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Behavioral Medicine: Unit 1 > Psych Interview > Flashcards

Psych Interview Flashcards

1
Q

What is the purpose of the psych interview?

A
  1. Create a therapeutic alliance
2. Gather pertinent information
A. Emergency Department
-Brief, focused
B. Inpatient
C. Outpatient
  1. Impression/Dynamic
    A. Diagnosis: DSM V
  2. Plan appropriate treatment
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2
Q

What are the components of a psych interview?

A
  1. Identifying Information
  2. Chief Complaint (CC)
  3. History of Present Illness (HPI)
  4. Past Psychiatric History (PPH)
  5. Psychiatric Review of Systems
  6. Medical History
  7. Social History
  8. Family Psychiatric History
  9. Mental Status Examination (MSE)
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3
Q

What info is included in identifying information?

A
  1. Identifying Data
  2. Accurate Historian: not always the pt
  3. Use of Collateral Informant: parent, spouse, medical records
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4
Q

Chief complaint definition

A

Reason why pt is in office

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5
Q

What are the components of the psych HPI?

A
  1. Define the present episode
  2. Precipitants: what was the inciting factor
3. Determine acuity or chronicity
A. Frequency
B. Duration
C. Intensity
D. Past treatment
  1. Essential Themes
    A. Precipitating events in previous weeks
    B. What has caused your problem to be worse/ better
    C. Past treatment for similar/same issue
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6
Q

What are the components of past psychiatric history? (PPH)

A
  1. Obtain Syndromal History
  2. Obtain Treatment History
    Go CHaMP
    A. General questions
    B. Current psychiatric caregiver
    C. Hospitalizations
    D. Medications
    E. Psychotherapy
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7
Q

What information is included in syndromal history

A
  1. Age of onset – why is this helpful?
  2. Premorbid or baseline functioning so can compare to current state
  3. History and precipitants of subsequent episodes to present: not everyone has a prior episode
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8
Q

What is the typical age of onset for schizophrenia?

A

Males: 21
Females: 27

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9
Q

What is the typical age of onset for major depression?

A

25

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10
Q

What is the typical age of onset for bipolar disorder?

A

19

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11
Q

What is the typical age of onset for panic disorder?

A

24

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12
Q

What is the typical age of onset for OCD?

A

23

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13
Q

What is the typical age of onset for drug abuse/dependence?

A

18

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14
Q

What is the typical age of onset for alcohol abuse/dependence?

A

21

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15
Q

What are the components of the general questions in psych treatment history?

A

A. Past treatment
B. What has worked
C. What was happening in your life when you were feeling your best?

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16
Q

What are the components of the current caregiver questions in psych treatment history?

A
  1. Medication Management (MD, NP, PA, PCP)
  2. Psychotherapist
  3. Outpatient Case Manager (ACT Team)
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17
Q

What are the components of the hospitalizations component of the psych treatment history?

A
  1. Chronology
  2. How many in your life
  3. First hospitalization
  4. Hospitalizations in the past year
  5. Last hospitalization and where
  6. What life circumstances precipitated inpatient admits
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18
Q

What are the components of the medications part of the psych treatment history?

A
  1. Medications: name, route, dose, what they’ve tried in the past
  2. Compliance
  3. Herbals
  4. How long was the med trial?
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19
Q

What are the components of the psychotherapy part of the psych treatment history?

A
  1. Relationship with therapist, do they have to see changing therapists?
  2. Was therapy helpful?
  3. What sort of treatments (CBT, cognitive behavioral therapy, Dialectical Behavioral Therapy, etc)
  4. Individual or group therapy
  5. Termination
    A. What were the circumstances?
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20
Q

What questions are asked in the history of suicide part of the PPH?

A
  1. Number of Attempts
  2. When
  3. How
  4. Were you hospitalized?
  5. Residual medical issues
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21
Q

What is included in the psychiatric review of systems?

A
  1. Mood Disorder
  2. Psychotic Disorder
  3. Substance Abuse
  4. Anxiety Disorder
  5. Posttraumatic Stress Disorder
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22
Q

What are types of mood disorders?

