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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overall dress, cleanliness, facial expressions, hostility, withdrawn, etc.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?

Heck no.

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.

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