Psychiatric Interview / Assessments, Tools & Forms Flashcards
specifically designed tasks used to measure a psychological function known to be linked to a particular brain structure or pathway.
Neuropsychological testing
Neuropsychological testing examples ?
Intelligence
Memory
Language
Exec Function
Visuospacial
Dementia specific
Battery tests
Where to Get the Information?
PCP ….. and others
Family
Past therapists
Patient
Psychiatric Interview outcome depends on ?
outcome depends on the situation ( ER versus office ( more appropriate))
Psychiatric Interview: In psychiatry often the lack of definition forces the exercise of _______ _______.
practical wisdom
Psychiatric Interview: Every encounter is ?
therapeutic
Psychiatric Interview: “…therapy is a kind of rhetoric in which you stimulate emotional arousal to ?”
transform the meaning of an event…
Psychiatric Interview: That transformation can occur only if you can offer the patient a conceptual framework for ___________ of his [or her] maladaptive assumptions…
making sense
**asking questions to provoke thought **
Psychiatric Interview: If accurately applying the DSM-5 diagnostic criteria in all their specify is the _______ of psychiatric interviewing, then the ___ if forming a therapeutic alliance…”
science
art
Psychiatric Interview: in an effective diagnostic interview, you conduct a form of rudimentary psychotherapy in which ____________ and provide appropriate support to a demoralized patient…
you instill hope
Psychiatric Interview: your ability to form an _______ however will be shaped by a person’s past experiences”
alliance
- Emergency department (new) vs established pt
- Prior psych history
- Current mental state
Model _____ and _____ to your patients
empathy and warmth
Psychiatric Interview: remember ?
You have no idea of the challenges they experienced and chances are you have never even come close to experiencing the pain they have experienced
Act like an __________ uncovering the complex history of a patient
anthropologist
Setting the tone – the environment ?
Lighting
Arrangement of office setting i.e. facing the patient or facing a computer
Talk from waiting room to the office
Note: Your seating position -> closest to the door for rapid egress if needed
Starting the dialog, example ?
Hi, I’m Steven and a Physician Assistant here at the clinic. I read your chart but I would like to know more about you…
The 30-Minute Interview adapted from ?
The Pocket Guide to the DSM-5 Diagnostic Exam
Minute 1: Introduction ?
“Hi my name is…”
Minute 2-4: Listen ?
Don’t talk unless you need to guide
Minute 5-12: Ask ?
HPI (History of Present Illness)
PPH (Past Psych History)
Safety (Suicidal or Homicidal Ideation
Minute 13-17: ROS ?
Mood Psychosis Anxiety Obsessions and Compulsions Trauma Dissociation Somatic Concerns Eating Sleeping Substance and other Addictions Personality Elimination
Minute 18-23: PMH ?
Allergies
FH, SH
Developmental Hx
Minute 24-28: Mental status examinations ?
MMSE
PHQ
GAD-7
etc…
Minute 29-30: Follow-up and closure ?
close up
Minute 1 ?
Introduction
Minute 2-4 ?
Listen
Minute 5-12 ?
Ask
Minute 13-17 ?
ROS
Minute 18-23 ?
PMH
Minute 24-28 ?
Mental Status Examinations
Minute 29-30 ?
Follow-up and Closure
Presenting the Patient: Psychiatry is _____ _________ and creating a story that includes evidence of the patients condition
pattern recognition
Presenting the Patient: Tell it as a story, just as you do for other medical presentations ?
Name
Age
Gender
Chief complaint with patient quote if appropriate
Presenting the Patient: Tell it as a story, just as you do for other medical presentations ?
HPI (using DSM criteria)
ROS
Past Psych Hx
Past Medical Hx
Family Hx
Developmental Hx
Social Hx
Presenting the Patient: Tell it as a story, just as you do for other medical presentations ?
Testing results (i.e. MMSE)
Differential Diagnosis
Assessment
Plan:
- Additional Tests/Treatment
- Medication
- Education
- Safety
- Nutritional
- Prognosis
Diagnostic Rating Scales identify what ?
Identify specific psychiatric disorders in epidemiological studies and large scale clinical trials
Diagnostic Rating Scales examples ?
- The Present State Examination
- The Composite International Diagnostic Interview
- The Diagnostic Interview Schedule
Symptom-Based Scales measure ?
change in a particular symptom or a syndrome-based group of symptoms
Symptom-Based Scales are completed by who ?
patient
Symptom-Based Scales examples ?
