Intro to Psych- Krysiak

intro, schizo

What is a mental disorder?

• behavioral or mental pattern causing significant distress or impairment of personal functioning

  • aka mental illness or psych disorder

What is DSM-V used for?

• widely accepted DIAGNOSTIC reference in the US

• source for practitioners for DIAGONSIS, assessment, and description of mental disorders

Is DSM-V a treatment guideline?

NO NO NO NO NO NO NO —> DIAGNOSTIC GUIDELINE ONLY

What are some counseling points when interviewing patients?

• may need release of info to get collateral information

• avoid leading the patient… start with open-ended questions

• use motivational interviewing (OARs technique)

• lowkey the rest are obvious: don’t judge, listen, etc. (use common sense)

What does each letter of the OARS motivational interviewing stand for?

O- open ended questions

A- affirmations

R- reflective learning

S- summary

What should be obtained when getting a patient’s psychiatric history?

• just recognize, DONT MEMORIZE

• current/previous history

• clinical presentation

• time frame

• length of psych events

• pharm tx

• highest level of fxn at baseline

• med history

What should be obtained when getting a patient’s social history?

• just recognize, DONT MEMORIZE

• background: education, job, marital status, religion, address, social support

• tobacco, alcohol, drug use

What should be obtained when getting a patient’s medication history?

• just recognize, DONT MEMORIZE

• med rec

• all meds (psych and non-psych)

• OTC

• herbals

• past meds

• determine if adequate trials of meds were provided

What are the components of a mental status examination (MSE)?

• just recognize, DONT MEMORIZE

• appearance

• attitude

• activity

• speech and language

• mood and affect

• thought and perceptual disturbances

• cognition

• insight and judgement

What is assessed under “Activity" in an MSE?

underactivity (DECREASED MOVEMENTS) and overactivity (INCREASED MOVEMENTS)

examples of overactivity and underactivity:

• overactivity

  • hand wringing

  • restless legs

  • picking clothing, skin, hair

  • pacing/fidgeting

• underactivity

  • rigidity

  • absence of movement

  • catatonia

For assessing “Speech and Language" in an MSE:

• What is thought blocking in MSE, and what causes it?

• What is pressured speech?

• What distinguishes flight of ideas from normal speech?

• thought blocking—> stops speaking suddenly without explanation, happens when hallucinations or delusions intrude a person’s thinking

• pressured speech—> accelerated pace to speech pattern w/ urgency that seems inappropriate to the situation

• flight of ideas—> abrupt changes from topic to topic

For assessing “Speech and Language" in an MSE:

• compare circumstantial and tangential speech?

• what is preservation?

• what is mutism?

• circumstantial speech—> eventually reaches the point but with excessive details

• tangential speech—> Never reaches the point, goes in circles

• preservation—> repetition of an original answer to subsequent questions (repeating words, phrases, or movements)

• mutism—> pt. doesn’t respond even though they are aware

What’s the difference between affect and mood?

• affect- current emotional tone observed by the clinician (facial expression, body posture, tone), OBJECTIVE from clinician

• mood- feelings reported by the pt., SUBJECTIVE from pt.

Match the type of affect with its definition:

Affect	Definition
	affect can be very intense, often excited
	rapid, often exaggerated change in mood
	inappropriate affect to the pts. mood or content of ideas or speech
	no change in expression occurs throughout the interview
	range of emotional expression is reduced, but not absent

Word Bank: flat affect, excited affect, blunted affect, labile affect, incongruent affect

Affect	Definition
excited	affect can be very intense, often excited
labile	rapid, often exaggerated change in mood
incongruent	inappropriate affect to the pts. mood or content of ideas or speech
blunted	no change in expression occurs throughout the interview
flat	range of emotional expression is reduced, but not absent

What is the difference between delusions, illusions, and hallucinations?

• delusions: fixed false BELIEFS that are not based in reality or consistent with the pts. religion or culture

  • can be paranoid, grandiose, or somatic

• illusions: VISUAL misperceptions involving a misinterpretation of a real sensory stimulus

• hallucinations: false SENSORY impressions or perceptions that occur in the absence of an external stimulus (can be auditory, visual, tactile,

Delusions are often accompanied by anosognosia.

What is anosognosia?

lack of awareness of a mental disorder

______________ do not always indicate a mental disorder.

a. illusions

b. delusions

Define thought broadcasting, obsessions, and compulsions:

• thought broadcasting: belief that one’s thoughts are audible to others

• obsessions: unwanted thoughts or ideas that intrude into a person’s thinking

• compulsions: actions performed in response to the obsessions or to control anxiety associated with the obsession

What are the components of evaluating cognition in an MSE?

• sensorium

  • level of consciousness

  • alertness

• memory

• abstraction

  • interpretation of info or similarities/differences between words

“Something is wrong, and I need help.” is a ________ insight.

a. productive

b. good

c. poor

d. opportunistic

b.

PRACTICE:

Which of the following is a component of the Mental Status Exam? SATA

A. Appearance

B. Activity

C. Speech and Language

D. Lab values

E. Mood and Affect

a, b, c, e

PRACTICE:

You are interviewing a patient in an out-patient psychiatric clinic. You ask him, “how are you

currently taking your medications?” He begins talking about his neighbor's dog, before

abruptly discussing his co-workers and family. After speaking for five minutes, he states that

he is taking his medications as prescribed. Which of the following BEST describes the

characteristic of his speech?

A. Circumstantial

B. Tangential

C. Grandiosity

D. Pressured

A.

What are labs used for in pts. with psych conditions?

useful for both monitoring medications and ruling out medical causes

___________________ scales are useful tools to provide an objective way to measure subjective data.

symptom-based rating scales

What rating scale is used to assess each of the following:

• adverse effects

• psychosis

• depression/ mood disorders

• anxiety and OCD

• adverse effects- abnormal involuntary movement scale (AIMS)

• psychosis- Positive and negative syndrome scale (PANSS)

• depression/ mood disorders

  • Hamilton Depression Rating Scale (HDRS)

  • Montgomery Asberg Depression Rating Scale (MADRS)

  • Beck Depression Inventory (BDI)

  • Patient Health Questionnaire (PHQ-9)

  • Mood Disorder Questionnaire (MDQ)

  • Young Mania Rating Scale (YMRS)

• anxiety and OCD

  • Hamilton Anxiety Scale (HAM-A)

  • Yale-Brown-Obsessive-Compulsive Scale (YBOCS)

PRACTICE:

Which of the following assessment scale is correctly paired with what it is assessing?

A. AIMS scale assesses diagnosis of depression

B. PANSS scale assesses psychosis

C. MADRS scale assesses response to treatment in bipolar disorder

D. YBOCS assesses severity of symptoms related to depression

B