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Psych Quiz 1
Terms in this set (52)
-objective evidence of a physical manifestation of a dz
-Example: RR 30, HR 110
(Provide ex -- hint hint something to do w salt & tears)
-Subjective state of physical or mental disturbance that leads to pt complaints
Example: Dizzy, palpitations, SOB
My salty tears are a symptoms of this program slowly killing me.
-Prediction of the probable course/outcome of dz, injury or developmental abnormality
-Pts with a similar dx can have a different prognosis (due to sex, age, length of dz, concurrent conditions, compliance w/ tx)
Persistent physical or mental defect, weakness or handicap that prevents a person from engaging in ordinary activities or normal life or performing a specific job.
Involves individuals interaction w/ their environment
True or false: a pt who has a medical or psychiatric disease is also considered disabled
Big fat false! Not necessarily, yo. Don't be judgemental.
What is the scale called that is used to measure disability?
WHODAS (WHO Disability Assessment Scale)
"Who Dat, Who Dat!" New Orleans Saint Fans errywhere
Any loss or abnormality of psychological, physiological, or anatomic structure or function (impairment does not mean disability)
E.g. Pt underwent right renal nephrectomy for CA. 6 weeks later she resumed normal activities. Pt has impairment, but not disability.
Medical dx rely heavily on _____, while psychiatric dx rely on ________. Psychiatric illnesses tend to lack _______.
___________ dx and tx is broader and focuses on pt physical, psychological, social and environmental aspects
You guessed it, psychological! You get a cookie.
Name that thing: medical or psychiatric
Abstract illness (mostly)
Relies on pt experience & behavior
Subjective indicator of dz
Pt communication is PARAMOUNT (ahem...)
Somatic & psychological tx modes
...JK Rowling guys, it's
Name that thing part duex:
Relies on PE & tests
Somatic tx modes
Medical. I won't mess with your head this time. For now...
What are the 5 types of psychiatric evaluations?
Brief psych interview
True or false:
In most situations, the pt must consent to the examination prior to it occurring?
Describe the general psychiatric evaluation (purpose, how long it takes, when its appropriate, and the setting)
-Main eval performed
-Comprehensive, take more than 1hr, or accomplished over several appointments
-Purpose: establish rapport w/ pt for tx, collect data for make dx and make tx plan
-Appropriate when pt is not in immediate distress and enough time to to collect info, perform mental status exam
-Office setting or bedside at institution
Emergency psych eval (performed by, key factor, time, goals)
-Psychiatrist, general practitioner, or emergency doctor performs emergency psychiatric evaluation
- Key factor: urgent intervention needed to safeguard the pt
-Limited time to collect info & take action
-Goals: collect sufficient information that is relevant to the emergency, identify the probable psychiatric condition & cause, immediately institute tx plan.
If a non-psychiatrist performs an emergency evaluation do you need to consult a psychiatrist afterward?
It is highly advisable!
True or false: emergency eval may be combined w/ tx and an extended period of observation in the hospital ER?
True....sorry this could have been a better question, but whatever, you got it right.
True or false: Emergency eval frequently involves admitting a pt to the hospital for psych tx against their will?
True or False: Under California Welfare & Institutions Code Section 5150, a pt with a psychiatric illness can be involuntarily held for 48 hrs for evaluation and tx if they are either dangerous to themselves, others, or gravely disabled?
FALSE...because it's actually 72 hours. The rest is true.
True or false: If after 72 hours the pt remains dangerous or gravely disabled WIC 5250 allows for an additional 14 days involuntary hospitalization and tx.
Now it's true.
Describe Clinical consultation (who makes the request, the scope, goals,
-At the request of a different clinician, a psychiatrist performs this
-The scope depends on the referring problem, it is up to the clinician making the referral to formulate the specific problem
- Goals: of the clinical consultation is to reach a diagnosis or conclusion in regards to the referring problem, communicate w/ the source of the consult, make recommendations for tx, and provide pt f/u as necessary.
Clinical consultation: will a competent consultant go beyond the scope of the referral when it is in the pt's best interest?
You're damn right!
Describe the Brief Psychiatric Interview (length, goals)
-Similar in the length of time & scope to an ER eval, except that the reason the patient is seeking or being referred for tx is not urgent and there is opportunity to conduct additional evaluations
-Goal: identify the pt's chief complaint, establish rapport for later evaluations and tx, and formulate a tentative dx and tx plan.
Describe Forensic Exam
-Performed when individual's mental condition raises legal issues, or it is necessary to determine their mental functioning in order to resolve a legal issue.
-Arises in the context of a judicial or administrative court proceeding
-Person's mental condition or functioning may be relevant in a criminal case or a civil case.
