Psych/Mental Health Assessment

Question 1

Presenting problem in the patient’s words.

Answer 1

Chief complaint

Question 2

COLDSPA - characteristics of symptoms, onset, lingering frequency of symptoms, duration symptoms last, stressors, precipitating triggers, alleviating factors.

Answer 2

History of present illness/problems (HPI)

Question 3

Previous inpatient/outpatient care, diagnoses, providers, medications used and effectiveness.

Answer 3

Past psych history

Question 4

Relationships, education, occupation/finances, living arrangements, trauma, legal involvement, hobbies.

Answer 4

Social history

Question 5

Mother’s pregnancy, developmental milestones, speech/occupational/physical therapy, learning disabilities/special accommodations.

Answer 5

Developmental history

Question 6

Family pedigree - medical and psychological, family diagnoses including substance use, known and suspected genetic predispositions.

Answer 6

Family history

Question 7

Strengths, competence, areas of improvement - self-identified and observed.

Answer 7

Personal evaluation

Question 8

Religious/spiritual beliefs, source of strength/comfort/hope, supports.

Answer 8

Culture and spiritual evaluation

Question 9

Previous medical problems including surgeries and hospitalizations, chronic disease, comorbidities, current diagnoses and medications/effectiveness, history of head trauma and significant infections, allergies including foods, and subjective report of systems.

Answer 9

Medical history

Question 10

Sleep frequency, duration, evaluation of restfulness; nightmares, waking, daytime naps. Changes with age - more late night wakefulness and need for longer sleep in late childhood and adolescents and more early night tiredness and early morning/frequent awakening in elder years.

Answer 10

Sleep patterns/evaluation

Question 11

Inhibits brainstem arousal nuclei which leads to inhibition of wake center and produces restful sleep.

Answer 11

Ventrolateral preoptic nucleus (VLPN) in hypothalamus

Question 12

Rapid eye movements, EEG activation, muscle atonia, muscle twitches, breathing irregularities, declines with organic brain dysfunction.

Answer 12

REM sleep

Question 13

CAGE assessment for alcohol use

Answer 13

Need to Cutback, people Annoyed by it, feelings of Guilt, need for Eye-opener.

Question 14

Alcohol use, illicit drug use, cannabis use, prescription med use, caffeine intake, tobacco, vaping, OTC med use, other substances/pica.

Answer 14

Substance use evaluation

Question 15

Objective documentation of observed presentation of patient NOT subjective patient reporting. General appearance, eye contact, motor activity; mood; affect; memory; attention and orientation; speech; thought content; thought process; insight and judgement; intellect (appropriate to age and developmental level).

Answer 15

Mental Status Exam

Question 16

Vital signs, neurologic exam, brief physical assessment

Answer 16

Review of systems

Question 17

Clock drawing with correct time listed and observation of patient independently completing task. Different scoring mechanisms depending on assessment used.

Answer 17

Brief cognitive exam

Question 18

ORAL 23 RWD - orientation to place and time, recognition of 3 objects, attention (serial 7s counting backward from 100), recall of previous 3 objects, language, identification of 2 objects from picture, following 3-step command (take paper in right hand, fold it in half, place it on floor), reading statement to self and performing direction (“close your eyes”), writing a sentence, drawing a design.

Answer 18

Mini-mental state exam (MMSE)

Question 19

Scoring: maximum of 30; no cognitive impairment 24-30; delirium/dementia 18-23 (mild), 0-17 (severe).

Answer 19

MMSE

Question 20

11 items measuring cognition through orientation, short-term memory, calculations, naming of animals, clock drawing, and recognition of geometric figures. Scores of 27-30 normal in individual with high school education, 21-26 indicate mild cognitive impairment, and scores 0-20 indicate dementia. Advantage of no cost (in public domain) and earlier detection of deficit.

Answer 20

SLUMS (St. Louis University Mental Status exam)

Question 21

Social support presence, Lethal plan, Access to means, Plan and/or previous attempts.

Answer 21

SLAP assessment for suicidal risk

Question 22

Ideation, Substance use, Purpose for living lost, Anxiety, Trapped feeling, Hopelessness, Withdrawing from loved ones, Anger/rage, Reckless behavior, Dramatic mood change.

Answer 22

IS PATH WARM assessment for suicide risk

Question 23

Either depressed mood (irritability in children/adolescents) most of day nearly every day x2 weeks and markedly diminished interest in activities. Additional symptoms include SIGECAPS - Sleep disturbance, Interest deficit (anhedonia), Guilt, Energy deficit, Concentration deficit, Appetite change, Psychomotor agitation or retardation, Suicidality.