A 
1. Depression
A. Major Depressive Disorder (MDD)
B. Dysthymia
2. Bipolar Disorder
A. Mania
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23
Q

What are the criteria for major depression disorder?

A
  1. Four of the eight symptoms present
    SIGECAPS
  2. Depressed mood or anhedonia
  3. For at least two (2) weeks
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24
Q

What does SIGECAPS for major depression stand for?

A
  1. Sleep = Insomnia or hypersomnia
  2. Interest Deficit = Anhedonia
  3. Guilt = Worthlessness, hopelessness, regret
  4. Energy deficit = Anergia
  5. Concentration deficit
  6. Appetite disorder = increased or decreased
  7. Psychomotor retardation or agitation
  8. Suicidality
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25
Q

What are the criteria for dysthymia?

A
  1. Two years of depression

2. Two of the six symptoms must be present: ACHEWS

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26
Q

What does the dysthymia pneumonic ACHEWS stand for?

A
  1. Appetite disorder
  2. Concentration deficit
  3. Hopelessness
  4. Energy Deficits
  5. Worthlessness
  6. Sleep disorder
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27
Q

What are the criteria for bipolar mania criteria?

A
  1. Elevated mood
    A. Three of the seven symptoms (DIGFAST)

OR

  1. If mood is primarily irritable
    A. Four of the seven symptoms for one week
28
Q

What does the DIGFAST pneumonic for bipolar disorder stand for?

A
  1. Distractibility
  2. Indiscretion = Excessive involvement in pleasure activities
  3. Grandiosity = “I am the Queen of England”
  4. Flight of ideas
  5. Activity increase
  6. Sleep deficit = Decreased need for sleep
  7. Talkativeness
29
Q

What are the components of schizophrenia?

A
  1. Delusions
  2. Hallucinations
  3. Speech disorganization
  4. Behavior disorganization
  5. Negative symptoms
30
Q

Define delusions

A
  1. Fixed, false beliefs
  2. Not widely held within the context of the individuals cultural or religious group
  3. Persist despite contradictory evidence
  4. Distorted or illogical misinterpretations of actual events or experiences
31
Q

What are delusions of control?

A

Thoughts/feelings controlled or manipulated by outside forces or agencies

32
Q

What are delusions of grandiosity?

A

Belief that one has extraordinary powers, gifts, or abilities
Bizarre
Exaggerated

33
Q

What are delusions of guilt?

A

Guilt that one has committed a terrible act or crime

34
Q

What are delusions of reference?

A

Casual events have special significance to person

Messages in newspapers, people talking about you

35
Q

What are delusions of persecutory?

A 
Belief that one is being conspired against
Threatened by others
FBI
Religious figures
Extraterrestrials
36
Q

What are somatic delusions?

A

Belief that one is carrying a severe disease
Disease is not supported by medical evidence
Often bizarre
Attributed to outside forces

37
Q

What are thought insertions, withdrawal, broadcasting delusions?

A

Implanted by an outside agency
Taken out of their mind
Read or heard via passive means

38
Q

What disorders may hallucinations occur with?

A 
Schizoprenia
Depression
Bipolar disorder
Substance abuse disorders
Dementia
39
Q

What is the most common type of hallucination? What other types may be present?

A
  1. May be auditory, visual, olfactory, gustatory, tactile
  2. Auditory most common
    A. Keep a running commentary
    B. Unfriendly, insulting, or accusatory
    C. Associated with delusional themes
40
Q

What is involved with speech disorganization asst. with schizophrenia?

A

A. Inability to process stimuli accurately
B. Inability to link thoughts coherently/logically
C. Non-linear
D. Illogical

41
Q

What are the types of disorganized speech in schizophrenia?

A 
A. Circumstantiality
B. Tangentiality 
C. Illogical
D. Clanging
E. Neologism
F. Thought blocking
42
Q

What is included in the behavior disorganization asst. with schizophrenia?

A
  1. Poor grooming
  2. Body odor
  3. Bizarre clothing combinations
  4. Wallet/purse filled with torn, bulging papers
43
Q

WHat are the negative symptoms of schizophrenia?

