Psych 1 Flashcards
Difference between mood and affect
Mood = Internal subjective feeling (i.e. how patient feels, typically in quotes)
Affect = Interviewer’s experience of a patient
Label:
Baseline is slightly shifted downwards and range of variation is less than full range
Restricted range
Label: Baseline shifted down significantly with almost no variation in affect of expression
Flat
Label:
- When affect of the eyes does not match affect of the mouth
- Can also be defined as the range between restricted and flat
Blunted
Label:
When patient’s subjective mood does not match the interviewer’s observed affect of the patient
Mood incongruent
Label:
Baseline shifted upwards but range of variation is less than full range
Bright
Label:
Baseline shifted upwards significantly with almost no variation in range
Euphoric
Label:
- Baseline shifted slightly upwards with normal amount of variation
- Between euphoric and bright
Expansive/Elevated
Label:
When a patient is just all over the place with really large variation (crying one second and super happy the next)
Labile
Words used to describe normal thought process
intact, logical, linear,
Word used to describe thought process: patient has lots of side thoughts, but eventually make their way back to the original though
Circumstantial
Word used to describe thought process: mind bounces around from idea to idea; the ideas are related to each other but the patient never gets back to the original thought; continuous side-tracking
Tangential
Word used to describe thought process: mind going around in a loop, coming back to the same thing over and over
Rumination
Word used to describe thought process: code for psychosis; the thoughts are connected to the thought before but it is hard to see the association and to follow the thought process
Loose
Describe name/time frame of PTSD disorder that refers to PTSD before time frame that allows it to be classified as PTSD
Acute stress disorder = lasts > 3 days and < 1 month
PTSD = lasts > 1 month
Diagnostic requirements of schizophrenia
Diagnosis of schizophrenia – requires at least 2 of the following, with at least one from 1-3:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms (affective flattening, avolition, anhedonia, asociality, alogia)
Names of the 3 different disorders on the spectrum of schizophrenia based on time period
- Brief psychotic disorder > 1 day and < 1 month
- Schizophreniform disorder > 1 month and < 6 months
- Schizophrenia > 6 months
What is schizoaffective disorder
- Mood episodes and active symptoms of schizophrenia occurring at the same time + at least 2 week lifetime history of delusions or hallucinations in the absence of prominent mood symptoms
- Aka normal schizo sometimes and schizo + mood at other times
Describe schizoid vs. schizotypal personality disorder
- Schizoid distant, detached, unemotional, and prefer to be alone
- Schizotypal magical thinking, eccentric, odd beliefs, interpersonal awkwardness
Components of mania
DIG FAST: ♣ D – Distractibility ♣ I – Insomnia / impulsive behavior ♣ G – Grandiosity ♣ F – Flight of ideas (e.g. racing thoughts) ♣ A – Activity / Agitation ♣ S – Speech pressured ♣ T – Thoughtlessness
Differentiate between Bipolar I and Bipolar II
- Bipolar I = 1 manic episode +/- a hypomanic or depressive episode
- Bipolar II = Hypomanic episode + major depressive episode
Diagnosis of Major Depressive Disorder
- Must be present for at least 2 weeks
- Must include at least 5/9 of SIG E CAPS symptoms (MUST include either depressed mood or anhedonia)
• Depressed mood
• S – Sleep disturbance (hyper/insomnia)
• I – Loss of Interest (anhedonia)
• G – Guilt or feelings of worthlessness
• E – Energy loss / fatigue
• C – Concentration problems
• A – Appetite / weight change
• P – Psychomotor retardation or agitation
• S – Suicidal ideations
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Average IQ score
85-115
Components of the mental status exam
General Behavior Motor - Mood Affect - Thought process Thought content Associations - Speech Language - Cognition Fund of knowledge Memory Orientation Concentration - Insight Judgment
Describe Behavior vs. Motor in the MSE
Behavior:
- Level of cooperation (e.g. cooperative, superficially cooperative)
Motor:
- Movements (increased/decreased)
- Agitation (e.g. pacing, tapping, fidgeting) – referring to movement; does not refer to affect
Describe Affect in the MSE
Interviewer’s experience of a patient
Full range, restricted, blunted, flat, incongruent, bright, elevated, euphoric
Describe thought process vs. thought content in the MSE
Thought Process:
- Rate, organization, goal orientation
Thought Content:
- Obsessions, delusions (e.g. paranoia), hallucinations, suicidal/homicidal ideation
- E.g. Delusions of grandeur, delusions of reference, paranoia, delusional parasitosis,
Describe associations in the MSE
ow thoughts are linked together (e.g. intact, logical, loose, circumstantial, tangential)
Describe Speech vs. Language in the MSE
Speech:
- Rate, rhythm, volume, tone, articulation, spontaneity, interruptible vs. pressured
- Decreased spontaneity = one word answers
- Pressured = difficult/impossible to interrupt; nothing to do with the rate of speech
- Think: formation of sounds; the mechanical part
Language
- Symbolic understanding and use of words/vocabulary
- Normal = grossly intact, expected vocabulary for age (for kids)
- Stilted/Pedantic language = using vocabulary inappropriate to the conversation
Describe Insight vs. Judgement in the MSE
Insight
- Understanding of current state (e.g. intact, good, fair, poor, absent)
- Ability to understand their mental illness
Judgment
- Ability to make decisions (good, fair, poor, impaired, very impaired)
- Can have great insight but impaired judgment (e.g. heroin users)
Describe Cognition in the MSE
♣ Ability to understand things
♣ Normal = intact
♣ Serial 7s = test cognition and attention
Describe Fund of Knowledge in the MSE
♣ Expected knowledge compared to peer group (e.g. average for age)
♣ Normal = aware of current events; intact
♣ E.g. person could be oriented (knows month) but have poor fund of knowledge (not know the president)
Describe Orientation in the MSE
Person, place, time, and situation (oriented x4)
What is the most common form of psychopathology
Anxiety disorders
Pharmacotherapy used in anxiety disorders
SSRI/SNRI = first line
- Benzodiazepine
- Non-addicting anxiolytics (diphenhydramine, hydroxyzine)
- Buspirone (5HT partial agonist)
- Beta blockers (control autonomic symptoms: palpitations, tachycardia, sweating, with panic attacks or performance anxiety)
- TCA and MAOIs if first line SSRI not effective
Symptoms of panic attack
Dizziness, disconnectedness, depersonalization, palpitations, paresthesias, abd distress, numbness, nausea, intense fear of dying, chills, chest pain, sweating, shaking, SOB
DSM-5 criteria of panic disorder
- Recurrent, UNEXPECTED panic attack without an identifiable trigger
- One or more panic attacks followed by > 1 month of continuous worry or avoidance behaviors
- Not caused by substance, other mental disorder, or medical condition
Treatment of Panic disorder
Pharmacotherapy and CBT
- SSRI = first line
- TCA if SSRI not effective
- Benzos PRN
DSM criteria of agoraphobia
AKA Mom from Shameless
- Intense fear/anxiety about >2 situations due to concern of difficulty escaping or obtaining help in case of panic or other humiliating symptoms
- Fear/anxiety is out of proportion to the potential danger posed
- Symptoms cause significant social or occupational dysfunction
- Symptoms last > 6 months
Treatment of agoraphobia
CBT and SSRI (for panic symptoms)