Answer 23

DSM-V diagnosis for depression

Question 24

9-item self-report questionnaire. Scoring: 1-4 = minimal symptoms, 5-9 = mild symptoms, 10-14 = moderate, 15-19 = moderately severe, 20-27 = severe.

Answer 24

PHQ-9 (Patient Health Questionnaire) for depression

Question 25

Measures severity of depressive symptoms. Scoring: 8-13 = mild, 14-18 = moderate, 19-22 = severe, 23 and greater (up to 76) = significant severity.

Answer 25

HAM-D (Hamilton Depression rating scale)

Question 26

Measures levels of depressive symptoms and diagnostic indicator. Scoring: 0-10 = normal, 11-16 = mild, 17-20 = borderline clinical diagnosis, 21-30 = moderate, 31-40 = severe, 40 and greater (up to 63) = extreme.

Answer 26

BDI (Beck Depression Inventory)

Question 27

14-item self-report scale to measure severity of anxiety. Scoring: 0-17 = mild, 18-24 = mild to moderate, 25-30 = moderate to severe, 31 or greater (up to 56) = severe.

Answer 27

Hamilton Anxiety Rating Scale

Question 28

7-item self-report measure of severity of anxiety. Scoring: 5-9 = mild, 10-14 = moderate, 15-21 = severe.

Answer 28

GAD-7 (Generalized Anxiety Disorder screening)

Question 29

A distinct period of abnormally and persistent elevated, expansive, or irritable mood and increased goal-directed activity/energy lasting 1 week most of day, nearly every day.

Answer 29

DSM-V diagnostic criteria for manic episode

Question 30

DIGFAST - Distractibility, Indiscretion, Grandiosity, Flight of ideas, Activities increased (goal-directed), Sleep deficit without tiredness, Talkativeness (pressured speech). Requires presence of 3 or more during period of mood disturbance (4 if mood only irritable).

Answer 30

Mnemonic for bipolar diagnostic criteria for manic episode.

Question 31

5-part self-report screening for symptoms of mania. Positive screen if 7 out of 13 questions “yes” in part I, “yes” in part II, and “moderate” or “serious” in part III. (See page 7 of study guide for questions).

Answer 31

MDQ (Mood Disorder Questionnaire)

Question 32

10-item self-report screening for trauma experiences in childhood.

Answer 32

ACEs (Adverse Childhood Experience questionnaire)

Question 33

Assesses both teachers’ and parents’ observations of child activity and attention. Validated for assessment with or without medications/monitoring of symptoms.

Answer 33

Vanderbilt Assessment Scale for ADHD

Question 34

Assesses for presence of psychosis.

Answer 34

Brief Psychiatric Rating Scale

Question 35

Assesses positive and negative symptoms of psychosis/psychotic disorders.

Answer 35

PANSS (Positive and Negative Symptom Scale)

Question 36

12-item clinician-observed measure of movement disorders caused by antipsychotic medications. Items measuring oral-facial movements, extremity movements, trunk movements, global judgement, and denture/dental status effecting score. Score of 2 or more positive.

Answer 36

AIMS (Abnormal Involuntary Movement Scale)

Question 37

Waist circumference (>40 in men, >35 in women), BP > 130/85, triglycerides > 150, FBG > 100, HDL < 40 in men and < 50 in women.

Answer 37

Standard measures for metabolic syndrome/risk

Question 38

Imaging study used for assessing structural, functional, and metabolic brain changes which can delineate gray from white matter and detect areas of demyelination. Contraindicated in patients with metal implants.

Answer 38

MRI

Question 39

Electrical impulses into brain cortex to screen for seizure cause/risk, tumors, abscesses, subdural hematomas, infarcts, and hemorrhages. Measures electrical activity of brain.

Answer 39

EEG

Question 40

Cranial nerves controlling smell, vision, and extraocular movements.

Answer 40

Olfactory, optic, oculomotor (I, II, III)

Question 41

Cranial nerves controlling down and inward eye movement, and muscles of mastication/facial and scalp sensations.

Answer 41

Trochlear and trigeminal (IV and V)

Question 42

Cranial nerves controlling lateral eye movement and facial movements/taste (anterior 2/3)/tear and saliva production.

Answer 42

Abducens and facial ( VI and VII)

Question 43

Cranial nerves controlling hearing/equilibrium and phonation/gag/carotid reflex/swallowing/taste (posterior 1/3)

Answer 43

Accoustic and glossopharyngeal (VIII and IX)

Question 44

Cranial nerve controlling talking, swallowing, general sensation from carotid body, and carotid reflex

Answer 44

Vagus (X)

Question 45

Cranial nerves controlling movement of trapezius and sternomastoid muscles (shoulder shrug) and movement of tongue.

Answer 45

Spinal accessory and hypoglossal (XI and XII)