A

Anhedonia

Alogia

Attention deficit

Affective flattening

Avolition

Social withdrawal

44
Q

Define anhedonia

A

inability to experience pleasure

45
Q

Define Alogia

A

Decrease in the production and fluency of spontaneous speech; may include pauses in responses

46
Q

Define attention deficits

A

Inability to maintain engagement in goal directed activity

47
Q

Define avolition

A

lack of motivation, drive to initiate or complete tasks

48
Q

What is the pneumonic asst with substance abuse disorders?

A
  1. Pneumonic: Tempted with Cognac

A. Tolerance: need for increasing amounts
A. Withdrawal: symptoms have occurred
C. Control (Loss of)

49
Q

What is the loss of control asst. with substance abuse?

A

Substance ingested in larger amounts than intended

Failed attempt to cut down

Increased amounts of time obtaining or recovering

Social, occupational or recreational activities suffer

Continued use despite knowledge of physical or psychological problems

50
Q

What is diagnosis criteria for substance abuse?

A
  1. Diagnosis is three of seven criteria

2. CAGE = 2 or more = high probability of dependence

51
Q

What is the alcohol abuse pneumonic CAGE stand for?

A
  1. Have you felt you should CUT back on drinking
  2. Has anyone ANNOYED you with comments about your drinking
  3. Have you felt GUILTY about your drinking
  4. Have you ever had a EYE opener in the morning to get rid of a hangover
52
Q

What is the diagnostic criteria for a panic attack?

A 
Palpitations
Chest pain
Nausea
SOB
Choking sensation
Dizziness
Paresthesias
Chills
Fear of: 
Death, going crazy, shaking, sweating
53
Q

Define agoraphobia

A

Anxiety of being in places or situations from which escape may be difficult or embarrassing

Situations are avoided or endured with marked distress

54
Q

Define OCD

A

Presence of obsessions, compulsions or both

Causes significant dysfunction

55
Q

What are common behaviors seen in OCD?

A
  1. Washing
  2. Straightening
    A. Ordering rituals
  3. Mental Rituals
    A. Magical words, number, etc.
  4. Checking
  5. Hoarding
56
Q

What are the diagnostic criteria for GAD?

A
  1. Excessive worry for six months
  2. Three of six symptoms must be present
    A. Muscle tension
    B. Fatigue
    C. Concentration problems
    D. Restlessness, feeling on edge
    E. Irritability
    F. Sleep problems
57
Q

What is the cycle asst. with GAD?

A

Insomnia leads to daytime Fatigue; Fatigue causes Irritability and Concentration problems and constant worry causes Muscle tension and Restlessness.

58
Q

What are the components of PTSD?

A
  1. Re-experiencing: Intrusive thoughts, nightmares
  2. Avoidance: Avoid things associated with trauma,
  3. Arousal
  4. Emotional numbing
59
Q

What are other anxiety disorders?

A
  1. Somatoform Disorders
  2. Bulimia Nervosa
  3. Anorexia Nervosa
60
Q

What are examples of cognitive disorders?

A
  1. Dementia
  2. Delirium
  3. Attention Deficit Disorder
    Note: 18 separate criteria PLEASE follow the DSM-V guidelines
61
Q

What is included in the psych medical history?

A
  1. Brief history; focus on any acute
  2. Medications
  3. Primary care physician
  4. Allergies
  5. Surgical history
  6. Labs
62
Q

What is included in the psych social history?

A 
Current living situation
Support systems (relationship status)
Education
Vocational 
Sexual assault
Physical assault
Drug/alcohol use 
Cigarette use
Developmental history if relevant
Legal issues/incarceration
63
Q

What is included in the psych family history?

A
  1. Blood relatives with mental health issues
  2. May have to name diagnoses
  3. History of family suicide
    A. Attempts and/or completion
64
Q

What is the mental status examination?

A

Set of systematic observations

Consolidated patterns and inferences

May be brief or more comprehensive

Environment dependent

65
Q

What are the components of the MSE?

A 
Appearance
Behavior
Speech
Mood and Affect
Thought Process
Thought Content
Cognition and Memory

Behavioral Medicine: Unit 1 (7 decks)

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