Describe the Multiaxial Diagnosis System
"Axis I: Psych diagnosis
Axis 2: Personality and mental disorders
Axis 3: Medical dx (current e.g. HTN, diabetes)
Axis 4: Life stressors
Axis 5: Global assessment of functioning (1-90)"
Is GAF score useful information?
Not very. It's manipulated to lt 30 so insurance will pay.
Define the mental status exam process
Description of patient behavior, thoughts, perceptions, function. And objective evaluation used for dx, assessment, and response. Components are: Appearance/attitude, activity, speech, mood/affect, though/perceptual disturbances,
Define the mental status exam components: Appearance and attitude.
overall dress, cleanliness, facial expressions, hostility, withdrawn, etc.
Define the mental status exam components: Activity
motor, fidgeting, overactivity, under activity
Define the mental status exam components: Speech
Abnormal speech: blocking
suddenly stops speaking
Abnormal speech: thought blocking
a hallucination or delusion has intruded into their thinking
Abnormal speech: circumstantial speech
lacks direction because of unnecessary information, but pt eventually makes his point
Abnormal speech: tangential speech
point is never made
Abnormal speech: perseveration
repetition of speech despite pt trying to produce new answer
Abnormal speech: flight of ideas
over productive, rapid speech jumping from one idea to another
Abnormal speech: mutism
pt doesn't respond even though they are aware of the discussion
Define the mental status exam components: Mood/affect
"affect: prevailing emotional tone (flat, labile, blunted)
mood: describes more sustained feelings"
Define the mental status exam components: Thought/perceptual disturbances
Thought and perceptual disturbances: delusions
Fixed false beliefs (not reality, religion, or culture). Can be paranoid, somatic, or grandiose. Pt may believe they are controlled by an outside source.
Should you try to talk a pt out of a delusion?
Thought and perceptual disturbances: obsessions
unwanted thoughts, ideas, impulses that intrude into pt's thinking. Pt is aware they are not normal.
Thought and perceptual disturbances: compulsions
actions performed in response to obsessions or to control anxiety with obsessions
Thought and perceptual disturbances: thought broadcasting
thinks others can hear their thoughts
Thought and perceptual disturbances: hallucinations
false sensory impressions with no external stimuli.
Thought and perceptual disturbances: illusions
visual perceptions that are misinterpreted, but have real sensory stimulus
Define the mental status exam components: Neuropsych eval
attention, concentration, memory, and higher cognitive functions (orientation, abstraction, calculation)
Define the mental status exam components: Insight/judgment
"insight: pt's awareness of their mental illness
judgment: ability to make appropriate decisions
Example: thinks nothing is wrong with him so doesn't take meds."
Thought and perceptual disturbances: psych hx
pt and family, social hx
Thought and perceptual disturbances: med hx
psych and non-psych, sig, determine adequate trial, non-compliance
Thought and perceptual disturbances: medical assessment
medical-psych can cross over, med conditions can cause psych symptoms
Thought and perceptual disturbances: psych testing
personality tests, IQ, neuropsych tests
Thought and perceptual disturbances: psych rating scales
clinician rated, patient rated
Recall significant personality disorder components and possible treatments and consequences
Pts don't know they have a disorder.
paranoid personality disorder
schizoid personality disorder
schizotypeal personality disorder
borderline personality disorder
self-mutilate, manipulative, anger
antisocial personality disorder
disregard for rights of others, present since adolescence
narcissistic personality disorder
histrionic personality disorder
avoidant personality disorder
dependent personality disorder
compulsive personality disorder
differs from Axis I because pt does not know anything is wrong
personality disorder NOS
treatment for personality disorders?
Train them to behave differently. Not very effective. Can't change the personality.