Psychiatric Interview Flashcards
Sxs relating to mood:
- Angry
- Happy
- Sad
Psychological Sxs
Somatic Sxs relating to body sensation:
- Pain
- Fatigue
- Palpitations
Physical sxs
Do most patients present with psychological complaints, or physical complaints?
- 2/3 pts w/ depression present w/ physical complaints (fatigue/back pain)
- 1/3 pts w/ depression complain of multiple unexplained somatic sxs
- What is the frequency of “difficult patient encounters?”
- Explain this encounter
- 15 - 20% (3 to 4 visits / day)
- Patients w/ unexplained/somatic sxs
Unexplained sxs lasting how long should raise concern for underlying depression, anxiety, or both?
Over 6 weeks
Little interest or pleasure in doing things
Anhedonia
Most screening questions for depression and anxiety ask if pt have been having sxs over the past 2 weeks. Which question is asked for 4 weeks?
Have you had an anxiety attack (suddenly feeling fear or panic)?
What is the mnemonic for depression?
SIGECAPS
S
I
G
E
C
A
P
S
- S- sleep disturbance
- I - interests decreased
- G - Guilt (worthless, poor self esteem)
- E - energy decreased
- C - concentration decreased
- A - appetite disturbance
- P - psychomotor changes
- S - suicidal thoughts
What is the anxiety mnemonic?
WATCHERS
W
A
T
C
H
E
R
S
- W - Worry
- A - Anxiety
- T - Tension in muscles
- C - Concentration difficulty
- H - Hyper arousal/irritability
- E - Energy loss
- R - Restlessness
- S - Sleep disturbance
A patient is considered “seriously ill” if they exhibit which sxs?
Losing interest in sex, hobbies, reading, or TV
Substance abuse mnemonic for ETOH?
- C - have you eve felt you should CUT back?
- A - ANGRY or ANNOYED at others comments about your use?
- G - GUILTY about your use?
- E - EYE opener to get you going in morning?
Substance abuse mnemonic for prescription med abuse?
- W - Work, school, or home role obligation failures
- I - Interpersonal or social consequences
- L - Legal problems
- D - Dangerous use
What is the psychological equivalent of a physical exam?
Mental Status Exam (MSE)
- Describes mental state & behaviors
- Incudes objective observations of clinician
- Includes subjective descriptions given by pt
- Utilized to establish dx, develop tx, & monitor progress
- “snap shot in time”
MSE (mental status exam)
What 3 PE components should you also always include in a PE of a psychiatric interview along w/ MSE?
- Cardiac
- Pulmonary
- Vitals
- Situation where feelings, desires, and expectations of one person are unconsciously redirected and applied to another.
- Give example
- Transference
- (maternal transference)
- Provider unconsciously projects his/her feelings towards a pt
(provider develops attachment to pt)
- What should you avoid??
- Counter-transference
- Avoid entanglement
Many psychiatric disorders are “familial.”
What else is familial?
The patient’s response to tx
What are the 6 major components of an MSE?
- Appearance/Behavior
- Speech/Language
- Mood/Affect
- Thoughts/Perceptions
- Insight/Judgement
- Cognition
(SAMTIC)
- The ability to focus/concentrate over time on particular stimulus or activity.
- An inattentive person is easily distractible and may have difficulty giving a hx or responding to questions
- Give an example
- Attention
- Ex: pt on cell phone
- The process of registering or recording info, tested by asking for immediate repetition of material, followed by storage or retention of info.
Memory
Cover minutes, hours, or days
Recent / Short term memory
Refers to intervals of years
Remote / Long term memory
- Awareness of personal identity, place, and time
- Requires both memory and attention
Orientation
- Sensory awareness of objects in environment & their interrelationships (external stimuli)
- Refers to internal stimuli such as dreams or hallucinations
Perceptions
- The logic, coherence, and relevance of the patient’s thought as it leads to selected goals
- “How people think”
Thought processes
- What the patient thinks about (level of insight & judgement)
Thought content
- Awareness that sxs or disturbed behaviors are normal or abnormal
- Ex: distinguishing between daydreams and hallucinations that seem real
Insight
- Process of comparing & evaluating alternatives when deciding on course of action
- Reflects values that may/may not be based on reality & social conventions of norms
Judgement
- A fluctuating pattern of observable behaviors that express subjective feelings or emotions through tone of voice, facial expression, & demeanor
- Give 4 examples
- “visualized by provider”
- Affect
- Flat, blunted, labile, inappropriate
- A more pervasive and sustained emotion that colors the person’s perception of the world
- May be: euthymic (normal range), elevated, dysphoric (unpleasant = sad/anxious/irritable)
- “Patient describes this”
Mood
- A complex symbolic system for expressing, receiving, & comprehending words
- As with consciousness, attention, and memory, what is essential for assessing other mental functions?
Language
- Assessed by vocabulary, fund of info, abstract thinking, calculations, construction of objects that have 2 or 3 dimensions
Higher cognitive functions (mini mental status exam)
Level of consciousness which can be associated w/ substance abuse
Hyper-alert
Opens eyes, looks at you and responds appropriately to stimuli
Alert
“drowsy” - opens eyes, looks at you, responds to questions, then falls asleep
Lethargic
Opens eyes, looks at you, responds slowly and somewhat confused
Obtunded
Arouses w/ painful stimuli, slow or absent verbal responses, lapses into unresponsive state when stimuli cease
Stupor
Unarousable w/ eyes closed
Coma
- Comprehension intact
- Unable to speak to varying degrees
- (Pt can point to nose when prompted to do so)
- (Pt can write words)
Expressive aphasia (Broca’s)
- Comprehension not intact
- Fluent, but nonsensical speech
Receptive aphasia (Wernicke’s)
Combination of receptive & expressive aphasia
Global aphasia
Aphasias are common with which 3 things?
- Strokes (MCA - medial cerebral artery)
- Trauma
- Mass lesions
Impairment of language ability
Aphasia
- Prevalent emotional states the pt communicated to you
- Often placed in “quotes”
- duration
- Appropriate given the situation
Mood
Themes tht occupy the patients thoughts and perceptual disturbances
Thought content
