Intro to Behavioral Medicine

Mental Illness

medical conditions involving a change in emotion, thinking (cognition) and/or behavior; associated with distress and/or difficulty functioning in social, work and/or family life

Behavioral Medicine

interdisciplinary field that integrates behavioral, psychosocial, and biomedical science knowledge and techniques

Psychiatry

medical specialty for the diagnosis, treatment, and prevention of mental disorders

Can be in a hospital (inpatient) taking care of patients in psychiatric unit (vitals), be a PA who is primarily involved in psychiatry, can also be outpatient and see more stable patients

What is the role of the PA in behavioral medicine?

We don't know, never one answer

What is the typical etiology/risk factor for mental disorders?

Biopsychosocial model

model that explains the possible etiologies/risk factors of mental illnesses

Psychological- how we cope with things, social- stressors, culture, religion, family, biological- neurotransmitter issues, genetics

Explain the different aspects of the biopsychosocial model.

Spectrum/continuum of "normal"

it is normal to be anxious about failing grade, sad about death; we aren't robots and will respond emotionally

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; main textbook for psychiatry, published by APA, most recent edition in 2022

What is the DSM-5?

Setting and patient; approach is different for someone in ER versus depressed elder who just loss spouse, psychotic patients (paranoid, delusion) have to be approached different for different tests

The assessment of the psychiatric patient will differ by what?

- History

- Mental Status Exam (added on)

- Physical Exam

- Diagnostic Tests

What are the most important components in assessing a psychiatric patient?

History

how diagnoses are made (no diagnostic tests to confirm diagnosis like in other specialties)

A. Chief complaint

B. Subjective history (patient reports)

- Past medical history, social history, family history

What is part of the history?

Mental Status Exam

What comes after the history?

Patient status; if anxious or paranoid can't just come at them

What is the physical exam dependent on?

Get common tests to make sure there isn't an underlying disorder that looks like a psychiatric disorder

What is the purpose of diagnostic tests in behavioral medicine setting?

Intelligence test, personality (clue us into patient thinking); Rorschach evaluation (Inkblot)

What are some examples of psychological evaluations?

Psychiatrist is medical doctor, psychologists do a lot of tests

What is difference between psychiatrist and psychologist?

Mental Status Exam

observations and questions at the time of interview, bigger picture, set of things we look for entire time while talking to patient

Mini-Mental Status Exam

good screen to tell us if there are areas of concern, we get a score

Behaviors and things that are different from the norm

What are things that are notable in the Mental Status Exam?

General Description (Appearance and Attitude)

What is the first part of the Mental Status Exam?

Things about overall appearance; alert, impaired, posture, clothes, gender, race; is there something impairing consciousness, can clothes help clue us in on disorder

What do we look for in the Appearance part?

Cooperative, hostile, withdrawn, pleasant

What do we look for in the Attitude part?

Mood and Affect

What is the second part of the Mental Status Exam?

Mood- subjective, what patient says; emotion reported by patient, what word(s) they use to describe mood

Affect- objective, what we look at, what we see; observed expression

What is the difference between mood and affect?

Speech

What is the third part of the Mental Status exam?

- If they are loud or quiet (inappropriate volume)

- If their speech is slurred

- Do they have monotone speech?

What are some observations you can make in the Speech part of the Mental Status Exam?

Perception

What is the fourth part of the Mental Status Exam?

Any hallucinations

What is noted in the perception part of the Mental Status Exam?

Hallucination

false sensory perception, not associated with real external stimuli (can occur in any of the 5 senses)

1. auditory

2. visual

3. Olfactory

4. Tactile

5. Gustatory

What are the different hallucinations that can occur?

Auditory

most common hallucination; hearing things that others don't hear, they may talk to someone who isn't in room; can be voices, sounds, multiple people, people they know or don't

Visual

second most common hallucination; in delirium and dementia

Olfactory

smelling things that aren't there, sometimes associated with seizure disorders (much less common)

Tactile

common in substance abuse or substance withdrawal, scratching at skin because they think something is there

Gustatory

tasting things that aren't there (much less common)

Thought (what is in a patient's mind?)

What is the fifth part of the Mental Status Exam?

Delusion, Obsession, Phobia, and Suicidal ideation and Homicidal ideation (S/I, H/I)

What are the four different parts of Thought?

Delusion

false belief, cannot be corrected by reasoning

Aliens came and replaced their organs with someone else's

What is an example of a delusion?

Because they could be real (CIA is tracking them)

Why would you need other people to get the rest of the story for some delusions?

Don't agree with it, but don't try to argue with them

What should you do when someone is telling you about their delusions?

Themes, like paranoia

What can delusions also have?

- somatic delusions- having to do with body

- Grandiose delusions- someone thinks they are very powerful/grand

What are two other specific types of delusions people can have?

Obsession

pathological persistence of a thought or feeling, cannot be eliminated by logical effort, in OCD

Phobia

persistent, irrational, or exaggerated fear, in anxiety disorders

Suicidal ideation and homicidal ideation (S/I, H/I)

What must you ask about and document?

Sensorium and Cognition (lifted from mini-mental status exam)

What is the sixth part of the Mental Status Exam?

- Consciousness

- Orientation

- Memory

- Concentration

What are the four parts of Sensorium and Cognition?

Are they conscious or not; level of consciousness

What do you look for with consciousness?

Person, Place, Time (who are you, where are you, what is the date)

What are the 3 basic questions you ask to determine Orientation?

"Alert and oriented x3" or (Situation) x 4

What is the record you can write for Orientation?

Awareness of the situation (why they are there)

If you write (Situation) x 4, what is the 4?

- Immediate: give 3 simple unrelated words, have them repeat it right back

- Recent: ask them 3 words again in couple minutes, anything in recent timeframe

- Remote: anything in past (past medical history, past historical history)

What are the 3 parts of Memory you must ask about and what are they?

- Serial 7s (count from 100 backwards by 7, don't let them use fingers)

- Spell WORLD backwards (have them spell it forwards first)

What are tests that can be done to determine concentration?

A subjective complaint, can be impaired with depression

What kind of complaint can concentration be?