Biopsychosocial Model and Mental Status Exam

3 components of the biospycosocial model of disease

Biological: physical health, IQ, drug effects, temperament, genetic vulnerabilities, disability

Psychological: self-esteem, coping skills, social skills, family relationships, trauma, temperament, IQ

Social: family relationships, trauma, drug effects, peers, family circumstances, school

biospychosocial model impact on clinician

- increases provider introspection

- remain empathetic

- recognize bias

- tolerance of uncertainty, learning to trust intuition

- preservation of functional practice based on trust and respect

- appropriate communication of clinical evidence to patient

DSM-5

disaggregates psychiatric disorders into discrete cases and makes it easier for practicing clinicians to interpret studies performed by epidemiologists

psycotherapy

describes the process of treating mental health issues through talking with a mental health provider (75% effective)

MMSE (Folstein Test)

- mini mental state examination consisting of 30 questions to measure cognitive impairment

- kept in pt chart and repeated over time to keep track of decline

MMSE scoring

24-30 no cognitive impairment

18-23 mild cognitive impairment

0-17 severe cognitive impairment

Patient Health Questionnaire- 9 (PHQ-9)

- 9 questions to screen for presence and severity of depression

- self administered

- scores each of the 9 DSM-5 criteria for depression

General anxiety disorder 7 (GAD-7)

self administered 7-point questionnaire to screen for ane measure severity of anxiety

Mood Disorder Questionnaire (MDQ)

-screens for Bipolar Disorder

- focuses on symptoms of mania and hypomania

- self administered

Abnormal Involuntary Movement Scale (AIMS)

- detect and monitor severity of tardive dyskinesia

- helps clinicians weight the benefits of a medication against the degree of distress the side effects are causing the patient

- helps aid in decision to maintain, reduce, or discontinue causative medications

Mental Status Exam

Appearance

Attitude

Behavior

Speech

Affect

Mood

Thought Process

Thought Content

Perception

Orientation

Concentration

Insight

Judgement

Cognition

Appearance

- assess the patient's physical aspects such as height, weight, manner of dress and grooming

- is pt. well nourished?

- do they appear to be stated age?

attitude

assess pts approach to the interview process and the quality of information obtained during the assessment

behavior

- general observations of the patient's level of activity and arousal

- does the pt lie in bed or prefer to walk around?

- observations of the pts eye contact and gait

- are there any abnormal movements?

- is the pt agitated with repetitive movements?

speech

- quantity: is pt talkative or silent?

- rate: is speech fast or slow?

- loud: is speech loud or soft?

- articulation of words: does pat speak clearly and distinctly?

- fluency: rate, flow, and melody of speech (hesitancies, monotone inflections, cicumlocutions, paraphasia)

Affect

- describe pts mood as evidenced in both behavior and client's statements

- is affect stable or labile?

- assess pts facial expressions (flat affect can be seen due to physical reason or psychological reason)

mood

- sustained emotion of pt

- use open ended questions to ask about mood

- how long has pt mood been this way?

- sometimes need to ask friends/family to help assess pt mood

- ASK about thoughts of self-harm or suicide

how to describe mood

euthymic: normal

dysthymic: depressed

manic: elevated

thought process

- how does pt think?

- are thought logical and presented in organized fashion and goal-oriented?

abnormalities in thought process

circumstantiality

derailment

flight of ideas

neologism

incoherence

blocking

confabulation

perseveration

echolalia

clanging

circumstantiality

abnormality in thought process where speech is characterized by indirection and delay due to pts excessive use of details that have no connection to the point

derailment

abnormality in thought process where pt shifts topics in speech with no apparent relation between topics

flight of ideas

abnormality in thought process where pt has accelerated change of topics in a very fast but generally coherent manner

neologisms

abnormality of thought process where pt uses invented or distorted words

incoherence

abnormality of thought process where speech is incomprehensible because it is illogical

blocking

abnormality of thought process where there is a sudden interruption of speech before the completion of an idea

- occurs in normal people

confabulation

abnormality of thought process where pt fabricates facts to hide a memory impairment

perseveration

abnormality of thought process where pt has persistent repetition of words or ideas

echolalia

abnormality of thought process where pt has repetition of words or phrases of others

clanging

abnormality of thought process where pt chooses a word on the basis of sound rather than meaning

thought content

what is pt thinking about?

- abnormalities include compulsions, obsessions, phobias, anxiety)

compulsions

abnormality of thought content where pt has repetitive behaviors and feels driven to perform to prevent or produce some future state of affairs

obsessions

abnormality of thought content with recurrent, uncontrollable thoughts, images, or impulses that a patient considers unacceptable

phobias

abnormality of thought content where pt has a persistent fear of a stimuli they feel is irrational

anxiety

abnormality of thought content where apprehension or fear may be focuses (phobia) or floating (general sense of dread)

perception

- awareness of the objects in the environment to the 5 senses and their interrelationships

- inquire about false perceptions (hearing voices, seeing people, knowing things other people don't)

- abnormalities of perception include delusions and hallucinations

delusion

abnormality of perception where pt has a false belief or judgement about external reality despite evidence to the contrary

hallucinations

abnormality of perception where there is a subjective external stimuli that the pt hears or sees that others do not hear or see, and pt may not recognize as false

- can be auditory, visual, olfactory, gustatory, or tactile

**does NOT include false perceptions associated with dreaming/falling asleep

orientation

- is pt oriented to time, place, and self?

- is pt awake and alert?

- does pt understand your questions?

memory

- process of recording and retrieving information

- short term and long term

short-term memory

covers events or memories that occurred minutes to days before

**assess memory by asking about something recent (weather, national event, etc)

long-term memory

covers events or memories that occurred months to years before

**assess remote memory by asking about past historical events

concentration

- is pt attentive or distractible?

- does pt respond appropriately and reasonably quickly or lose track of topic and fall silent or even asleep?

how to assess attention

digital span: give pt a string of numbers to recite back to you

serial 7s: ask pt to subtract serial "7s" from 100

spelling backward: ask pt to spell W-O-R-L-D backwards

insight

- awareness that thought, symptoms, or behaviors are normal or abnormal

- does pt have a good understanding of their mental illness?

- do they understand problem an dunderstaind treatment options?

judgement

- process of comparing and evaluating different possible courses of action

- does pt have ability to predict the consequences of their behavior and make "sensible" decisions?

cognition

- mental action or process of acquiring knowledge and understanding through thought, experience, and senses

- are learning disabilities present?

- does pt have a low IQ?

- does pt appear to be on the autism spectrum?

hgiher cognitive functions

level of intelligence assessed by vocabulary, knowledge base, calculations, and abstract thinking

calculating ability

ask pt to perform more difficult calculations such as making change