Psychiatric Vocabulary And Screening

Question 1

Parts of a psychiatric evaluation

Answer 1

CC: reason for consult and make sure the patient is compliant and gives consent

HPI: get as specific as possible about the illness. “The story” of the patient

• timeframe
• triggers
• pertinent positives and negatives symptoms associated with present illness (DSM-5 criteria)
• depression = “DIGS-SPACE”
• mania = “DIG FAST”

Psychiatric history: past diagnosis, psychiatric hospitalizations, previous suicide attempts or thoughts, previous providers, homicidal history

Medication history: any psych medications taken in the past and present as well as reactions to meds and duration of each medication.

Family history: family members with psych diagnosis, suicide attempts, meds used successfully in family members.

Social history: social support, occupation, marital status, abuse status, any arrests incarcerations, alcohol/tobacco/cannabis/elicit drug use (be specific as possible with drugs)

Psychiatric ROS: (past and present)

• MDD/dysthymia symptoms
• manic or hypomanic symptoms
• psychotic symptoms (hallucinations, delusions and paranoia)
• generalized anxiety symptoms (worry, irritability, fatigue, muscle tension
• panic disorder symptoms ( how long do panic episodes last if they do)
• OCD symptoms (any activity the patient they must do constantly. If yes, what happens if your dont do them, how much time doing tasks?)
• other areas based on HPI (dementia/eating disorder, PTSD, dissociative disorders)

MSE:

Question 2

Social history for psychiatric evaluation

Answer 2

Socioeconomic status
- ask about finances and employment (professionally)

Interpersonal relationships and sexual history
- ask about family and intimate relationships, snoop out possible sexual violence, multiple partners, risky sex acts, family abuse etc.
“Who are the most important people in your life, how are they doing and do you rely on them for support?”

Legal history:
- incarceration and previous experience with violence and crime

Development history:

• “how would you describe your childhood in 1 sentence?“
• “what’s the highest grade you have finished in school?”
• can ask upfront about verbal, physical or sexual abuse but is risky so need to observe the scene
• ACES screening (if a child)

Question 3

AMPPSS screening tool

Answer 3

Adds onto the standard ROS for a psych evaluation (Psych ROS)
-Anxiety

• Mood
• Psychosis
• Substance Use
• need to be super specific, more specific than general HPI*
• Suicide
• on top of general ROS in organ systems that are relevant to the CC, to rule out organic causes from psychiatric causes*

Question 4

Mental Status Examination (MSE)

Answer 4

Psychiatric physical exam that is also added on top of the standard physical exam

Must be done with every psychiatric evaluation

Parts include:
- Appearance: hygiene/grooming/recent changes in appearance?

• Attitude: cooperative/guarded/irritable/disinterested/etc. during interview?
• Speech: rate,rhythm and volume of speech?
• mood: patients own words. Have them describe their mood
• affect: facial expressions (full range or not?), how quickly does it change, if at all? (Lability), is the affect congruent with he state mood and appropriate to topics under discussion
• thought process: how is the patient thinking? Is the patient clear train of thought or are they all over the place (flight of ideas/tangential)?
• thought content: what is the patient thinking?
  What is the main theme or subject matter when the patient talks? Any delusions, obsession, compulsions, suicidal or homicidal?
• perceptions: auditory/visual or tactile hallucinations?
• cognition: alert and oriented x4? Serial 7s intact?, WORLD backwards? Can recall 3 words? Also MMSE or MOCHA charts if applicable
• insight: does the patient recognize there is an illness or disorder present? If there is a treatment plan or prognosis, does the patient understand?

Judgement: what is the patients plan to secure a safe environment? Do they have access to food/clothing shelter etc? Can the patient make decisions that support a safe treatment plan?

Reliability: is the patient able to provide information that is consistent and accurate with other sources?

Question 5

What is the only part of the MSE that is specifically from the patient only?

Answer 5

Mood

Question 6

Affect

Answer 6

How the face/expression moves in conjunction with emotions/mood

• stable/broad = normal
• labile = lots of movement
• constricted/limited = little movement
• blunted = more severe than limited but not flat
• flat = restriction fo all expression or emotion

“flat” affect only means if there is no movement at all (very rare and is always a disorder)