Psychiatry Flashcards
First psychiatric examination
Most important aspects:
chief complaints/symptoms,
their course over time,
immediately dangerous behavior?
What does involuntary commitment mean in psychiatry?
If the patient displays signs of immediately dangerous behavior; that is, due to their mental health condition, the patient poses immediate and direct danger to harm the health, well-being, social or financial situation of themselves or others
Who has the right to refer a patient to a psychiatric ward? What should be contained in a referral?
From the referring physician. Apart from the personal and insurance data of the patient, the referral must include the chief complaints, the most relevant symptoms, the most likely diagnosis, a brief history of illness and past treatments, and a statement on the presence or absence of directly-endangering behavior.
Psychiatric Status
provides a detailed, comprehensive description of the most relevant psychological functions, behavioral responses and psychopathological symptoms organized in structured manner, that records both the pathological symptoms and the physiologic functions/behaviors.
Consciousness-related functions (Figure 2.3.1.):
the awareness of self and the environment
- consciousness alertness (vigility) és quality (integrity)
- orientation (time, space, self, others)
- attention alertness (vigility) and ability to sustain focus (tenacity)
Perceptual functions (Figure 2.3.2.):
Ability to detect and recognize stimuli:
- perception formal (quantity, quality) and content by sensory modality
Cognitive functions (Figure 2.3.3.):
Ability to process, integrate/associate, learn and forget the perceived stimuli
- thought formal/procedural (speed, structure) and thought content disorder
- concept formation abstract thinking
- memory: encode, store, retrieve
- intellect: global cognitive ability
Emotional (affective) functions (Figure 2.3.4.):
An archaic, non-analytic information processing, reflects a subjective involvement and disposition
mood: the long-lasting emotional tone with no specific object
- self-feeling: the emotional tone of perceiving oneself, no object
- emotional reactions: object oriented reaction reflecting one’s involvement
- impulse-control: strength of affect control
- anxiety: vegetative, subjective, behavioral signs
Volatile or response functions (Figure 2.3.5):
Ability to initiate or respond actions
- psychomotorium: planned motor activity,
- volatile functions: motivation, activity, instinct-driven behavior
- communication: verbal, non-verbal
- complex behavior: social activity, value orientation, personality functions, attitude towards the examiner
Risk factors:
Symptoms that correlate with immediately dangerous behavior or efficacy of treatment
- suicidal behavior: ideation, intention, past attempts
- violent behavior, verbal, physical hostility, previous actions
- insight of illness: adequate, partial
- critical sense/judgement: intact, diminished
- reality-testing: ability to distinguish the objective/real contents from the subjective/fantasy elements or distortion
what three things are included in a psychiatric case report?
Internal/physical examination
Neurological examination
Psychiatric examination
The most important steps of the emergency psychiatric care:
- Psychiatric, internal and neurological examination, and (if necessary) laboratory tests, imaging techniques and consultation with other professionals as well.
- Immediate treatment (reduction or elimination) of the psychiatric emergency (symptom).
- Deciding if the patient needs further care?
- Deciding if the patient’s behavior is dangerous to himself or others?
Pharmacological interventions in emergency psychiatry.
In psychiatric emergency, antipsychotics and anxiolytics (high-potential benzodiazepines) are the most frequently administered drugs.
Most common indications of antipsychotics in emergency psychiatry:
- aggression or hostility
- agitation or psychomotor retardation,
- acute psychotic symptoms (e.g. hallucination, delusion).
