pysch:clinical interview&mental status Flashcards
what are the “three Ds” of pysch disorders?
Deviance
Discomfort
Dysfunction
3 part guide to Dx and txt (pysch interview)
- Gather information and monitor progress
- Develop, maintain, conclude the therapeutic process
- Educate the patient and implement treatment plans
what are the 3 stages of interview?
- Inception: Introduction, rapport
- Reconnaissance: Let pt tell their story, Gather basic information
- Detailed Inquiry: Gather detailed information
how do you “meet your pts where they are” in the interview?
- Choice of your words
- Same physical level
- Match voice, intensity level or just slightly different (one stage below)
define “level of consciousness” , and “orientation”
how aware the person is of
his environment
Orientation: aware of person (who they are), place (where they are), and time (when is it); this requires memory and attention
define “attention”
the ability to focus or concentrate
includes: alert, lethargic, obtunded, stuporous, coma
define “alert”
Alert: the patient is awake and aware
define “lethargic”
Lethargic: you must speak to the patient in a loud forceful manner to get a response
define “obtunded”
Obtunded: you must shake a patient to get a response
Stuporous: the patient is unarousable except
by painful stimuli (sternal rub)
define “coma” (in terms of attention)
Coma: the patient is completely unarousable
define memory and the two types
the process of recording and retrieving information
- Short-term memory covers events or memories that occurred minutes to days before
- Long-term memory covers events or memories that occurred months to years before
define “thought processes”
the logic, coherence, and relevance of a patient’s thoughts as they lead to thoughts and goals; HOW people think as opposed to WHAT they think (thought content)
define “insight”
awareness that thought, symptoms, or behaviors are normal or abnormal; e.g., distinguishing that a daydream or hallucination is not real
define “judgement”
process of comparing and evaluating different possible courses of action
define “affect”
the observable mood of a person expressed through facial expression, body movements, and voice
define “mood”- what are 3 types?
the sustained emotion of the patient
Euthymic: normal
Dysthymic: depressed
Manic: elated
define “language”
the complex symbolic system for expressing written and verbal thoughts, emotion, attention, and memory
define “higher cognitive function”
level of intelligence assessed by vocabulary, knowledge base, calculations, and abstract thinking
assessing mental status includes what 5 parts?
- Appearance and behavior
- Speech and language
- Mood
- Thoughts and perceptions
- Cognitive function
what does cognitive fxn include?
memory, attention, information and vocabulary, calculations, abstract thinking, and constructional ability
5 parts of speech and language to look at
quantity, rate, volume, articulation of words, fluency
what are the 4 different fluency types and what may they indicate?
- Hesitancies in speech
- Monotone inflections
- Circumlocutions:
- Paraphasias:
fluency: what might monotone inflections indicate?
schizophrenia or severe depression
fluency: hesitancies in speech may indicate what?
aphasia from stroke
fluency: what are circumlocutions ?
words or phrases are substituted for the word a person cannot remember; e.g., “the thing you block out your writing with” for an eraser
fluency: what is paraphasia?
words are malformed (“I write with a den”), wrong (“I write with a branch”), or invented (“I write with a dar”)
10 types of abnormalities in thought PROCESS
circumstantiality derailment flight of ideas neologisms incoherence blocking confabulation preservation echolalia clanging
thought process: circumstantiality
speech characterized by indirection and delay due to the patient’s excessive use of details that have no connection to the point
thought process: derailment
speech in which a person shifts topics with no apparent relation between the topics
thought process: flight of ideas
accelerated change of topics in a very fast but generally coherent manner
thought process: neologisms
invented or distorted words
thought process: incoherence
Incoherence: speech that is incomprehensible because it is illogical
thought process: blocking
Blocking: sudden interruption of speech, before the completion of an idea, occurs in normal people
thought process: confabulation
Confabulation: fabrication of facts to hide memory impairment
thought process: preservation
Perseveration: persistent repetition of words or ideas
thought process: echolalia
Echolalia: repetition of the words or phrases of others
thought process: clanging
Clanging: choosing a word on the basis of sound rather than meaning
abnormalities of thought CONTENT
compulsions, obsessions, phobias, delusions
thought content: compulsions
Compulsions: repetitive behaviors that a person feels driven to perform to prevent or produce some future state of affairs
thought content: obesssions
Obsessions: recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable
thought content: phobias
persistent fear of a stimuli the patient feels is irrational (spiders, snakes, the dark)
thought content: delusions
false, fixed beliefs that are not shared by other members of the person’s culture
somatic vs systematized delusion
Somatic delusion: believing one has a disease or defect that he does not
Systematized delusion: a single delusion with many elaborations around a single theme all systematized into a complex network; i.e., the KGB is after the patient
two types of abnormality in thought PERCEPTIONS
illusions and hallucinations
illusions vs hallucinations
Illusions: misinterpretations of real stimuli
e.g., the bird flying by is a UFO
Hallucinations: a subjective external stimuli the patient hears or sees that others do not hear or see and that the patient may not recognize as false; these can be auditory, visual, olfactory, gustatory, or tactile
e. g. Abe Lincoln speaks to the patient from the back of a penny
* Do not include false perceptions associated with dreaming/falling asleep
