Intro Psych Rotation (P2)

Psychiatry

study of disorders affecting the mind

Health

State of wellbeing in body, spirit, and mind

What are the normal functions of the mind

Cognition

Emotion

Reality Checks

Personality

Cognition

the ability to be aware of where you are, who you are, and surroundings.

What are the aspects of cognition

speech

attention

Concentration

sensorium or alertness

orientation

memory

intelligence

how is speech assessed on MMSE

ability to repeat

ability to say Name

the ability to comprehend speech

the ability to do multiple step commands

Attention

the ability to focus on what you're currently doing in the moment

Concentration

the ability to pay attention and remember

What are the types of orientation

person

time

place

situation

What are the aspects of memory

Immediate recall

recent memory

long Term memory

What are the aspects of intelligence

capacity to acquire general knowledge

Problem solving

calculation ability

abstraction

Delirium

An altered mental state where it is difficult to focus and pay attention, usually with acute disorientation and visual hallucinations

Dementia

a condition that includes problems with recent memory, progressive disorientation, aphasias, apraxia

What is the order of disorientation with dementia

time

Then place

than person

Intellectual disability

A developmental disability with limited intelligence

How is an intellectual disability assessed

Administration of an IQ test

How is IQ found

(mental age divided by chronological age) times 100

What should be noted about the chronological age for IQ

The highest possible chronological age is 18 as mental age does not progress past this point.

What is considered normal IQ

90 to 110

How does IQ scoring reflect intellectual disability

normal= 90 to 110

Dull normal= 80 to 90

Borderline intellectual functioning = 80 to 70

mild intellectual disability= 70 to 55

Moderate intellectual disability= 55 to 35

severe intellectual disability = 35 to 20

profound intellectual disability = less than 20

What are the main emotions dealt with in psychiatry

sadness

Happiness

anger

Anxiety

Depression

an excessive level of sadness that affects the ability to function

What is the minimum duration need it for major depression diagnosis

two weeks

How many symptoms are needed for major depression diagnosis

5 symptoms total

One symptom must be depressed mood, Apathy, or anhedonia

What are the physical depression symptoms

changes in appetite

changes in weight

Sleep Disturbances

changes to energy

psychomotor agitation or retardation

What are the psychological symptoms of depression

pore concentration

feelings of worthlessness or hopelessness

feelings of excessive guilt

thoughts of death or suicide

Mania

an excess of happiness or anger that impedes the ability to function

What is the minimum time required to diagnose a manic episode

one week

How many symptoms are needed to diagnose a manic episode

3 symptoms with elevated mood or 4 if mood is only irritable

What are the symptoms of mania

racing thoughts

pressured the speech

Increase energy add goal directed activity

Decrease Need for sleep

distractibility

poor judgment

engaging with risky behavior

Generalized Anxiety disorder (gad)

a condition of excessive worry or restlessness

What is the duration to diagnose generalize anxiety disorder

6 months

What symptoms are usually seen with generalized anxiety disorder prestige

Disturb Sleep

Poor concentration

Phobia

Fear of specific things or situations

Panic Disordeer

Fear of panic attacks

what are symptoms of a panic attack

SOB

Palpitations

Chest Pain

Fear of syncope

sweating

Obessive Compulsive Disorder

A condition of obsessions and compulsions

Obsessions

Senseless repetitive thoughts that do not make sense and that are recurrent

compulsions

actions compelled to act upon due to a obsession

Reality checks

the inner processes of the mind to stay in touch with reality

Psychosis

A break in touch with reality

Types of psychosis

(STAT)

senses

Thoughts

Actions

thought organizations or processes

Hallucinations

an abnormality of the five senses

illusions

mistaking a real thing for something else

Delusions

false fixed believes opposed by cultural beliefs that do not dissipate with evidence

