Mental Health Assessment

Mood disorders:

• depression (MDD)

• bipolar disorder

Psychotic disorders:

• schizophrenia

Anxiety disorders:

• panic disorder

• generalized anxiety disorder (GAD)

• Social anxiety disorder (SAD)

• specific phobias

• agoraphobia (inability to escape)

Sleep - wake disorders: 

• insomnia

• shift-work disorder

• restless leg syndrome (RLS)

Other common mental health disorders:

• attention-deficit hyperactivity disorder (ADHD)

• posttraumatic stress disorder (PTSD)

• obsessive compulsive disorder (OCD)

• personality disorders

reduce stigmatizing language:

• us non-stigmatizing person-first language

• emphasize the individual first and then their disease state

• “living with depression”

Main structures of the brain:

• cerebrum (frontal, parietal, occipital, temporal lobes)

• cerebellum

• brain stem

5 major neurotransmitters in psychiatry: 

• dopamine

• norephinephrine

• serotonin

• GABA

• Glutamate

Neurotransmitters = chemical messengers that regulate…

• mood

• cognition

• behavior

Norephinephrine (NE) actions:

• alertness

• concentration

• energy

Serotonin (5-HT) actions: 

• obsessions/compulsions

• memory

• wake promoting

Dopamine (DA) actions:

• pleasure

• reward

• motivation

Serotonin (5-HT) AND Norepinephrine (NE) actions: 

• axiety

• impulse

• irritability

Serotonin (5-HT) AND Dopamine (DA) actions:

• mood cognition

• sex

• appetite

• aggression

Norepinephrine (NE) AND Dopamine (DA) actions:

• attention

• concentration

GABA actions:

• inhibitory

Glutamate actions:

• excitatory

Anxiety means there is _____ serotonin (5HT). So we _______ 5HT meds. 

• too little

• increase 5HT

• ans. for anxiety

Anxiety means there is _____ norepinephrine, so we _____ meds.

• too much

• modulate

If you have anxiety, you are given meds to ____/____ GABA.

• target or enhance

Depression means there is _____ dopamine, so we ____ DA meds.

• too little

• inc. DA

• ans. for depression

Depression mean there is ______ serotonin (5HT) so we ____ serotonin meds.

• too little

• inc. 5HT

• answer for depression

Depression means there is ______ noreinephrine (NE) so we ____ NE meds.

• too little

• inc. NE

• ans. for depression

Depression requires an ______ in glutamate so we give meds.

• increase

Schizophrenia means there is _____ Dopamine so we give meds to ____ DA.

• too much

• decrease DA

• ans. for schizo

Schitzophrenia meds block what serotonin?

• 5HT2a

Bipolar disorder means there is _____/_____ of dopamine, so we give meds to ____ DA.

• too much/imbalance

• decrease DA

• answ. for bipolar

Bipolar disorder means there is ____/____ of serotonin so we give meds to _____ serotonin.

• too much/imbalance

• modulate serotonin

• ans. for biopolar

In Bipolar disorder there is _____ glutamate.

• too much

In bipolar disorder, there is _____ GABA.

• too little

In substance use disorders, the substances ______ DA, so we give meds to ____ positive reinforcement. 

• enhance

• decrease

in Alcohol use disorder, glutamate is ______.

• targeted

In alcohol withdrawal, drugs ____ GABA actions (this can cause CNS sedation)

• enhance

ADHD means there is ____ DA, so we give meds to _____ DA. 

• too little

• increase DA

• ans. for ADHD

ADHD means there is _____ norepinephrine (NE) so we give meds to _____ NE.

• too little

• increase NE

• ans. for ADHD

Sleep promoting NTMs and Hormones:

• melatonin

• GABA

• adenosine

-

Wake promoting NTMs and Hormones:

• Norepinephrine

• Ach

• Histamine

• Serotonin

• Dopamine

• Orexin (hypocretin)

Medication targets of sleep promoters:

• melatonin agonists

• GABA - positive allosteric modulators, receptor site agonists

Medications targets of wake promoters: 

• antagonists treat insomnia (histamine, orexin)

• agonists can cause insomnia as a side effect (DA agonists)

Role in sleepiness/wakefulness - Melatonin:

• produced by pineal gland

• regulated by suprachiasmatic nucleus (biological clock)

• suppressed production in bright light environment

Role in sleepiness/wakefulness - histamine:

• released by activation of mast cells

• stress → inc. cortisol → activates SNS (fight or flight) → mast cell release → histamine production

• antihistamines promote sleep (anti-stress = relaxation = sleep)

Role in sleepiness/wakefulness - serotonin:

• stimulation of 5-HT2z receptor causes wakefulness → causes insomnia in excess

• 5HT2a antagonists cause sedation

What provides the primary diagnostic criteria for mental disorders?

