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Flashcards in 2nd Objective - Psych Exam Deck (22)
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1
Q

The major purpose of the initial psychiatric interview, to include; prediction of illness course which is…

A
  • The assessment section where you explain what and why the patient’s problem is.
  • Includes professional observations and thoughts regarding the patient encounter.
  • May include a DDx or progress note. Usually in paragraph form.
2
Q

The major purpose of the initial psychiatric interview, to include; treatment decisions which is…

A
  • The plan section where you explain how you will manage the patient’s problem.
  • Usually in list form.
  • Includes lab/imaging obtained, medication changes, reasons to return.
3
Q

State some interviewing skills that can facilitate good rapport and trust in this patient population

A

Ensuring confidentiality, obtaining consent before talking to family members, not disclosing personal information when talking to family members, treating the patient with respect, maintaining a non-judgmental attitude, displaying nonverbal interventions such as head nodding, putting down the pen, leaning toward the patient, empathetic interventions or brief comments can accomplish objectivity and empathy and facilitate good rapport and trust with patients.

4
Q

Obtaining an adequate medical and psychiatric history on the chronically mentally ill patient is important because…

A

Will allow the clinician to know where to start with current treatment options.
• Knowing what symptoms the patient has experienced in the past related to similar or different disorders
• Asking what medications or treatments worked versus those that didn’t, and assessing prior self-harming behaviors are all of importance during a new visit.
• Patient reactions to these illnesses and the coping skills employed will provide a good basis of what to expect, potential causes of mental illness as well as comorbid or confounding factors that may dictate potential treatment options or limitations
• Medical illnesses can precipitate or mimic a psychiatric disorder.

5
Q

What are the challenges and option to acknowledge areas of possible difficulty with regards to cultural issues

A

• The challenges relating to cultural issues include the presentation of illness, the decision when and where to seek care, the decision as to what information to share, and the acceptance of and participation in treatment plans.

6
Q

What are the challenges and option to acknowledge areas of possible difficulty with regards to utilizing an interpreter

A
  • It might make the patient feel uncomfortable to share information to another person they do not know.
  • It might also be a challenge because the interpreter might not translate everything the patient says.
  • On the opposite side, an interpreter may be able to explain cultural beliefs better than the patient is able to convey or express.
  • When using an interpreter, continue to speak directly to the patient and pretend like there is no middle man.
  • Family members should not be used as interpreters if at all possible because they may not portray the portray a patient’s deficits or the patient may be reluctant to discuss sensitive issues in front of that family member
7
Q

Identify the components of the initial psychiatric interview

A
  • Identifying data
  • source and reliability
  • chief complaint
  • present illness
  • past psychiatric history
  • substance use/abuse
  • past medical history
  • family history
  • developmental and social history
  • review of systems
  • mental status examination
  • physical examination
  • formulation
  • DSM-5 diagnoses
  • treatment plan
8
Q

What are the elements of the psychiatric ROS

A
  • A ROS is crucial to formulating and delineating a differential diagnosis.
  • It is used to reveal diagnoses that may not be apparent when obtaining the HPI.
  • It is also used to rule out diagnoses.
  • It is often helpful to block together groups of signs and symptoms based on a unifying diagnosis.
9
Q

Components of the mental status exam and demonstrate the ability to conduct a mini-mental status exam.

A
  • The mental status exam begins the moment that the appointment or encounter begins.
  • It involves appearance, behavior, motor activity, speech, mood, affect, thought content, thought processes, perceptual disturbances, cognation, abstract reasoning, insight and judgment.
10
Q

Appearance

A

How the pt acts during the interview.
• Distinguishing features, including disfigurations, scars, and tattoos, are noted.
• Grooming and hygiene also are included in the overall appearance and can be clues to the patient’s level of functioning.

11
Q

Behavior

A

General statement about whether he or she is exhibiting acute distress and then a more specific statement about the patient’s approach to the interview.
• The patient may be described as cooperative, agitated, disinhibited, disinterested, etc.

12
Q

Motor Activity

A
  • Normal, slow, or agitated.
  • Gives clues to diagnosis as well as confounding neurological and medical issues. Gait, freedom of movement, any unusual or sustained postures, pacing, and handwriting. jitteriness, tremor, apparent restlessness, lip-smacking, and tongue protrusions. These can be clues to adverse reactions or side effects of medications.
13
Q

Speech

A

Elements considered include
• fluency (English or non English speaker)
• amount (normal, increased, or decreased)
• rate (slow, rapid)
• tone and volume (irritable, anxious, dysphoric, loud, quiet, timid, angry, or childlike).

14
Q

Mood

A

Defined as the patient’s internal and sustained emotional state.
• Its experience is subjective, and hence it is best to use the patient’s own words in describing his or her mood.
• Terms such as “sad,” “angry,” “guilty,” or “anxious” are common descriptions of mood

15
Q

Affect

A

The expression of mood or what the patient’s mood appears to be.
• Described with the following elements: quality, quantity, range, appropriateness, and congruence.
• Terms used to describe quality or tone is dysphoric, happy, euthymic, irritable, angry, agitated, tearful, sobbing, and flat.

16
Q

Thought Content

A

What thoughts are occurring to the patient
• Ask about Suicidality and homicidality.
• Get a sense of ideation, intent, plan, and preparation.

17
Q

Thought Process

A

How the thoughts are formulated, organized, and expressed.

• Normal thought process is typically described as linear, organized, and goal directed

18
Q

Perceptual disturbances

A

hallucinations, illusions, depersonalization, and derealization.

19
Q

Cognation

A

cognitive functioning that should be assessed are alertness, orientation, concentration, memory (both short and long term), calculation, fund of knowledge, abstract reasoning, insight, and judgment.

20
Q

Abstract reasoning

A

Ability to shift back and forth between general concepts and specific examples.

21
Q

Insight

A

Patient’s understanding of how he or she is feeling, presenting, and functioning as well as the potential causes of his or her psychiatric presentation.
• May have none, partial or full insight.

22
Q

Judgment

A

Person’s capacity to make good decisions and act on them.
• The level of judgment may or may not correlate to the level of insight.
• A patient may have no insight into his or her illness but have good judgment