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What areas should be evaluated when evaluating a psychiatric patient?
- Mental Status Exam
- Medication History
- Medical Assessment
- Psychological Testing
- Psychiatric Rating Scales
- Psychiatric History
- Patient’s and Family’s psychiatric history
- Social History
Mental Status Examination (MSE) includes what?
- Appearance and Attitude towards Examiner
- Insight and Judgment
- Mood and Affect
- Speech and Language
- Thought and Perceptual Disturbances
- Neuropsychiatric Evaluation
What is blocking?
When a person suddenly stops speaking without an obvious reason
What is thought blocking?
Hallucination or delusion has intruded into the person’s thinking, or upsetting issues are discussed
What is circumstantial speech?
Lacks direction because of excessive unnecessary information, but will eventually make his or her point
What is tangential speech?
Ultimate point is never made
What is perseveration?
Repetition of speech despite the patient trying to produce a new answer
What is flight of ideas?
Over productive, rapid speech during which patients jump rapidly from one idea to the next
What is mutisum?
Patient doesn’t respond even though they are aware of the discussion
What is Affect?
prevailing emotional tone – e.g. flat (no expressional change), labile, blunted
What is Mood? describes more sustained feelings than affect
What are Delusions?
- Fixed false beliefs that are not based in reality, religion, or culture
- Paranoid, somatic, or grandiose in nature, and patients may believe that they are controlled by outside force
- (Don’t try to talk the patient out of the delusion)
What are Obsessions?
Unwanted thoughts, ideas, or impulses that intrude into a person’s thinking
What are Compulsions?
Actions often performed in response to obsessions or to control anxiety associated with the obsessions.
What is Thought broadcasting?
Belief that one’s thoughts are audible to others.
What are Hallucinations?
- False sensory impressions or perceptions that occur in the absence of an external stimulus
- Auditory, visual, olfactory, or gustatory
- Continuous or intermittent
What are Illusions?
Visual perceptions that are misinterpreted, but have a real sensory stimulus.
What is included in a Neuropsychiatric Evaluation?
- sensorium (level of consciousness)
- higher cognitive functions such as orientation, abstraction, and calculation
- Drug/medication use alter results
What is Insight?
Patient’s awareness of their mental illness and the consequences of the illness on their life.
What is Judgment?
Ability to make decisions appropriate to the situation.
When performing a Medication History, what should you obtain?
- Psychiatric and Non-psychiatric
- How taken – side effects, response, why stopped
- Determine adequate trial
- Noncompliance (non-adherence) – causes
What is Axis I?
- Primary diagnosis – psychiatric
- (e.g. major depressive disorder)
What is Axis II?
- Personality disorders and developmental disorders
- (e.g. IQ issues, etc.)
What is Axis III?
- Medical diagnosis
- (e.g. HTN, DM, Thyroid, etc.)
What is Axis IV?
- Life stressors
- (e.g. broad and individualized, whatever they say they are a stressor for them)
What is Axis V?
- Global Assessment of Functioning (GAF) (1-90)
- e.g. acute care inpatients are around 20-25, normal person is around 80-85
- This is also important when billing insurance
- (Objective assessment of how severe the patient’s impairment is)
What hallucinations are most common?
- (Sometimes pleasant)