Lecture 1: Principles and Psychiatric Interview

Psychiatry

medical specialty that focuses on the diagnosis and treatment of mental and behavioral disorders

Psychiatrists

medical doctors who undergo a full medical education and training in the treatment of mental disorders

What is a disorder?

a diagnosable medical condition with identifiable symptoms

-fundamental cause is unknown

What is a disease?

a diagnosable medical condition with identifiable symptoms that may be TRACED to a specific underlying biological dysfunction

define Beneficence

"doing good" for the patient

define Nonmaleficence

avoiding harm to the patient

define Autonomy

respect for the patient's status as an individual with human rights

define Justice

to treat all patients equally and equitably

Patient-Provider Boundaries

-the doctor-patient relationship is a "business" or professional relationship

-every encounter should be a professional one

-intimate and physical relationships are forbidden

what is The Psychiatric Interview

the fundamental process for gathering information for psychiatric practice

-the result of the interview is the Mental Status Examination (MSE)

What is the mnemonic for Psychiatric Interview?

A - appearance, attitude

M - mood

S - sensorium (alertness)

I - intellectual (cognitive) function

T - thought patterns and content

Appearance of Patient

You start accessing the patient before a word is exchanged

-Describe patient: age, stated gender

-Attitude: cooperative, uncooperative, belligerent, uninterested

-Describe situation: office, hospital room, emergency room

-Is the patient seeking help or coming from an outside source?

What to note about patients speech:

-Note fluency of speech: flows easily? halting? rapid?

-Note quantity of speech: excessive verbosity? sparse?

-Note quality of speech: clearly articulated? mumbled/slurred?

define Mood

(overall emotional tone)

-depressed, anxious, angry, elated, euthymic ("normal")

define Affect

(visual expression and mood)

-quality and intensity of facial expressions, consistent with mood or not

Sensorium

(different types)

-Alert to person, place, time, and situation (AOx4)

-clear sensorium vs. impaired: is patient confused? unsure of some basic facts such as location or situation?

-obtunded: a dulled or reduced level of consciousness (not knocked out but unaware of surroundings)

-unconscious or unresponsive?

note patients cognitive functions:

memory - immediate, short-term, long-term

concentration - able to focus on thoughts or tasks? able to pay attention during interview?

able to answer questions appropriately?

Circumstantial Thought Processes

uses excessive detail and verbiage but is able to convey complete thoughts

Tangential Thought Processes

thought processes change topics before reaching conclusion, may have minimal connections to each other

-their thoughts keep running and they can't remember initial thought

Loose Associations Thought Processes

thought processes jump from topic to topic with almost no logical connections

Word Salad Thought Processes

clearly articulated but logically incoherent speech with apparently random or near-random word selection

-pt. makes no sense

Delusions (thought content)

fixed but demonstrably false beliefs not amenable to logic or argument

-so false but pt. is fixed in their belief

-pt. can be stuck in their delusions for months/years

(helicopter patient example)

Hallucinations (thought content)

perceptions unrelated to an external stimulus such as hearing voices or sounds not present in the room, seeing people or objects not present in the room. can involve any sensory system, or multiple systems

Suicidal Thoughts

ALWAYS inquire about suicidal thoughts

-has the patient made plans, written notes, etc.

-can the patient maintain safety outside of a controlled environment such as a hospital?

-are they thinking about harming others (be careful of mother-child relationship)

-have to ask patient!

Documentation

-you are documenting how the patient is right now in the room with you (date and time are important)

-it serves as a "snapshot" of the patient's mental state

Cognitive Behavioral Therapy

focuses on interaction between core beliefs, thought, and feelings and guides patient to reformulate these connections to improve mood and reduce distress

Psychoanalytic Therapy

explores childhood experiences and long-standing paradigms of thought