Psychiatric Health Assessment Midterm Flashcards
5Ss of taking a Psychiatric History
Symptoms
Social
Substances
Psychosis
Self Harm
If a patient does not have risk factors associated with suicide then they are considered no risk for suicide.
T or F
False - no risk factors does not exclude risk
What is the best Pneumonic for the Psychiatric Interview
CHAMPIONS PSYCH EVAL
What does CHAMPIONS stand for in CHAMPIONS PSYCH EVAL
Chief Compliant
How can I help?
Assessment
Medical History
Psych History
Ideation (suicidal & homicidal)
Orientation (person/place/time/situation)
Navigation (safe - environment)
Social Support
What does PSYCH EVAL stand for in CHAMPIONS PSYCH EVAL
Prescriptions
Substances
Youth Development
Collateral (outside perspectives)
Housing
Employment
Victimization
Ancestry
Legal Issues
What are the 4 tasks of the Psychiatric Interview?
- Build a therapeutic alliance
- Obtain a Psych Hx
- Interview for Diagnosis
- Negotiate a tx plan and communicate it to your patient
Is the Diagnostic Interview about treatment or diagnosis?
Treatment!
Name 3 reasons pts do not return after the initial interview
- Poor rapport/alliance with clinician
- Feel that after the first visit they are good/boosted their morale enough
- Not really interested in tx in the first place
What are Shea’s 8 goals of the clinical assessment?
- Effective engagement/data gathering process
- Collect info/form a valid database
- Develop evolving and compassionate understanding of pt
- Develop an assessment/tentative diagnosis
- Collaboratively identify problems and therapeutic goals
- Collaboratively develop tentative treatment
- Help the pt anxiety
- Instill hope and ensure the pt comes to the next appt.
Research suggest that the better the ______ the more _______ the data.
pt/clinician relationship
Valid
Autonomy
Respecting the pts right to make their own decisions. Includes informed consent, refusing medication, and maintaining confidentiality
Beneficence
act for the benefit of the patient, protect and defend the right of others, prevent harm, remove conditions that will cause harm, help persons with disabilities, and rescue persons in danger
Being empathetic and not letting personal interests/opinions get in the way
Non-malificence
“Do no harm”
Justice
fair, equitible and appropriate tx of persons
Distributive Justice
different valid principles of distributive justice. These are distribution to each person (i) an equal share, (ii) according to need, (iii) according to effort, (iv) according to contribution, (v) according to merit, and (vi) according to free-market exchanges.
Dialectical Principalism
an approach that addresses ethical dilemmas → method of laying out, prioritizing and balancing conflicting considerations
- The approach is designed to help one determine the most ethical action
Which ethics principle most favors advising the patient
about the possible consequences of providing information
that she is suicidal?
A. Autonomy
B. Nonmaleficence
C. Beneficence
D. Distributive justice
E. None of the above
A. Autonomy
The psychiatrist catches the smell of
alcohol on the patient’s breath as he talks, and although
there is no evidence of prior violence, the psychiatrist knows
that the patient has access to guns as a law enforcement
officer.
2.2 In light of the patient being a law enforcement officer,
which ethics principle is now weighted more heavily in favor
of interrupting the patient and advising him on the limits of
doctor-patient confidentiality?
A. Autonomy
B. Nonmaleficence
C. Distributive justice
D. Legal justice
E. None of the above
Nonmaleficence
What are the 3 types of practice as a PMHNP?
Full - w/o supervising physician
Reduced - perform some of the scope without a physician (restrictions in operating their own practices - Np will have to go through MD/practice to order certain tests & dx conditions)
Restricted - must work under supervision of physician - all tests and prescribing; NOT independent practitioners
What are the 2 certification options for PMHNP?
ANCC - American Nurses Credentialing Center
AANPCB - American Academy of Nurse Pracitioners Certification Board
HPI (History of Present Illness)
- provides foundational info thats gathered from the assessment
The present illness is a chronological description of the evolution of the symptoms of the current episode. Also, the account should include any other changes that have occurred during this same period in the patient’s interests, interpersonal relationships, behaviors, personal habits, and physical health.
What are the essential questions to be answered for HPI?
Symptoms
Severity (how much)
How Long?
Associated factors
Why is pt seeking help now?
What are the triggering factors?
*Also want to identify setting of HPI (can help provide additional info) & If any treatment has been received for the current episode, it should be defined in terms of who saw the patient and how often, what was done (e.g., psychotherapy or medication), and the specifics of the modality used.
Elements of the HPI for psychiatry:
Location: Regarding mental status, location could correspond to domain (e.g., mood, thought process, perception, etc.)
Quality: Descriptive language (e.g., forgetful, depressed, disorganized, hallucinating)
Severity: Language that relates to how bad the problem is (e.g., “8 out of 10,” controlled, uncontrolled)
Timing: Language that relates to when symptoms are experienced, such as in certain situations or time of day
Duration: Onset of symptoms and how long symptoms last
Context: Psychosocial factors related to the problem
Modifying factors: What brings on or relieves the problem?
Associated signs and symptoms: What else is happening? (e.g., loss of functions/drives, such as appetite, weight, libido, etc.)
What are the 4 areas of Review of Systems (ROS) from table 1.2 in Kaplans Review/Synopsis of Psychiatry
Mood - Depression/Mania/Mixed
Anxiety - GAD, Panic Disorders, OCD, PTSD, Social Anxiety symptoms, Simple Phobias
Psychosis - Hallucinations, Paranoia, Delusions, Patient’s perception:reality testing
Other (ADHD/Eating disorders)