Neuro - Diagnosis Classification of Psychiatric illness

avan1980's version from 2015-07-22 21:54


Diagnosis/Classification of Psych Illness and Mental Status Exam
Question Answer
Axis IMajor psychiatric illness – i.e.: schizophrenia, post traumatic stress disorder, panic disorder, bipolar illness, drug abuse 2.Tend to have episodic occurrence interspersed between periods of normalcy. 3. Sometimes diseases tend to be progressive with intermittent flare-ups (Schizophrenia).
Axis IIpersonality disorder and mental retardation 1. More chronic, enduring , and trait based.
Axis IIInon-psychiatric medical disease – i.e.: heart disease, cancer, diabetes
Axis IVpsychosocial stressors 1.Describes things that are happening in people’s life: patient finds out he has cancer, patient just lost his job, patient is getting divorced, etc.
Axis Vglobal assessment of Function
General characteristics of the mental status exam1. A rough and ready approach to wide ranging assessment of symptoms, cognition, and functioning 2.Not broad enough to be useful for research 3. Not detailed enough for differential diagnosis 4. Absolutely critical in most clinical settings 5. Different than physical exam in that it’s kind of a thing that we get from our interaction with patient. What do you really observe during the course of talking to somebody?
Content Areas of Mental Stats ExaminationABC STAMP LICKER 1. Appearance 2.Behavior 3.Cooperation 4. Speech 5. Thought 6. Affect 7. Mood 8. Perception 9. Level of consciousness 10. Insight 11 Cognition 12. Knowledge 13. Endings 14. Reliability
Appearancedifferent things you notice – 1. Grooming 2.Clothing 3. Hygiene 4. Accessories: tattoos, piercing, etc.
Behaviorwhat are they doing while they are talking to you? 1. Focused: sitting in room, making eye contact while having conversation? 2.Appropriate to situation - How do they react to different topics?Can they talk about certain things calmly but other things get them agitated? 3. inappropriate to situation: Aggressiveness, Seductiveness, Some of this behavior is used to avoid talking about certain topics. 4. Subjective impression of interaction quality – follow your gut
Cooperationwillingness to answer questions – 1. Apparent truthfulness 2. Evasiveness 3. Manipulativeness – patient trying to play you or control the interview in such a way that you didn’t talk about certain topics
Speech1 Spontaneity 2. Fluency- in Bipolar illness (when they have mania) – can talk really really fast and you won’t be able to understand them, in patients with depression – will talk very slowly, quietly 3. Volume 4. Prosody: emotional intonation in speech or capacity to appreciate emotional intonation in speech.
ThoughtForm - refers to overt patterns of language (Goal directed?, Information value) 2. Organization (Tangentiality, Circumstantiality)3. Unusual features (Neologisms (invented words); word approximations; clang associations (patient says words that are phonetically similar)), word salad (putting words together where the syntax is off) 4. Content – what are people talking about, and what are the ideas they are trying to convey? (Normality of expressed beliefs, Influence of culture, Mood congruence of ideation, Ideation – there is a continuum
Affect (a sign)1 Full vs limited 2. Quality 3.Euthymic: the persons seems to be in a pretty good mood 4.Irritable: when you talk to a person, do they get annoyed? 5. Restricted: neutral behavior (not annoyed, not in good mood) 6. Blunted: it doesn’t change no matter the situation (severe form of restricted affect) 7. Congruence to situation
Mood1. Subjective and self reported (Depression, Elation, Expansive vs euphoric [more affect], Anxiety, Anger, Does the behavior we observe in patient match with what they are telling us?
Perceptions1. Illusions – Misperception, i.e: like when you are driving, and it’s very hot and the heat distorts the light waves and it looks like there is water on the road. 2. Hallucinations - Not misperceiving, but you are seeing something that is really not there. Auditory-Characteristic, Can range from non descript whispering to well articulated voices telling the patient what to do (command hallucination)-More common in psych illness. Visual -More common in delirium. Olfactory-Seen in severe mood disorders Gustatory-Temporal lobe epilepsy (both olfactory and gustatory hallucinations)- Tactile-Can happen with any kind of psych illness.
Level of Consciousness1. Alertness (fully responsive to severe pain required) 2. Orientation (Time, Place, Person) 3. Stability/Fluctuation (Is the observed level of consciousness consistent over the assessment ) -Fluctuation: common in delirium but not in psych disease.
Insight1. Awareness of the current situation? 2. It is not orientation - instead it is focused on the “why” and “what” 3 Understanding of Symptoms, Reason for assessment / treatment, Requirements of the environment
Cognition (think mini mental state exam)1. Complex and multifaceted 2. Requires and efficient assessment
Knowledge1.Verbal: word meanings and information 2. Non-verbal: facial recognition; object recognition 3. Examination of congruence with expectations - Based one education, Based on prior life history
Endings1. Suicidality: does (Ideation, Planning, Mechanism – do they have the means to carry out plan, Rationale) 2. Homicide – wide spectrum: (Target, Reason, Mechanism – do they describe how or when they’re going to do it?)
Reliability1. Accuracy and trustworthiness of information – if patient is having hallucinations can you really trust they know what their BP medicine dose is? Is it better to contact family member? 2. Plausibility, consistency with observations/other information
Things missing in evalintoxication and gender identity related issues