Behavioral Medicine: Unit 1 > Psych Interview > Flashcards

Psych Interview Flashcards

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1
Q

What is the purpose of the psych interview?

A
  1. Create a therapeutic alliance
2. Gather pertinent information
A. Emergency Department
-Brief, focused
B. Inpatient
C. Outpatient
  1. Impression/Dynamic
    A. Diagnosis: DSM V
  2. Plan appropriate treatment
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2
Q

What are the components of a psych interview?

A
  1. Identifying Information
  2. Chief Complaint (CC)
  3. History of Present Illness (HPI)
  4. Past Psychiatric History (PPH)
  5. Psychiatric Review of Systems
  6. Medical History
  7. Social History
  8. Family Psychiatric History
  9. Mental Status Examination (MSE)
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3
Q

What info is included in identifying information?

A
  1. Identifying Data
  2. Accurate Historian: not always the pt
  3. Use of Collateral Informant: parent, spouse, medical records
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4
Q

Chief complaint definition

A

Reason why pt is in office

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5
Q

What are the components of the psych HPI?

A
  1. Define the present episode
  2. Precipitants: what was the inciting factor
3. Determine acuity or chronicity
A. Frequency
B. Duration
C. Intensity
D. Past treatment
  1. Essential Themes
    A. Precipitating events in previous weeks
    B. What has caused your problem to be worse/ better
    C. Past treatment for similar/same issue
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6
Q

What are the components of past psychiatric history? (PPH)

A
  1. Obtain Syndromal History
  2. Obtain Treatment History
    Go CHaMP
    A. General questions
    B. Current psychiatric caregiver
    C. Hospitalizations
    D. Medications
    E. Psychotherapy
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7
Q

What information is included in syndromal history

A
  1. Age of onset – why is this helpful?
  2. Premorbid or baseline functioning so can compare to current state
  3. History and precipitants of subsequent episodes to present: not everyone has a prior episode
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8
Q

What is the typical age of onset for schizophrenia?

A

Males: 21
Females: 27

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9
Q

What is the typical age of onset for major depression?

A

25

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10
Q

What is the typical age of onset for bipolar disorder?

A

19

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11
Q

What is the typical age of onset for panic disorder?

A

24

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12
Q

What is the typical age of onset for OCD?

A

23

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13
Q

What is the typical age of onset for drug abuse/dependence?

A

18

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14
Q

What is the typical age of onset for alcohol abuse/dependence?

A

21

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15
Q

What are the components of the general questions in psych treatment history?

A

A. Past treatment
B. What has worked
C. What was happening in your life when you were feeling your best?

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16
Q

What are the components of the current caregiver questions in psych treatment history?

A
  1. Medication Management (MD, NP, PA, PCP)
  2. Psychotherapist
  3. Outpatient Case Manager (ACT Team)
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17
Q

What are the components of the hospitalizations component of the psych treatment history?

A
  1. Chronology
  2. How many in your life
  3. First hospitalization
  4. Hospitalizations in the past year
  5. Last hospitalization and where
  6. What life circumstances precipitated inpatient admits
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18
Q

What are the components of the medications part of the psych treatment history?

A
  1. Medications: name, route, dose, what they’ve tried in the past
  2. Compliance
  3. Herbals
  4. How long was the med trial?
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19
Q

What are the components of the psychotherapy part of the psych treatment history?

A
  1. Relationship with therapist, do they have to see changing therapists?
  2. Was therapy helpful?
  3. What sort of treatments (CBT, cognitive behavioral therapy, Dialectical Behavioral Therapy, etc)
  4. Individual or group therapy
  5. Termination
    A. What were the circumstances?
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20
Q

What questions are asked in the history of suicide part of the PPH?

A
  1. Number of Attempts
  2. When
  3. How
  4. Were you hospitalized?
  5. Residual medical issues
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21
Q

What is included in the psychiatric review of systems?

A
  1. Mood Disorder
  2. Psychotic Disorder
  3. Substance Abuse
  4. Anxiety Disorder
  5. Posttraumatic Stress Disorder
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22
Q

What are types of mood disorders?

A 
1. Depression
A. Major Depressive Disorder (MDD)
B. Dysthymia
2. Bipolar Disorder
A. Mania
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23
Q

What are the criteria for major depression disorder?

A
  1. Four of the eight symptoms present
    SIGECAPS
  2. Depressed mood or anhedonia
  3. For at least two (2) weeks
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24
Q

What does SIGECAPS for major depression stand for?

