The Psychiatric Diagnostic Interview Flashcards
In Nussbaum’s 30 min interview, what should you cover during MINUTE 1?
- Introduce yourself
- Ask how they want to be addressed
- Set expectations (how long we have, what we want to accomplish)
- Ask why they are there
In Nussbaum’s 30 min interview, what should you do during MINUTES 2-4?
LISTEN! Try to allow the pt to talk w/o interruption. Uninterrupted speech shows mental status, guides your Hx taking, & builds alliance.
In Nussbaum’s 30 min interview, what should you do during MINUTES 5-12?
HPI, Past Psych Hx, Safety
What are some questions that should be asked in the psych HPI?
- Qs that follow DSM-5 criteria
- Why now?
- When did this start?
- When did you last feel well?
- Can you ID any precipitating events?
- How do you view your current lvl of functioning & how has it changed?
- When did they first notice symptoms?
- When did they first seek treatment?
- Did they ever experience full recovery?
In Nussbaum’s 30 min interview, what should you do during MINUTES 13-17?
ROS (include Cross-Cutting Symptom measures here)
In Nussbaum’s 30 min interview, what should you do during MINUTES 18-23?
PMHx, PFHx, Social Hx
What should be asked in the psych PMHx interview?
Previous dx
Surgeries
Allergies
Hospitalizations
(Have they ever been hospitalized? How many times? What was the reason for the hospitalization? Do they receive outpatient mental health treatment?)
Medications
(Do they take any medications for a mental illness? Which medications have helped the most? Did they ever have any side effects from any medications? What was the reason for stopping prior medications? For how long and how often did they take prior medications?)
(Do they know the name, strength, and number of doses per day for any medications they are currently taking?)
What should be asked in the social Hx for psych interview?
Diet, exercise, living situation, occupation (how do you support yourself?), tobacco, Alcohol (CAGE form), recreational drugs
In Nussbaum’s 30 min interview, what should you do during MINUTES 24-28?
Mental Status Exam (i.e. many ppl dealing w/stress have some difficulty concentrating or remembering, have you had problems like that?)
OR
MMSE
In Nussbaum’s 30 min interview, what should you do during MINUTES 29-30?
- Any follow up questions
- Ask if there is anything they wanted you to know about that you didn’t cover
- Thank pt for their time
- Move onto PE
What ‘tool’ do you use to present a case?
SBAR (situation, background, assessment, recommendations)
What should you include in your SBAR presentation?
- pt by name, age, gender, CC
- HPI (DSM-5 criteria w/pertinent psych ROS as well as bio/social/psych predisposing factors & stressors)
- Steps to obtain/maintain safety
- How pts health affects Tx?
- Indicated psych Tx
- Social/cultural needs, strengths/obstacles
- Prognosis
What psych disorders predispose youth to early CVD?
Major depressive d/o & bipolar d/o
What is the 10th leading cause of death in the US?
Suicide
How common is autism in the US?
1 out of 8 children by 8 y/o
Prevalence of d/o in adults?ADHD, depression, Alcohol, bipolar, schizophrenia, anxiety)
18% - anxiety 7.2% - alcoholism 6.7% - major depression 4.1% - ADHD 1.6% - bipolar d/o 1% - schizophrenia
Prevalence of d/o in teens? (ADHD, depression, Alcohol)
9% - ADHD
- 4% - alcoholism
- 3% - major depression
What type of population is most likely to get mental illness in the US adult population? (i.e. gender, age, race) Least likely?
Female, 26-49 y/o, American Indian/Alaskan Native
Male, 50+, Asian
What is the general prevalence of mental illness in the US adult population?
18.5%
What is the cross-cutting SSx measure?
Screening tool for the pt to complete before an initial eval for mental health.
Adult: 23 qs, 13 domains
Child: 25 qs, 12 domains
What d/o are the questions below from cross-cutting targeting?
- Do you have little interest/pleasure in doing things?
- Are you feeling down, depressed, hopeless?
Depression
What d/o is the question below from cross-cutting targeting?
-Are you feeling more irritated, grouchy, or angry than usual?
Anger
What d/o are the questions below from cross-cutting targeting?
- Are you sleeping less than usual, but still have a lot of engery?
- Have you started lots more projects than usual or are doing more risky things than usual?
Mania
What d/o are the questions below from cross-cutting targeting?
- Feeling nervous, anxious, frightened, worried, or on edge?
- Feeling panic or being frightened?
- Avoiding situations that make you anxious?
Anxiety
What d/o are the questions below from cross-cutting targeting?
- Unexplained aches & pains (i.e. head/back/joints/abdomen/legs)?
- Feeling that your illnesses are not being taken seriously enough
Somatic SSx
What d/o are the questions below from cross-cutting targeting?
-Thoughts of actually hurting yourself?
Suicide
What d/o are the questions below from cross-cutting targeting?
- Hearing things that other people couldn’t hear (voices, even when no one was around)?
- Feeling that someone could hear your thoughts, or that you could hear what another person was thinking?
Psychosis
What d/o are the questions below from cross-cutting targeting?
-Problems with sleep that affected your sleep quality overall?
Sleep problems
What d/o are the questions below from cross-cutting targeting?
-Problems w/memory (i.e. learning new info) or with location (i.e. finding way home)?
Memory
What d/o are the questions below from cross-cutting targeting?
- Unpleasant thoughts, urges, images that repeatedly enter your mind?
- Feeling driven to perform certain behaviors or mental acts over and over?
Repetitive Thoughts and Behaviors
What d/o are the questions below from cross-cutting targeting?
-Feeling detached/distant from yourself, your body, your physical surroundings, or your memories?
Dissociation
What d/o are the questions below from cross-cutting targeting?
- Not knowing who you really are or what you want out of life?
- Not feeling close to other people or enjoying your relationships with them?
Personality functioning
What d/o are the questions below from cross-cutting targeting?
- Drinking at least 4 drinks of any kind of alcohol in a single day?
- Smoking any cigarettes/cigar/pipe/snuff/etc?
- Using meds or drugs?
Substance use
How do you know what to ask to get to the correct diagnosis/underlying problem?
DSM-5 to guide
Improves Dx accuracy by measuring severity of d/o, aligning it with ICD system, & incorporating recent advances in neuroscience
Symptoms vs. signs?
Symptoms: pts subjective report
Signs: objective findings
Signs more telling than symptoms
How does the DSM-5 classify a psych Dx? What factors are at play here?
Disorder! Disturbance in physical & psychological functioning
Biological, Social, Cultural, Psychological
What must a diagnosis have and what does it determine?
Must have clinical utility
-prognosis, tx plans, potential tx outcomes for pt
What is a “A syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning”?
Mental disorder
What is it up to the clinician to decide regarding diagnosing mental d/os?
Is it clinically significant!
Does it affect and to what extent the person’s cognition, emotions, behavior
-How did they function before compared to now?
How do you establish therapeutic alliance?
Asking questions!
What are some alliance building questions?
What do you think caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you?
How does it work?
How severe is your sickness?
Will it have a short or long course?
What kind of treatment do you think you should receive?
What are the most important results you hope to receive from this treatment?
What are the chief problems your sickness has caused for you?
What do you fear most about your sickness?
