Psychiatric Mental Health Review

Documentation:

General appearance, motor activity, speech patterns, general attitude, emotions, affect, thought processes and content, hallucinations, delusions, suicidal or homicidal thoughts.

 

Look at the diagnosis!! Why is the patient in the hospital and not at home…..ALWAYS chart to substantiate diagnosis. If patient is in for substance remember to chart the type and frequency of observations.

Mood

internal, subjectively experienced emotion. Client usually reports being happy, sad, depressed angry etc.

Affect

This is the emotional range attached to ideas which are outwardly manifested. They are external, observable manifestations of emotion ( blunted, flat, expansive, labile, constricted). 

Affective Disorders:

Major depression, Dysthymic Disorder, Bipolar I, Bipolar II, Cyclothymic Disorder, Substance induced mood disorder, mood disorder due to medical condition.

Labile Affect:

rapid change in emotional feeling and tone. It is unrelated to external stimuli.

Blunted or Constricted Affect:

disturbance is manifested by severe reduction in the intensity of affect

Flat Affect:

absence or near absence of any signs of affective expression.

Inappropriate Affect: 

incongruence between emotional feeling (tone) and the idea, thought, or speech, accompanying it

Appropriate Affect

emotional range in harmony with accompanying idea, thought, or verbalization.

Bipolar I : 

One or more manic episodes or mixed episodes (both manic and depressive) occurring every day for at least I week. Often the patient has had one or more depressive episodes.

Bipolar II:

Disorders are one or more major depressive episodes and at least one hypo-manic (elated mood) episode, but NO manic episode.

Thought Process:

this tells how the patient is thinking. Divided into Content and Form

Delusions:

false personal beliefs that are inconsistent with the person’s intelligence or cultural background. The individual continues to have the belief in spite of obvious proof that it is irrational or false. Subdivided according to their content. Persecution, Grandeur, Reference, Control or Influence, Somatic, and Nihilistic

Religiosity:

Excessive obsession or demonstration with religious ideas and behavior.

Paranoia

Extreme suspiciousness of others.

Magical Thinking

The person believes his thoughts or behaviors have control over specific  situations or people.

Flight of Ideas: 

nearly continuos flow of rapid speech with abrupt changes from topic to topic. Seen most often in manic phase of bipolar.

Loose Associations:

characterized by vague fragmented unfocused and illogical thought patterns. Observed most often in people with schizophrenia. Internal stimuli triggers this.

Circumstantiality

interruption of the stream of thought caused by excessive associations of an idea. The person gives excessive unnecessary details before giving the main idea. Serves to avoid emotionally charged issues

Tangentiality

responses that are irrelevant to the topic at hand.

Neologisms

most often seen in schizophrenic patients who are having psychotic features. The client creates new words for psychological reasons.

Clanging

rhyming words or puns. Seen most often in mania, autism, schizophrenia.

Perseveration

repetition of the same word or idea in response to a different question. Most often noted in organic mental disorders and schizophrenia.

Concrete Thinking:

literal interpretation of meanings

Word Salad:

an incoherent mixture of words and phrases consisting of real and imaginary words. Seen in severe schizophrenia.

Mutism

inability to speak

Confabulation:

fabrication of facts in response to memory impairment. Most often seen in patients with organic brain disorders. Patients are NOT lying.

 

DSM-IV terminology

Axis 1

Axis 2

Axis 3

Axis 4

Axis 5

In the DSM 5, only ONE axis now – the psychiatric diagnosis

Axis 1

this is the psychiatric diagnosis

Axis 2

this is for personality disorders and mental retardation

Axis 3

this is for medical diagnosis

Axis 4

this is where social support, family issue, or environmental problems are listed

Axis 5

the GAF  score