POM Flashcards
general appearance
dress, groom, posture, facial expression, mannerisms, pacing, posturing, psychomotor increase/decrease
manner
cooperative, polite, hostile, calm, eye contact
mood
what the patient reports
affect
what the clinician sees (dysphoria, euphoria, euthymia, range)
*range= full, contracted, blunt flat
perceptions
hallucinations (nothing is there), illusions (embellishing the truth)
thought process
organized, goal directed, circumstantial, tangential, loos associations
thought content
obsessions (recurrent thoughts), delusions (fixed false comment), suicidal/homicidal ideation
speech
rate (slowed-pressured), rhythm, prosody
cognitive
orientation, attention, concentration, short/long term memory, intelligence
too happy, neutral, too sad
too happy–> euphoric
neutral–> euthymic
too sad–> dysphoric
full
full range of emotions
constricted
will not completely reach euphoria and dysphoria
*could be due to head trauma
blunt
only can get a little happy and a little sad (some facial expression)
flat
no emotion change- completely euthymic (no facial expressions)
restricted
stuck on one side of the euthymic division (either towards dysphoric or towards euphoric)
linear/organized thoughts
directly gives answer to the question
circumstantial thoughts
will go on and on but eventually gives answer to the question
tangential thoughts
goes on and on but will not give the answer
loose associations
gives a completely different answer that does not make sense
psychomotor increase
agitation, pacing, intense, anxious (i.e. rocking in a chair)
psychomotor decrease
retardation, move slowing, think slowly, speak slowly, bradykinesia, schiezophrenia, depression
goal directed
sticking to the topic of conversation
ego defense mechanism
saying everything is okay and denying that there is an issue
attention vs. concentration
attention- short term (i.e. repeating numbers back)
concentration: more in depth and involves different part of brain(given numbers, say them backwards)
best predictor of intelligence
vocabulary
abstract vs. concrete vs. expansive
abstract: i.e. able to give many similarities between an orange and a basketball
concrete: i.e. only says orange and basketball are both orange and round but nothing more
expansive: very abstract
insight
understanding your medical or psychiatric condition
judgment
knowing what is going on and then making a decision about what will be the next step
what aphagia, what is the first thing to go?
ability to say “no ifs, ands or buts”
what is the peripheral retina sensitive to?
motion- so do not move fingers when testing peripheral vision
*visual acuity vs. visual field
acuity: nerve; central 10 degrees of vision; sensitive and specific
field: brain
*if moving eyes are disconjugate
nerves or muscles in the orbit
where do pursuits and saccades originate from?
brainstem
complete lag
will not move past midline
*UMN vs. LMN
UMN: central, upper face is sparred
LMN: peripheral, complete half of face is affected
tongue deviates to:
side of weak muscle
pronator drift
very sensitive and specific and will indicate cortico-spinal dysfunction
what does joint pain do?
it limits effort
when you check reflexes, you are:
stretching the tendons
Babinski sign
is abnormal in adults and means UMN issue
*consistent, VERY specific, less sensitive however
motivational interviewing definition
- client centered
- directive
- time limited form of individual psychotherapy
- facilitating change by helping people to explore and work through ambivalence
6 elements of success in brief interventions
FRAMES
- feedback
- responsibility
- advice
- menu of alternatives
- empathy
- self-efficacy
*5 basic principles of MI
DARES
- develop discrepancy
- avoid argumentation
- roll with resistance
- support self-efficacy
- express empathy
MI techniques
- open-ended questions
- reflections
- feedback
- explore ambivalence
- dealing with resistance
- summarizing
- negotiating a plan
empathy
the intention to understand the client from the client’s frame of reference
simple examples
it seems that everyone drinks at least as much as you do
you do not like the idea of being in treatment here
complex examples
drinking has some positive aspects for you. it is hard for you to imagine not drinking after work
you are frustrated about the tension between you and your wife
amplified examples
it seems impossible for you to say no to your co-workers
you believe that you do not have any problem at all, and your wife is wrong
double-sided examples
you would like to drink less alcohol, but you are worried that you cannot resist when they invite you to the pub
you don’t think that you have a problem now, and at the same time you are concerned that you might lose your wife if you do not seek help
repeat
you have been feeing sad lately
rephrase
so your sadness is getting worse and you do not know why
paraphrase
you would like to understand why your mood changes like that
reflect feeling
it is scary not to be able to understand your depressed feelings
theory of mind
mentalizing system: attribution of mental states (beliefs, intentions)
mirror neuron system
motion/action-understanding system: internal imitation
oxytocin
high levels increase altruism
impaired empathy reasons
autism, schizophrenia, ADHD, SUD’s, narcissistic and antisocial PD, acute stress/fear
two specific examples where motivational interviewing may be helpful in clinical practice
expressing empathy, smoking cessation