The Brief Psychiatric Rating Scale
The Hamilton Rating Scale for Depression
The Beck Depression Inventory
Zung Depression Scale
The Brief Psychiatric Rating Scale ?
psychotic and no psychotic issues - evaluation of baseline measures
The Hamilton Rating Scale for Depression ?
most widely used more so assess sxs. of depression nd if it progressivee over time
The Beck Depression Inventory ?
self rating and used to evaluate depression - feedback from patient how the tx. is going
Zung Depression Scale ?
self rating and used to evaluate depression - feedback from patient how the tx. is going
Neuropsychological assessment completed by ?
Neuropsychologist
Neuropsychological assessment: Acquire data about a subject’s ?
Cognitive
Motor
Behavioral
Linguistic
Executive functioning
Neuropsychological assessment topics / examples ?
CAGE SMAST DAST-10 GAD-7 PHQ-9 AUDIT (self and clinician versions) MMSE
What is CAGE ?
is a brief, 4-item questionnaire used for the routine and rapid screening of alcohol problems
CAGE acronym ?
Feeling the need to Cut down,
Becoming Annoyed at criticism
Feeling Guilty about drinking
Needing a drink first thing in the morning to get going, Eye-Opener
CAGE specificity and sensitivity ?
Specificity of 76%
Sensitivity of 93%
SMAST aka ?
Short Michigan Alcohol Screening Test
- *(note FYI - there are 3 different versions)
- *
SMAST: Each of these are __ item measures about problems experienced by the indicated person as a result of __________.
13
drinking alcohol
SMAST sensitivity and specificity ?
Sensitivity of 48%
Specificity of 100%
(several caveats to these results)
DAST-10 aka ?
Drug Abuse Screening Test
DAST-10 sensitivity and specificity ?
Sensitivity: 80-85%
Specificity:78-88%
DAST-10: _______, yes/no self-report Drug Abuse Screening instrument that has been condensed from the ______ DAST and should take less than _ minutes to complete.
10-item
28-item
8
DAST-10: Designed to provide a brief instrument for clinical screening and treatment evaluation and can be used with ?
adults and older youth
GAD-7 aka ?
Generalized Anxiety Disorder 7
Generalized Anxiety Disorder 7 is a ____-_______ questionnaire for screening and severity measuring of __________ ________
self-reported
generalized anxiety
GAD-7 has _____ items, which measure severity of various signs of ________________ according to reported response categories
seven
generalized anxiety disorder
GAD-7: Assessment is indicated by the total score, which made up by adding ?
together the scores for the scale all seven items.
GAD-7 is a sensitive self-administrated test to assess generalized anxiety disorder, however it cannot be used as replacement for ?
clinical assessment
GAD-7 sensitivity and specificity ?
Sensitivity (89%)
Specificity (82%)
GAD-7: Increasing scores on the scale were strongly associated with multiple domains of ?
functional impairment
PHQ-9 aka ?
Patient Health Questionnaire 9
The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the ?
severity of depression
___________ on the PHQ-9 screens for the presence and duration of suicide ideation
Question 9
PHQ-9 was established in studies involving __ primary care and __ obstetrical clinics
8
7
PHQ-9 sensitivity and specificity ?
Sensitivity of 88%
Specificity of 88% for major depression
AUDIT aka ?
The Alcohol Use Disorders Identification Test
AUDIT: This ___________________ can help determine whether a patient might have problems with _____________.
10-question screening test
drinking alcohol
AUDIT sensitivity and specificity ?
Sensitivity 70.1%
Specificity 95.2%
(some caveats to this depending on the population being tested)
MMSE aka ?
Mini Mental State Examination
The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of________ ______
memory problems
MMSE: It can be used by clinicians to help diagnose ________ and to help assess its?
dementia
progressionand severity
The _____ is a series of questions and tests, each of which scores points if answered correctly.
MMSE
MMSE: If every answer is correct, a maximum score of __ points is possible.
30
The MMSE tests a number of different mental abilities, including a person’s ?
memory
attention
language.
Whats the cause ? it can be ?
Organic(“Do a Psych Eval”)
Psychiatric (“Medically Clear The Patient”)
Chronic
Transient
Environmental
Social
Financial
Long list
**has it just began of few days or have they had these between months and years **