation and management of interacting medical conditions
Which of the following best describes the function of the mental status examination?
a. The interpretation of observed mental processes during a structured exam
b. A cognitive exam for the signs of a neurological disorder
c. Is a paper and pencil test to assess for signs and symptoms of dementia
d. Can rule out neuropsychiatric manifestations of an autoimmune disorder
e. Assesses for the presence of mind altering substances
a. The interpretation of observed mental processes during a structured exam