True or false: forensic exam is only performed by psychiatrists with special training
True or false: Unlike the other types of psychiatric evaluations, no doctor patient relationship is established when performing a forensic examination.
A non-psychiatrist can perform all the evaluations mentioned with the exception of two, which are they?
Clinical consultation and forensic exam
True or False: All 5 types of evaluation are based on basic psychiatric hx, general medical exam, and the mental status exam?
What are the 6-ish typical settings for conducting psychiatric evaluations?
1. Inpatient psychiatric wards - locked and unlocked
2. General medical/surgical wards
3. Intensive care units
4. Emergency departments
5. Medical clinics and doctor's offices
6. Nursing homes and extended care institutions
7. Prisons, jails, and schools
True or false: Each setting has different levels of privacy, opportunity for behavioral observations, safety, availability of medical personnel and diagnostic tools
True...apparently I am bad at making false questions.
True or false: One of the challenges of performing a psychiatric evaluation is becoming familiar with the various settings.
You guessed it...true. I'll try harder.
What are the 5 components of the general psychiatric exam?
1. The psychiatric exam/interview
2. The physical exam
3. The mental status exam
5. Treatment plan
The psychiatric exam/interview is composed of what 7 parts, and give a few details from each?
1. Chief complaint
2. Identifying info
3. Medical Hx
4. Family hx (to include psychiatric predisposition, behavioral sx, suicide, learning disability)
5. Social & occupational hx (to include toxic chemicals that may result in medical or psychiatric conditions, marital status, relationship hx, domestic violencelegal hx, finanes)
6. Developmental hx (important w/ children and adolescents, look for developmental delays or psychological stressors)
7. ROS- physical AND emotional sx
Describe the physical examination
The same as in medicine, it should include brief neurological exam, looking for signs of trauma (self-inflicted or otherwise) and substance abuse
Describe the mental status examination
Document pt's current emotional state & cognitive functioning in systematic format that can be used for charting the pt's progress, research, and communication w/ other members of the tx team.
True or False: The mental status examination is NOT analogous to the physical exam
False...this was the best I could do, forgive me. But yea, Mental status = Physical exam
What are the 9 components of the mental status examination?
1. General appearance
3. Motor behavior
6. Thought Process
7. Thought content
Describe General appearance
Describes the pt's physical build, unusual features, identifying marks or scars, manner of dress & hygienic state, and grooming.
-Briefly state whether the pt's physical appearance is consistent with their age and gender.
Assesses the pt's grasp of time, place, and recognition of herself or himself to the present situation.
-Pt's level of alertness and responsiveness to people around him or her and questions asked of him.
E.g. what time is it? the day? the location? the year
In pt's with obvious cognitive difficulties, orientation can be assessed by asking these standard questions:
What time is it? The day? The location? The year?
In other pt's orientation time can also be assessed by these 4 things:
a. The patient's arrival time to the appointment
b. Does the patient check their watch or a clock
c. Ability to arrange appointments
D. Ability to arrange events in chronological sequence
Orientation date is assessed by these two things:
-The patient's ability to place present date in context (e.g., tomorrow and yesterday)
-Recollection of recent holidays, birthdays, and important events concerning their
medical history (e.g., last appointment)
Orientation to person is assessed by:
1) Patient's recognition of familiar people
2) Recognition of roles of persons in the hospital, office, etc.
3) Recognition of the setting of the exam (e.g., hospital, jail, office)
Describe motor behavior:
Motor behavior evaluates the patient for abnormal body movements such as tremors, involuntary muscle movements or facial tics, gait abnormalities, posture and station (ability to stand erect) abnormalities, muscle tenseness and agitation.
Mood describes the patient's overall emotional level. For example, sadness, elation, euphoria and anxiousness are common emotional states. The term euthymic refers to a patient whose mood is normal or even-tempered.
Affect is the patient's facial expressions that give the observer a clue to their underlying mood. Typical affects are smiling, apprehension, tearfulness, hostility, anger, ambivalence and normal.
Describe Thought Processes:
Thought process assesses the patient's ability to organize information and communicate it coherently. The patient's ability to process information and respond to questions appropriately is also assessed.
Describe Thought Content:
The thought content refers to the overall theme of the patient's conversation or narrative of their situation.
Memory assesses the patient's ability to recall remote information, recent events, and immediate information.
Cognition assesses a patient's ability to mentally process information. For example, simple arithmetic, recognition of similarities between common objects, and engage in abstract thinking.
Define diagnosis in the
The diagnosis may be definitive or provisional. It should follow DSM-5 format or ICD criteria and terminology. The diagnosis may also state something about the cause of the patient's condition, additional factors affecting the patient, and their prognosis.
True or false: the tx plan outlines the proposed course of tx....state the duration and frequency of modality (medication, surgery, psychtherapy, or advice to pt)
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