Intro to Psychiatry

main diagnostic tool, open ended questions

Psychiatric interview

main diagnostic tool

open ended questions

Mental Status Exam

Presentation, speech, mood and affect, thought process, thought content, perceptual disturbances, cognition, insight and judgement

Presentation

Appearance, (grooming, note distinguishing characteristics), general behavior, motor activity (posture/gait, activity, facial expression)

Speech

Quantity, rate, volume and tone, articulation, fluency and rhythm, coherent

Coherent

Neologism (made up words), clanging (rhyming), word substitution, aphasia

Wernike's aphasia

speech fluent, rapid, malformed (gibberish)

posterior temporal lobe

Broca's aphasia

Words are sparse, inflection impaired, not fluid speech

frontal lobe

Mood

What patient reports

Affect

How patient outwards express mood

Words to describe mood

normal/congruent (does it match mood or situation), flat (no reaction), blunted/constricted (very limited emotional expression), elated (extreme happiness), labile (rapidly fluctuating), histrionic (exaggerated/dramatic)

Flow of thought

• normal: linear

• tangential: thoughts jump, never return

• circumstantial/circumferential: thoughts jump, eventually return

• loose association: connections between thoughts less evident

• flight of ideas: rapid thoughts, little to no connection (pressured speech)

• word salad: complete incoherent (words thrown together)

• blocking: sudden interruption (speech cuts off)

• confabulation: making up facts to fill in gaps of memory loss

• preservation: repetition of own words/ideas

• echolalia: repetition of others words/phrases

Thought content

delusions, obsessions, intrusive thoughts, phobias, SI/HI

Delusions definition

false beliefs not based in reality, not within the context of social, cultural, or religious/spiritual norms

Types of delusions

• thought control/broadcasting/insertion: something outside is controlling thoughts (can hear/being put into head)

• delusions of influence: controlled by external force

• paranoia: feelings of persecution

• grandiosity: inflated/exaggerated sense of self (celebrity)

• somatic: pertains to organ/body part (organs are rotting)

• ideas of reference: assigning personal meaning to things

Thought content

• obsessions: uncontrollable, obsessive thoughts

• compulsions: repetitive behaviors

• intrusive thoughts: old memory keeps popping in head, can’t control it

• phobias: irrational/exagerated fear that impairs daily functioning

• SI/HI: thoughts to kill self or others, MUST BE EVALUATED THROUGHLY

Perceptual disturbances

• illusions: misinterpretation of actual external stimuli

• hallucinations: false sensory experience, no external basis

Types of hallucinations

• auditory: hearing voices ( ask though ears or in head)

• visual: seeing things that aren’t there (substance use, withdrawals, delirium)

• olfactory: noxious smell (temporal lobe disorders)

• gustatory: weird taste (temporal lobe dysfunction)

• tactile: skin “crawling” (alcohol/opiate withdrawal, phantom pain)

Sensorium

level of attention and awareness, fluctuates —> delirium

Cognition

evaluated using mini mental status exam (MMSE)

5 areas of cognition

• orientation: person, place, time, situation

• registration: ability to learn (3 words)

• attention and calculation: spell world backwards, count backwards by 7

• recall: recall 3 words

• language: name common objects when shown

insight

understanding of current illness

judgement

ability to identify consequences of action