persecution delusion

a Paranoia the others are attempting to harm the person

Grandiose delusion

A delusion of extraordinary powers money or talent

Somatic delusion

The belief of a terrible physical illness despite evidence to the contrary

Bizarre delusion

The belief of an absurd idea is true

Thought control

the delusion that others are controlling what you think

thought withdrawal

the delusion that others are removing thoughts from your brain

Thought insertion

the delusion that others are putting thoughts in your brain

Bizarre behavior

an abnormality in normal behavior

Catatonia

an inability to move despite the physical capability too

Disorganize thoughts

Difficulty with organizing thoughts

Types of disorganized thought

incoherence

loosening of association

pressured speech

Flight of ideas

circumstantiality

tangentiality

loss of

Neologism

Echolalia

persevation

poverty of speech

Alogia

stilted speech

poverty of thought

Illogicality

thought blocking

clanging

loosening of associations

No connection between spoken sentences

Pressured speech

a rapid rhythm of speech that is difficult to interrupt

Flight of ideas

A combination of pressured speech and loosening of associations

the feeling that thoughts are coming and leaving the brain rapidly

Circumstantiality

talking in circles with too much information

Tangentiality

a remote connection to the question

Loss of goal

losing track of what is being said in the middle of a sentence

Neologism

the making up of a new word

Echolalia

the repeating of spoken word

Perservation

repeating a word repeatedly

Poverty of speech

Minimal speech

alogia

No speech

Stilted speech

speech is overly formal for context

Poverty of thought content

Very little information or no information

Illogicality

speaking statements that make no logical sense

thought blocking

stopping in the middle of a sentence and cannot continue

Clanging

the repeating of a specific sound or syllable

Schizophrenia

a psychotic disorder that presents for at least 6 months

schizoaffective disorder

A psychotic disporter with overlapping mood symptoms (depressive or manic symptoms)

Personality

the characteristic and conduct of a person that makes them unique

Includes how the person deals with stress externally and internally

ego syntonic

refers to processes that are a part of normal acting

When does personality become a disorder

causes disruptive behavior

pervasive pattern of behavior

What are the Cluster A personality disorders

schizoid

Paranoid

Schizotypal

Schizoid personality disorder

a cluster a personality disorder in which the patient does not want to be social outside of close family, often leading to a solitary lifestyle

Paranoid personality type

A personality disorder from cluster A where the patient cannot trust others in his reluctant to confide in others

often suspects others of taking advantage of them and holds grudges and is quick to anger

Schizotypal personality disorder

a personality disorder from Cluster A where the patient has odd and eccentric thinking

often has ideas of reference and magical thinking

What personality disorders are from cluster B

histronic

narcissistic

borderline

Antisocial

Histronic personality disorder

A cluster B Personality Disorder in which the person wants to be a center of attention and is often shallow

The Narcissistic Personality disorder

A cluster B Personality Disorder in which a patient draws attention to themselves with a sense of grandiosity and self importance

often lacks empathy and ax arrogant

Borderline personality disorder

hey Cluster B Personality disorder in which the person acts with unstable affect, often with intense anger and temper tantrums

often has a confusion of identity an intense unstable relationships, which causes frantic efforts to avoid abandonment

Antisocial personality disorder

A cluster B personality disorder where a patient does not experience guilt or conscious

often takes advantage with others without remorse and violates others rights

What are the cluster C personality disorders

depended

Obsessive Compulsive

avoidant

Dependent Personality Disorder

A cluster C Personality disorder where a patient let's others make decisions for them and often fears abandonment and disagreement

obsessive compulsive personality disorder

a cluster C Personality disorder where a patient is overly occupied with perfection, details, add rules

often coincides with hoarding

Avoidant personality disorder

a personality disorder from cluster C where a patient does not want to be social due to a fear of rejection or acceptance

What conditions are considered the serious and persistent mental illnesses

schizophrenia

major depression

Bipolar disorder

Schizoaffective disorder

Borderline Personality Disorder

What is good practice for taking history for paranoid patients

Refain from taking notes

what are components of comprehensive psych evaluation

Identification

Chief Complaint

HPI

Past Psych History

Drug and Alcohol History

Medical Illness

ROS

Social Hx

Family Hx

Mental Status Exam

Diagnosis

Treatment Plan

What is part of identification for psych evaluation

Age

sex

martial status

Children

education status

immigrant status

occupation

living status

what is placed as chief complaint

the patients own word on what is wrong

what is placed in HPI for psych eval

Commitment status

reason for hospitalization

symptoms of depression

symptoms of mania

symptoms of psychosis

symptoms of anxiety

what should placed in the past psych history

first and most recent hospitalization

>3 hospitalizations?

History of psychatric illness

Reason for hospitalizations

Past Suicide Attempts

Medication that were trailed

what should be documented in the drug and alcohol history section

drug of choic

route

first use

when use becam issue

last use

quanity pr day

legal issuees

rehab attempts

how far back should a psych HPI go

1 month prior to hospitalization

What are the components of MMSE

Apperance

Behavior

Speech

Mood

Affect

Though Process

Thought Content

Preceptual Distrubance

Cognitive Functions

Impuls Control

Insight

Judgement