2 אומדן כוללני וסטטוס מנטלי

Assessments, scales, definitions and terminologies

A patient comes into the psych ward for the first time. what are the first things to check before a psych assessment?

check the physical state - ECG, electrolytes (Sodium), liver and kidney function, drug test, medications, neuro and physical checks, endocrine, lifestyle

GAF (Global Assessment of Functioning)

0-100, overall OBJECTIVEpsychological, social, and occupational functioning (100 = high function)

WHODAS 2.0 - World Health Organization Disability Assessment Schedule

6 topics - cognition, mobility, self-care, interpersonal relationships, daily activities, and participation in society. - SUBJECTIVE - explained by the patient

How is GAF different to WHODAS?

GAF is not as in detail and is only a general objective assessment tool whereas WHODAS is very detailed and is subjective - patient lead assessment

 Mental Status Examination (MSE)

Evaluates higher cognitive function

Patient-examiner relationship - Suspicion, eye contact, brief answers appearance and behavior
speech - Rapid, hard to interrupt, monotonous, laconic (brief) , mutism
psychomotor activity - Hyper, agitation, tics, stupor, catonia, abnormal postures (posturizing), repitive behaviour (compulsions, stereotypies)
consciousness - awareness of oneself and the surrounding environment - Delirium**
orientation -  recognizes time, place, other people, and themselves.
thinking and cognition, mood and affect, and insight, judgment, and dangerousness

Delirium

disturbance of attention and awareness, often with confusion and acute changes in consciousness (over a few hours) , agitation. Assesd in MSE

Thought Process ארגון (ורצף) החשיבה

A general term to refer to how ideas are organized, connected and expressed

Thought process disorders: Circumstantial thinking עקיפנות

 when asked a question, the patient includes excessive unnecessary details but eventually answers

Thought process disorders: Tangential thinking משיקנות

 when asked a question, patient moves away from the topic without reaching the answer.

Thought process disorders: Thought blocking חסימה

A sudden interruption in the flow of thoughts

Thought process disorders: others

loosening of associations (weak or illogical connections between ideas), word salad (incoherent combinations of words), and neologisms (invented words)

Thought Content תוכן החשיבה: Delusions דלוזיות / מחשבות שווא

Thought content תוכן - what does the patient say? “I am king of the world, I can heal everyone” = thought content / delusion
A delusion is a fixed, false belief that does not correspond to reality, cannot be corrected by logical reasoning, and is not explained by the person's cultural beliefs.

Delusions - Nihilistic

Believing the world or limbs/parts of oneself does not exist

Other types of Delusions

Types include persecutory delusions (believing someone is following or harming them), grandiose delusions (believing they possess special powers), delusions of reference (believing unrelated events refer specifically to them), jealous delusions (unfounded beliefs of infidelity), erotomanic delusions (believing someone is in love with them), somatic delusions (false beliefs about bodily functions)
Thought-control delusions involve believing that external forces control or influence one's thoughts.

Ego Syntonic

 Ego-syntonic disorders and symptoms are perceived as consistent with/ part of the person's identity, beliefs, or values, so the individual may not recognize them as a problem.
They think it's "normal."
Examples include certain personality disorder traits and delusional beliefs.

Ego dystonic disorders and symptoms

ego-dystonic symptoms feel unwanted, distressing, or inconsistent with the person's sense of self.
For example, individuals with obsessive-compulsive disorder (OCD) may recognize their intrusive thoughts as irrational but still find them difficult to control.

Phobia

excessive or irrational fear of a particular object or situation

Higher Cognitive function: Attention קשב and Concentration ריכוז assessment

mathematical exercises

Higher Cognitive function: Memory assessment

Immediate, short term, long term,
Amnesia: memory loss

Confabulations קונפבולציה - gaps in memory are filled with inaccurate “memories” (not lies)
Abstract thinking מופשטות: understanding proverbs / metaphors
Concrete thinking: difficulty understanding abstract meanings
Intelligence: problem solving and reasoning

Confabulations קונפבולציה

Higher Cognitive function: Memory assessment

- gaps in memory are filled with inaccurate “memories” (not lies)

Abstract thinking מופשטות

Higher Cognitive function: Memory assessment
assessed by understanding proverbs / metaphors

Mood versus Affect: Mood

The patient's sustained, subjective emotional state, such as feeling depressed, anxious, or euphoric

Mood Vs Affect: Affect definition

 the observable expression of emotion
Affect is assessed according to its quality or tone (such as dysphoric, euphoric, or euthymic), range (full, restricted, or flat מלא מצומצם שטוח), congruence תואם with the patient's reported mood, and stability (stable or labile)

Mood Vs. Affect: Flat Effect

 minimal or absent emotional expression
Facial expression that does not convey emotion

Mood Vs. Affect: Restricted Affect

 a limited range of expression

Mood Vs. Affect: תואם Incongruent Affect

when observed emotion does not match the situation or the patient's reported feelings
A patient says her partner left her while smiling and laughing continuously

Perception: Imagination versus Reality HERE