Term
| What is a "difficult" patient? |
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Definition
| Someone who frequently comes to sick call with vague, multiple or unexplainable symptoms. |
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Term
| What do you want to consider with a "difficult patient"? |
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Definition
| Underlying mental disorder. This is important because often times these patients respond well to treatment. |
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Term
| How many physical complaints are medically unexplained? |
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Definition
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Term
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Definition
| Something that has multiple possible symptoms (not limited to one thing). |
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Term
| What is the consequence of not properly labeling a pt's complaint as physical or physchological? |
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Definition
| They can have a decreased quality of life and treatment outcomes. |
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Term
| _____ of outpatients have a mental disorder and _____ to _____ of them go undetected? |
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Definition
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Term
| What percentage of the US population has a mental disorder? |
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Definition
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Term
| What are the identifiers for a need to do a mental health screening? |
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Definition
If symptoms >6wks
Multiple somatic symptoms
High severity of presenting symptom
Chronic pain
"difficult pt"
recent stress
low self rating of health
frequent flyer
substance abuse |
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Term
| How should you screen your pts? |
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Definition
| Using a two tier approach. Use high-yield questions at first then use more in depth questions as needed. For example start with "Over the past two weeks have you felt down, depressed etc.." |
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Term
| Why is it important to not screen everyone for mental health disorders? |
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Definition
| It takes time and is expensive |
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Term
| What is the Whitely index test used for? |
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Definition
| Hypochondria; pt rates themselves on a scale from 1-5 |
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Term
| Why can't you defer mental health screenings since soldier all take a psch test to get into the Army? |
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Definition
| Because they may have hidden their symptoms or they may have gotten worse over time |
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Term
| What is PRIME-MD used for? |
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Definition
| It is a multi-dimensional diagnostic tool for depression, anxiety, alcohol, somatoform and eating disorders. It's main draw back is that it takes time (26 questions taking 10 minutes of time). |
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Term
| What is the prevalence of anxiety in the primary care setting? |
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Definition
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Term
| What is the prevalence of mood disorders such as bipolar in the primary care setting? |
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Definition
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Term
| What is the prevalence of depression in the primary care setting? |
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Definition
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Term
| What is the prevalence of somatoform disorders (presenting with physical symptoms)? |
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Definition
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Term
| What is prevalence of alcohol and substance abuse in the primary care setting? |
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Definition
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Term
| What is the definition of a character or personality disorder? |
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Definition
| Early (childhood) onset, not related to drug abuse or other medical condition which impairs their interpersonal skills |
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Term
| Why are character and personality disorders often missed? |
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Definition
| Because they coincide with other problems like drug dependency. |
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Term
| What are the s+s of border-line personality disorder? why is it often missed? |
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Definition
| Impulsive, cut themselves, unhappy, depressed, mood swings, extremes of rage. sadness and or anxiety. Easily missed since it shares criteria with mant other personality disorders. |
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Term
| This mental illness is the 11th leading cause of death and 3rd in 10-24 year olds. |
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Definition
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Term
| What are clues to a potential suicide? |
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Definition
Recent doctor's visit (10-40% visited doctor the prior week, 1/2 in past month)
Depression or other mental disorders
Drug abuse
Family hx
family violence
firearms in house
incarceration |
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Term
| How many suicides are successful upon first attempt? |
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Definition
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Term
| Why is it important to use targeted rather than generalized screening for suicide? |
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Definition
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Term
| Which mental health disorder is the leading cause of preventable conditions? |
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Definition
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Term
| Why is drug use a part of every hx? |
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Definition
| Because of it being the leading cause of preventable disease |
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Term
| A pt that is drowsy and can't keep eyes open for long before passing out is called what? |
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Definition
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Term
| what is a pt called who can open their eyes but responds slowly and are often confused? |
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Definition
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Term
| If a pt is dressed appropriatley and well groomed on one side but not the other, what may this indicate? |
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Definition
| a brain lesion on one hemisphere or the other |
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Term
| If a pt is not responsive upon evaluation of their appearance and behavior, what do you do? |
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Definition
| Assess for coma or stupor (does not explain how you do that) |
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Term
| How do you check for responsiveness? |
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Definition
| Same way as in EMT: verbal, touching, pain |
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Term
| This pt will be distrustful and suspicious |
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Definition
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Term
| this pt will be detached from social relationships and have a restricted range of emotional expression |
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Definition
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Term
| this pt will have eccentricities in behavior and cognitive distortions. they will also have discomfort with close relationships |
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Definition
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Term
| this pt will have a disregard for the rights of others, defect in the experience of compunction (remorse) for harming others |
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Definition
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Term
| this person will have difficulty with interpersonal relationships, self-image and affective regulation (expressions) |
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Definition
| borderline personality disorder |
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Term
| this pt will be emotionally overreactive with theatrical behavior and seductiveness |
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Definition
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Term
| this pt will have persisting grandiosity, need for admiration, and a lack of empathy for others |
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Definition
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Term
| this pt will have social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation |
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Definition
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Term
| this pt is a stage-5 clinger |
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Definition
| dependent. "submission" is another word the book relates to this one. |
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Term
| What does evaluating attention, speech, mood, insight, orientation and memory do for you? |
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Definition
| It allows you to judge the pt's intelligence when paired with vocabulary and background as well as see their ability to judge and have insight. |
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Term
| What is the definition of attention? |
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Definition
| ability to focus or concentrate on one task over time |
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Term
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Definition
| an observeable feeling or tone expressed through facial expression, voice etc |
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Term
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Definition
| a more sustained emotion that may color a person's view of the world (mood is to affect as climate is to weather) |
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Term
| How long must someone have anxious symptoms for it to be officially deemed clinical anxiety? |
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Definition
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Term
| What is a panic disorder? |
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Definition
| panic attacks with intervals of anxiety about future attacks (this person must have great abs, because, as we all now know, the sympathetic division burns fat. |
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Term
| This pt has intrusive thoughts and ritualistic behavior |
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Definition
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Term
| This pt we be avoidant, numb and prone to hyperarousal. |
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Definition
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Term
| If symptoms of PTSD last for less than a few months, what is it? |
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Definition
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Term
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Definition
| an acute change in behavior/state of mind. it is worse at night and lasts hours to weeks. pt will have altered LOC |
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Term
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Definition
| a chornic disorder of mental precesses. this pt will not have an altered loc until later in the disease |
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Term
| Are men or women more likely to be depressed? |
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Definition
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Term
| what is the prevalence of post-partum depression? |
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Definition
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Term
| What are some risk factors for depression? |
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Definition
| serious illness, single, divorced, female, bereaved |
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Term
| what are some early signs of depression? |
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Definition
| low self-esteem, loss of pleasure (anhedonia), sleep disorders, difficulty concentrating |
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Term
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Definition
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Term
| What are the things your looking for when evaluating a pt's speech? |
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Definition
Quantity
Rate
Loudness
Articulation of words (Clear? nasal?)