• diagnostic and statistical Manual of mental disorders 

• DSM-5-TR

For diagnosis to be made, symptoms must:

• cause significant distress or impairment to

  • social, occupational, functional and academic functions

• NOT be attributable to a substance or medical condition

Before confirming psychiatric diagnosis, must rule out: 

• underlying medical causes

• substance abuse related issue

Lab to take before diagnosis:

• thyroid

• glucose

• hepatic/renal function

• pregnancy test

Imaging to take before diagnosis:

• brain MRI

Collect information before diagnosis:

• medication history

• comorbidities

• utilize rating scales

Common Screening Tools:

• PHQ-9

• GAD-7

PHQ-9 is: 

• a screening tool for depression based on the DSM 

• PHQ-2 is the prescreening for PHQ-9

GAD-7 is:

• screening tool used for anxiety based on DSM-5 criteria

Diagnostic criteria for MDD:

• more than or 5 of the following most days for at least 2 weeks:

  • depressed mood

  • loss of interest or pleasure

  • weight changes

  • sleep changes

  • psychomotor agitation or retardation

  • fatigue or reduction in energy

  • dec. concentration

  • suicidal ideation or attempt

Diagnostic Criteria for GAD:

• excessive anxiety and worry for at least 6 months

• finds it difficult to control the worry

• anxiety and worry are associated with 3 of the following:

  • restless

  • fatigued

  • difficulty concentration

  • irritability

  • muscle tension

  • sleep disturbances

Diagnostic criteria for Insomnia disorder:

• sleep complaint at least 3 nights/week

• causes significant functional distress

• occurs with lots of time for sleep

• isn’t associated with sleep-wake disorder, substance abuse, or psychiatric illness

• Symptoms: 

  • hard sleep initiation

  • hard sleep maintenance

  • early morning waking with incapability to return to sleep

what is a assessment tool for insomnia?

• insomnia severity index

Psychiatric disorder with sleep complaints:

• GAD

• MDD

• PTSD

• bipolar DO

• schizophrenia

Suicide assessment:

• avoid negative questions

• promote open dialogue

• 988 = national suicide and crisis hotline

• Columbia-Suicide Severity Rating Scale (C-SSRS) - tool for assessing risk

What are the components of the Mental Status Exam?

• appearance

• attitude

• activity

• speech

• mood/affect

• thought content

• thought process

• cognitie functions

  • insight/judgement

Appearance:

• describe the patient

• what do they look like?

• anything distinguishing?

Normal for appearance:

• well dressed

• nourished

• normal age stated

• cooperative

• receptive

Abnormal for appearance:

• poor hygiene

• dressing inappropriate

• restless or slumped 

• other out of the ordinary

Attitude:

• Mood = patient’s opinion of how they are feeling

• affect = appearance of patients emotional state

Normal for attitude:

• receptive

• cooperative

Abnormal for attitude:

• evasive

• hostile

• paranoid

• guarded

• defensive

Motor activity: 

• observe their physical movements

Normal for motor activity:

• appropriate for the situation

• body movements - voluntary, deliberate, coordinated

Abnormal for motor activity: 

• over activity

• underactivity

• rigid or odd posture

Speech:

• describe their speech

Normal for speech: 

• normal rate

• volume

• rhythm

• tone

Abnormal for speech:

• amount - lots, or none at all

• rate - fast, slow

• volume - loud, quiet

-

Normal for level of consciousness:

• awake, alert

• appropriately responding to internal and external stimuli

Abnormal for level of consciousness:

• lethargic

• stuporous

• comatose

Normal mood/affect:

• appropriate facial expressions

Abnormal mood/affect:

• labile

• inappropriate for stated mood

• depressed

• irritable

• angry

• flat or mask-like

Thought process:

• how would you describe the way they are thinking?

Normal thought process:

• organized

• logical

• timely responses to questions

Abnormal thought process: 

• disorganized

• tangential/circumstantial 

• flight of ideas

• loose associations

• word salad

• perseveration (words repeating)

• echolalia (echos your words)

• neologisms (makes up words)

• thought blocking

• confabulations (making things up)

Thought content:

• what are they thinking?

• are there SI or HI?

• voices?

Normal for thought content:

• ideas/believes within context of normal

abnormal for thought content:

• hallucinations

• delusions

• SI/HI

• Phobias

• obsessions

• compusions

Orientation/Concentration/Attention Assessment

• where are you, what time/day is it?

• spell WORLD backwards

• count back by 7s from 100

Abstraction:

• do they see things in black and white?

Normal for abstraction: 

• can interpret a proverb

• can state similarities/differences between 2 objects

Abnormal for abstraction:

• unable to abstract

• have concrete/literal interpretations

Insight and Judgement:

• do they know they have a disorder?

  • do they take their medications as prescribed?

Normal insight and judgement: 

• recognize they have abnormal symptoms

• acknowledge their diagnosis

• take steps to improve their health

Abnormal insight and judgement: 

• lacks insight

• may be unwilling to participate in health care

• stopped medications

• took too many medications

Conducting an MSE: 

• quiet area

• patient and you should be seated

• easy access to door

• open-ended questions first

• during MSE used close ended questions

• be flexible

• stay neutral

Mental health disorder impacts ______ Americans

1 in 5