A
  1. Sleep = Insomnia or hypersomnia
  2. Interest Deficit = Anhedonia
  3. Guilt = Worthlessness, hopelessness, regret
  4. Energy deficit = Anergia
  5. Concentration deficit
  6. Appetite disorder = increased or decreased
  7. Psychomotor retardation or agitation
  8. Suicidality
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25
What are the criteria for dysthymia?
1. Two years of depression | 2. Two of the six symptoms must be present: ACHEWS
26
What does the dysthymia pneumonic ACHEWS stand for?
1. Appetite disorder 2. Concentration deficit 3. Hopelessness 4. Energy Deficits 5. Worthlessness 6. Sleep disorder
27
What are the criteria for bipolar mania criteria?
1. Elevated mood A. Three of the seven symptoms (DIGFAST) OR 2. If mood is primarily irritable A. Four of the seven symptoms for one week
28
What does the DIGFAST pneumonic for bipolar disorder stand for?
1. Distractibility 2. Indiscretion = Excessive involvement in pleasure activities 3. Grandiosity = “I am the Queen of England” 4. Flight of ideas 5. Activity increase 6. Sleep deficit = Decreased need for sleep 7. Talkativeness
29
What are the components of schizophrenia?
1. Delusions 2. Hallucinations 3. Speech disorganization 4. Behavior disorganization 5. Negative symptoms
30
Define delusions
1. Fixed, false beliefs 2. Not widely held within the context of the individuals cultural or religious group 3. Persist despite contradictory evidence 4. Distorted or illogical misinterpretations of actual events or experiences
31
What are delusions of control?
Thoughts/feelings controlled or manipulated by outside forces or agencies
32
What are delusions of grandiosity?
Belief that one has extraordinary powers, gifts, or abilities Bizarre Exaggerated
33
What are delusions of guilt?
Guilt that one has committed a terrible act or crime
34
What are delusions of reference?
Casual events have special significance to person | Messages in newspapers, people talking about you
35
What are delusions of persecutory?
``` Belief that one is being conspired against Threatened by others FBI Religious figures Extraterrestrials ```
36
What are somatic delusions?
Belief that one is carrying a severe disease Disease is not supported by medical evidence Often bizarre Attributed to outside forces
37
What are thought insertions, withdrawal, broadcasting delusions?
Implanted by an outside agency Taken out of their mind Read or heard via passive means
38
What disorders may hallucinations occur with?
``` Schizoprenia Depression Bipolar disorder Substance abuse disorders Dementia ```
39
What is the most common type of hallucination? What other types may be present?
1. May be auditory, visual, olfactory, gustatory, tactile 2. Auditory most common A. Keep a running commentary B. Unfriendly, insulting, or accusatory C. Associated with delusional themes
40
What is involved with speech disorganization asst. with schizophrenia?
A. Inability to process stimuli accurately B. Inability to link thoughts coherently/logically C. Non-linear D. Illogical
41
What are the types of disorganized speech in schizophrenia?
``` A. Circumstantiality B. Tangentiality C. Illogical D. Clanging E. Neologism F. Thought blocking ```
42
What is included in the behavior disorganization asst. with schizophrenia?
1. Poor grooming 2. Body odor 3. Bizarre clothing combinations 4. Wallet/purse filled with torn, bulging papers
43
WHat are the negative symptoms of schizophrenia?
Anhedonia Alogia Attention deficit Affective flattening Avolition Social withdrawal
44
Define anhedonia
inability to experience pleasure
45
Define Alogia
Decrease in the production and fluency of spontaneous speech; may include pauses in responses
46
Define attention deficits
Inability to maintain engagement in goal directed activity
47
Define avolition
lack of motivation, drive to initiate or complete tasks
48
What is the pneumonic asst with substance abuse disorders?
1. Pneumonic: Tempted with Cognac A. Tolerance: need for increasing amounts A. Withdrawal: symptoms have occurred C. Control (Loss of)
49
What is the loss of control asst. with substance abuse?
Substance ingested in larger amounts than intended Failed attempt to cut down Increased amounts of time obtaining or recovering Social, occupational or recreational activities suffer Continued use despite knowledge of physical or psychological problems
50
What is diagnosis criteria for substance abuse?
1. Diagnosis is three of seven criteria | 2. CAGE = 2 or more = high probability of dependence
51
What is the alcohol abuse pneumonic CAGE stand for?
1. Have you felt you should CUT back on drinking 2. Has anyone ANNOYED you with comments about your drinking 3. Have you felt GUILTY about your drinking 4. Have you ever had a EYE opener in the morning to get rid of a hangover
52
What is the diagnostic criteria for a panic attack?
``` Palpitations Chest pain Nausea SOB Choking sensation Dizziness Paresthesias Chills Fear of: Death, going crazy, shaking, sweating ```
53
Define agoraphobia
Anxiety of being in places or situations from which escape may be difficult or embarrassing Situations are avoided or endured with marked distress
54
Define OCD
Presence of obsessions, compulsions or both Causes significant dysfunction
55
What are common behaviors seen in OCD?
1. Washing 2. Straightening A. Ordering rituals 3. Mental Rituals A. Magical words, number, etc. 4. Checking 5. Hoarding
56
What are the diagnostic criteria for GAD?
1. Excessive worry for six months 2. Three of six symptoms must be present A. Muscle tension B. Fatigue C. Concentration problems D. Restlessness, feeling on edge E. Irritability F. Sleep problems
57
What is the cycle asst. with GAD?
Insomnia leads to daytime Fatigue; Fatigue causes Irritability and Concentration problems and constant worry causes Muscle tension and Restlessness.
58
What are the components of PTSD?
1. Re-experiencing: Intrusive thoughts, nightmares 2. Avoidance: Avoid things associated with trauma, 3. Arousal 4. Emotional numbing
59
What are other anxiety disorders?
1. Somatoform Disorders 2. Bulimia Nervosa 3. Anorexia Nervosa
60
What are examples of cognitive disorders?
1. Dementia 2. Delirium 3. Attention Deficit Disorder Note: 18 separate criteria PLEASE follow the DSM-V guidelines
61
What is included in the psych medical history?
1. Brief history; focus on any acute 2. Medications 3. Primary care physician 4. Allergies 5. Surgical history 6. Labs
62
What is included in the psych social history?
``` Current living situation Support systems (relationship status) Education Vocational Sexual assault Physical assault Drug/alcohol use Cigarette use Developmental history if relevant Legal issues/incarceration ```
63
What is included in the psych family history?
1. Blood relatives with mental health issues 2. May have to name diagnoses 3. History of family suicide A. Attempts and/or completion
64
What is the mental status examination?
Set of systematic observations Consolidated patterns and inferences May be brief or more comprehensive Environment dependent
65
What are the components of the MSE?
``` Appearance Behavior Speech Mood and Affect Thought Process Thought Content Cognition and Memory ```
Behavioral Medicine: Unit 1
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