Fluency (rate, flow) |
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Term
| What are circumlocutions? |
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Definition
| When a pt can't think of a word so uses other words to get around it. "what you write with" instead of "pen" |
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Term
| If you note that a pt is speaking fast, what may it be? what if they talk slow? |
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Definition
fast=possible manic episode
slow=depression |
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Term
| A pt that has decreased fluency may have what? |
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Definition
Aphasia (not a psychotic disorder).
If pt speaks "fluently" but words have no meaning, they have Wernicke's aphasia
If their words have meaning but lack fluency in that they go two or three words at a time, it's Broca's aphasia |
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Term
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Definition
| A type of fluency defect where a pt may say things that are malformed "I write with den" or wrong "I write with a bar" or invented "I write with a dar" |
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Term
| IF abnormalities are found with fluency, what do you do? |
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Definition
| Further testing: word comprehension, repititon, naming, reading comp and writing |
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Term
| If a pt's mood changes fast, what may it indicate? |
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Definition
| bipolar disorder. If they present with a down mood now but there are up swings in hx, think bipolar not depression. |
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Term
| Are reports from family and friends helpful when assessing a pt's mood? |
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Definition
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Term
| IF you suspect depression, what questions should you ask to assess its depth? |
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Definition
How low do you feel?
What do you see for yourself in the future?
Do ever feel that life isn't worth living?
Have you ever thought of doing away with yourself?
How would you do it?
What do you think would happen if you were dead? |
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Term
| What are you assessing when evaluating a pt's thoughts/perceptions? |
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Definition
| logic, relevance, organization, coherance |
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Term
| If a pt mentions something like they see golbins on their lawn, should you follow that lead with more questions? |
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Definition
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Term
| How should you ask questions to evaluate the thought processes of a pt? |
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Definition
| Couch them in tactful ways "Sometimes people who are upset like this {do this...} do you feel that way?" |
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Term
| When is insight best evaluated? |
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Definition
| When determining c/c "What brings you in today? This allows you to see if a pt is aware of that mood |
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Term
| In what pt would you see delusions? |
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Definition
| Psychotic pts, or those with delirium, dementia, or severe mood disorders |
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Term
| Compulsions, obsessions, phobias and anxieties are often associated with what kind of general disorders? |
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Definition
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Term
| What is the difference between an illusion and an hallucination? |
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Definition
| an illusion is triggered by a real external stimuli |
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Term
| what is the difference between an illusion and delusion? |
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Definition
| delusion is an abnormality of though, more chronic while an illusion is an acute misinterpretation of a real external stimuli |
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Term
| What is a feeling of depersonalization? |
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Definition
| a sense that one's self is different, changed, or unreal. detached form oneself |
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Term
| what is the difference between feelings of unreality and feelings of depersonalization? |
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Definition
| feelings of unreality are the sense that the environment is strange while depersonalization is about the person themself changing or being disconnected from themselves. |
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Term
| How do you assess judgement? |
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Definition
| Ask the pt how they plan on coping with certain things eg family situations, use of money etc. "How are you going to manage if you lose your job?" |
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Term
| What must you evaluate when getting feedback from a pt while assessing their judgement? what are you looking for? |
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Definition
| If their plans are based on reality or if they're disordered, based on impulse etc |
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Term
| If a pt has fucked up insight, what might this indicate? |
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Definition
| psychotic disorder may lack insight while neurological disorders may deny their impairment |
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Term
| What do you gauge to assess cognitive function? |
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Definition
orientation (person place time)
attention (serial 7s, spell backwards)
Remote memory
Recent memory
New learning ability (remember 3 words) |
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Term
| What may explain poor performance on serial 7s or spelling backwards |
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Definition
| poor performance, dementia, retardation, delirium, performance anxiety, depression or limited education |
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Term
| How do you assess higher cognitive function? |
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Definition
Start with easy questions, asking about hobbies, who's the President and then progress to harder ones. Assess diction, understanding etc.
Calculations (easy to hard)
Abstract thinking (proverbs)
COnstructional ability (copy drawing) |
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Term
| What do you assess in the mini-mental state exam? |
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Definition
Orientation
Registration (say three words, repeat back)
Reading (have pt read and do what writing says)
Record this all in objective part of SOAP |
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