Psych History

Psych ROS

SHIMMS HAD AC

S - Sleep pattern

H - Hallucinations

I - Irritability - being aggravated very easily

M - Memory loss

M - Mood changes

S -Suicidal ideations - thought or desire to harm yourself

H - Homicidal ideations - thought or desire to harm someone else

A.- Anxiety - persistent worrying

D - Decreased concentration

A - Anhedonia - loss of interest in things they once enjoyed

C - confusion

Depressed Mood or Memory Loss Conditions

• Major Depressive Disorder

• Delirium

• Dementia

• Schizophrenia

Major Depressive Disorder

Onset: Gradual onset over days to weeks; may follow a stressor or occur w/out a clear trigger

Duration: Symptoms present most days for greater than or equal to 2 weeks

Character: Persistent depressed mood and/or loss of interest or pleasure in activities

Associated symptoms: Sleep changes, loss of interest, guilt/worthlessness, low energy, poor concentration, appetite changes, psychomotor changes, suicidal ideation (SIGECAPS)

Alleviating factors: Social support, therapy, exercise, enjoyable activities, medication

Aggravating factors: Stress, isolation, medical illness, substance use, major life changes

Temporal profile: Persistent symptoms with episodes that may recur over time

Previous episodes: Commonly recurrent; ask about prior depressive episodes

Delirium

*Common in older adults

Onset: Acute; develops over hours to days with a sudden change from baseline mental status

Duration: Hours to days; may persist longer if the underlying cause is not corrected

Character: Confusion, disorientation, impaired attention, altered level of consciousness, disorganized thinking, agitation, or lethargy

Associated symptoms: Hallucinations, sleep disturbances, emotional lability, agitation, lethargy, recent illness, medication changes, dehydration, or substance withdrawal

Alleviating factors: Treatment of the underlying cause, reorientation, hydration, sleep, and familiar surroundings

Aggravating factors: Infection, hospitalization, unfamiliar environment, sleep deprivation, medication effects, or withdrawal states

Temporal profile: Fluctuating course with periods of lucidity and confusion; often worse in the evening or at night

Previous episodes: May have occurred previously during illness, hospitalization, surgery, medication changes, or substance withdrawal

Dementia

*Acquired memory impairment disorder

Onset: Gradual onset over months to years

Duration: Chronic and progressive

Character: Memory loss, cognitive decline, impaired judgment, language difficulties

Associated symptoms: Difficulty with daily activities, personality changes, getting lost, mood changes

Alleviating factors: Routines, familiar environments, memory aids, caregiver support

Aggravating factors: Stress, fatigue, illness, changes in routine, unfamiliar environments

Temporal profile: Slowly progressive decline without significant day-to-day fluctuation

Previous episodes: Ongoing symptoms with gradual worsening rather than distinct episodes

Schizophrenia

*Chronic disorder affecting thought, perception, and behavior

Onset: Gradual onset, typically in late adolescence or early adulthood

Duration: Chronic; symptoms persist for greater than or equal to 6 months

Character: Hallucinations, delusions, disorganized thinking or speech, negative symptoms (flat affect, social withdrawal, lack of motivation)

Associated symptoms: Impaired functioning, cognitive difficulties, poor self-care, social isolation

Alleviating factors: Antipsychotic medication, therapy, social support, structured environment

Aggravating factors: Stress, substance use, medication nonadherence, sleep deprivation

Temporal profile: Chronic course with periods of exacerbation and remission

Previous episodes: Often recurrent with prior psychotic episodes, hospitalizations, or psychiatric treatment

Schizophrenia Cont.

