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84 terms

Psych-Ch. 1-4

STUDY
PLAY
most imp. factor for dx of neuropsychiatric dz
hx, PE, observing the pt.
nature of mental illness
dz or conditions made of signs & sx that are serious, either indiv. or together, to the point that the indiv. is compromised in life endeavors including forming & sustaining good attachments to others, performing work or fulfilling a role in society & developing strengths & capacities as a person
where does the biologic origin of mental illness originate
in brain or influenced by brain processes
how is it expressed
in emotion, thoughts & behaviors
what is it NOT
1) NOT poor coping or odd people (ex. CA)
2) NOT natural response to daily stress (ex. widow)
3) NOT solely on content of thought or observable behavior
whats affected with a pt. w/ mental illness
affect one's way of engaging life
interpretation of signs & sx for dx
not straight-forward
considerations for dx
consider a medical or biologic origin (ex. post-op=confused but doesn't mean they have dementia)
what knowledge is needed of the pt. for dx
comprehensive knowledge (whats said and not said)
lifetime prevalence for a nonpsychotic mental illness worlwide (therefore)
1:8 (so its prevalent & should always consider it)
direct & indirect cost each year
1.2 trillion
% of PCP visits with mental health concerns
10-50%
% major depression in US prevalence (in women)
16% (women-20-25%)
how much is dx missed by with PCPs
50%
what screening to use (what is it)
prime md (time consuming questionnaire)
suicide % of death in US from mental health
1%
dementia % in US (in >85 yo)
3-11% (25-47%)
common to have neuropsychiatric d/o + (ex.)
other co-occuring d/o (ex. substance abuse & depression)
what are there links bw with depression
depression & CA
intervention helps
1) improve functional capacity
2) quality of life
3) survival rate
whats depression an adverse predictive factor for
heart dz function & outcome
T/F psych d/o are often seen as high utilizers of health care system
True
where does pt. prefer to go to with seeking care
PCP
whats the backbone bw clinical, ethical & legal skills
therapeutic relationship
cure or prevention
none
core of psychiatry
living with the illness
what can decrease the associated stigma
biological basis
key with difficult situations
maintaining barriers
ethical basis for pt.-provider relationship
1) beneficence
2) nonmaleficence
3) respect for autonomy
4) justice
view of illness from pt. perspective w/ his or her preference & needs
patient centered care
whats needed for informed consent
1) provide info.
2) pt. needs decision making capacity
3) pt. acts voluntarily w/out coercion
decisional capacity
1) communicate preference by speaking, writing, gesturing
2) comprehend info. needed to make decision
3) appreciate significant of decision in terms of pt.'s own circumstance
4) use info. to reason & weight options & consequences to come to a judgement
what can override the pt.'s autonomy (ex.)
involuntary admission: 302 (ex. pose danger to self)
who's responsibility is it for maintaining professional boundaries
providers
times when values & preferences differ from the provider
1) pt refusing medical tx
2) pt has diff. cultural background than provider
3) pt who poses danger to self or others
4) pt who tests professional boundaries
5) caring for the difficult pt
most essential source of info
clinical interview (observation, hx)
what can happen with pt. w/ severe sx (ex.)
may evoke strong emotional rxn in providers (ex. anxious pt.=fidgety provider)
how is ^ helpful for the provider to know this
1) obtaining a dx
2) instruct them about pt. interactions w/ others (family frustration, friends burdened)
gathering data
1) identify info
2) CC
3) family hx
4) social hx
5) premorbid personality
6) medical hx
7) meds
8) past psych hx
9) HPI
10) MSE
11) assessment
12) plan
whats critical in beginning the interview
first impression
d/o if pt. goes off topic & never comes back to main topic
thought d/o
how to get info. of premorbid personality
may need to gather from family or friends
premorbid personality
precedes occurrence of sx dz or d/o
strongest predictor for suicidal ideation
past attempts
what to know if subs. abuse
1) quantity
2) route
3) date & time of last use
4) misuse of Rx meds
5) age at 1st use
6) previous drug tx
7) hospital admission
8) WD sx
9) blackouts
10) SZ
11) flashbacks
what is the objective portion of the interview
mental status exam (MSE)
what is it
description of the pt. throughout the interview (test for cognitive impairment)
N thought process
linear & goal-oriented
gravitating further from topic
tangential
wandering off topic, but returning to subject
circumstantial
sensory awareness of object in environ. & their interrelationships (external & internal stimuli)
perception
sensory perception w/out presence of stimuli in any sensory modality (ex.)
hallucinations (ex. voices telling to do something)
misinterpretations of real external stimuli
illusions
recognition of having a mental d/o & degree of personal awareness & understanding of illness
insight
admission of illness & recognition that sx are irrational feelings or disturbances
intellectual insight
awareness of motives/feelings & underlying meaning of sx
true emotional insight
how to test for cognition
clock drawing test
T/F clock drawing test tests for dementia
false
what to do if impaired
complete dx eval for dementia (DSM-IV criteria) should be considered (include MMSE)
scores of MMSE if mild, mod or severe
mild=>21
mod=10-20
severe=<9
max total
30
type of ?'s for psychotic pt.
short concrete (avoid open-ended, long, abstract)
unpredicted violence is proceeded by
30 min of accelerated psychomotor agitation
most imp. factor to evaluate w/ tx plan (result)
harm to self or others (invol. hospitalization)
mild d/o
1) few sx
2) minor social or occupational impairment
moderate d/o
1) sx
2) functional impairment bw mild & severe
severe d/o
1) many sx
2) marked impairment in social or occupational function
partial remission
full criteria for d/o met & some sx remain
full remission
no sx remain
dx based on
DSM-IV criteria
illness w/ psychological or behavioral manifestions associated w/ significant distress & impaired function d/t biologic, social, psychological, genetic, physical or chemical disturbances
mental d/o
DSM requires
1) condition not caused by direct effects of any drug
2) psych d/o not caused by effects of medical condition
3) significant impairment of social functioning, occupational functioning or both
primary d/o (whats secondary)
med condition or subs. abuse is cause of sign or sx (psych sx are secondary)
whats needed for psych dx
1) signs/sx
2) predictable longitudinal course
3) prognosis
4) response to tx
axis I
clinical syndrome and other conditions that may be a focus of clinical attention (mood d/o, schizo, GAD)
axis II
personality d/o & MR
axis III
any general medical condition
axis IV
-psychosocial & environ. problems relevant to the illness (divorce, injury)
-list stressors
-mild, mod, severe, extreme catastrophic
axis V
-global assessment of function (GAF) exhibited by pt. during interview
-numerical rating for 100-1 (1 being the worst)
-superior to grossly impaired functioning
ex. of GAF
overdose of meds w/ intention of suicide
inability to determine main dx and there is equal contribution
dual dx
parts of MSE
1) orientation to time
2) registration (repeat words)
3) naming (object)
4) reading (read & do task)
different bw clock drawing and MMSE
1) clock drawing test for cognitive impairment, NOT dementia
2) MMSE test for cognitive impairment AND dementia
what kind of functioning does the GAF include
psychological, social & occupational (NOT physical or environmental)