Symptom domains:

• Positive (Symptoms that are abnormally present):

  • Hallucinations, delusions, disorganized speech

• Negative (When expected emotions are not present):

  • Diminished expression: blunted affect (decrease in outward emotional expression), alogia (symptom that caused you to speak less)

  • Avolition/apathy: anhedonia, abolition (lack of motivation to start or complete an activity), asociality (lack of motivation to engage in social interaction)

• Cognitive symptoms:

  • Difficulty with attention, concentration, and memory

• Disorganized Symptoms

  • Confused thinking and speech or abnormal movements

Anxiety Conditions

• Generalized anxiety disorder

• Obsessive compulsive disorder

• Post-traumatic stress disorder (PTSD)

Generalized anxiety disorder

Onset: Gradual onset over months to years

Duration: Persistent anxiety for greater than or equal to 6 months

Character: Excessive, difficult-to-control worry about multiple concerns

Associated symptoms: Restlessness, fatigue, poor concentration, irritability, muscle tension, sleep disturbance

Alleviating factors: Relaxation, exercise, counseling, medication, social support

Aggravating factors: Stress, uncertainty, life changes, caffeine

Temporal profile: Chronic symptoms that wax and wane

Previous episodes: Often recurrent, especially during stressful periods

Obsessive compulsive disorder

*Excessive, hard-to-control worry

Onset: Gradual onset, often beginning in childhood, adolescence, or early adulthood

Duration: Chronic, symptoms persist for months to years

Character: Recurrent intrusive thoughts (obsession) and/or repetitive behaviors or mental rituals (compulsions)

Associated symptoms: Anxiety, distress, avoidance behaviors, impaired daily functioning

Alleviating factors: Performing compulsions, reassurance, therapy, medication

Aggravating factors: Stress, uncertainty, triggers related to obsessions

Temporal profile: Chronic symptoms that may fluctuate in severity

Previous episodes: Often recurrent with periods of worsening and improvement

Post-traumatic stress disorder (PTSD)

*worry or anxiety

Onset: Begins after exposure to a traumatic event; symptoms persist for greater than 1 month

Duration: Chronic; may last months to years

Character: Intrusive memories, flashbacks, nightmares, avoidance of trauma reminders

Associated symptoms: Hypervigilance, exaggerated startle response, irritability, anxiety, sleep disturbance, emotional numbness

Alleviating factors: Therapy, social support, coping strategies, medication

Aggravating factors: Trauma reminders, stress, anniversaries of the event, sleep deprivation

Temporal profile: Persistent symptoms that may worsen when triggered

Previous episodes: Symptoms are often ongoing; may worsen during periods of stress or re-exposure to trauma-related triggers

Neurotransmitters

• Serotonin

• Norepinephrine

• Dopamine

• Acetylcholine

Serotonin

Location of synthesis: Brainstem - raphe nuclei

Regulatory function: Mood, arousal, cognition

Decreased in: Depressive disorders, anxiety disorders, psychosis/mania

Norepinephrine

Location of synthesis: Brainstem - locus coeruleus

Regulatory function: Mood, arousal, cognition, attention

Increased in: Anxiety disorders

Decreased in: Depressive disorders

Dopamine

Location of synthesis: Brainstem - substantia nigra

Regulatory function: Mood, arousal, cognition, motor control

Increased in: Psychosis/mania

Decreased in: Depressive disorders

Acetylcholine

Location of synthesis: Basal forebrain

Regulatory function: Sleep, arousal, attention

Decreased in: Alzheimer's disease

Alzheimer’s disease

• Most common form of dementia

• 60-80% of dementia patients

Dementia Risk Factors

• Age

• Genetics/Family history

• Smoking/alcohol use

• Atherosclerosis

• Plasma homocysteine (high levels contribute to brain tissue damage)

• Diabetes

• Mild cognitive impairment

Dementia Screening

Common screening tests for dementia and cognitive impairment include:

• Mini-Mental State Examination (MMSE)

• Montreal Cognitive Assessment (MoCA)

• Mini-Cog

• Saint Louis University Mental Health Status Exam (SLUMS)

• Clock drawing test

NOT routinely performed in asymptomatic individuals

• False positives

• Lead to unnecessary anxiety

• Additional testing

• Cost

• Potential stigma

Anxiety Disorders: Risk Factors

• Family history of anxiety

• Personal history of anxiety/mood disorder

• Childhood stressful life event or trauma

• Female gender

• Chronic mental illness

• Behavioral inhibition

Suicide Risk Factors

• Depression

• Substance Abuse

• Previous Attempt

• Chronic Pain

• Legal/Financial Problems

• Impulsivity & Aggression

• Social Isolation

• Access to Lethal Means

Depression Risk Factors

• History of Depression

• Family History

• Stressful Life Event

• Childhood Adversity

• Female Gender