Psychiatric Interview

Question 1

Sxs relating to mood:

• Angry
• Happy
• Sad

Answer 1

Psychological Sxs

Question 2

Somatic Sxs relating to body sensation:

• Pain
• Fatigue
• Palpitations

Answer 2

Physical sxs

Question 3

Do most patients present with psychological complaints, or physical complaints?

Answer 3

• 2/3 pts w/ depression present w/ physical complaints (fatigue/back pain)
• 1/3 pts w/ depression complain of multiple unexplained somatic sxs

Question 4

• What is the frequency of “difficult patient encounters?”
• Explain this encounter

Answer 4

• 15 - 20% (3 to 4 visits / day)
• Patients w/ unexplained/somatic sxs

Question 5

Unexplained sxs lasting how long should raise concern for underlying depression, anxiety, or both?

Answer 5

Over 6 weeks

Question 6

Little interest or pleasure in doing things

Answer 6

Anhedonia

Question 7

Most screening questions for depression and anxiety ask if pt have been having sxs over the past 2 weeks. Which question is asked for 4 weeks?

Answer 7

Have you had an anxiety attack (suddenly feeling fear or panic)?

Question 8

What is the mnemonic for depression?

Answer 8

SIGECAPS

Question 9

S
I
G
E
C
A
P
S

Answer 9

• S- sleep disturbance
• I - interests decreased
• G - Guilt (worthless, poor self esteem)
• E - energy decreased
• C - concentration decreased
• A - appetite disturbance
• P - psychomotor changes
• ​S - suicidal thoughts

Question 10

What is the anxiety mnemonic?

Answer 10

WATCHERS

Question 11

W
A
T
C
H
E
R
S

Answer 11

• W - Worry
• A - Anxiety
• T - Tension in muscles
• C - Concentration difficulty
• H - Hyper arousal/irritability
• E - Energy loss
• R - Restlessness
• S - Sleep disturbance

Question 12

A patient is considered “seriously ill” if they exhibit which sxs?

Answer 12

Losing interest in sex, hobbies, reading, or TV

Question 13

Substance abuse mnemonic for ETOH?

Answer 13

• C - have you eve felt you should CUT back?
• A - ANGRY or ANNOYED at others comments about your use?
• G - GUILTY about your use?
• E - EYE opener to get you going in morning?

Question 14

Substance abuse mnemonic for prescription med abuse?

Answer 14

• W - Work, school, or home role obligation failures
• I - Interpersonal or social consequences
• L - Legal problems
• D - Dangerous use

Question 15

What is the psychological equivalent of a physical exam?

Answer 15

Mental Status Exam (MSE)

Question 16

• Describes mental state & behaviors
• Incudes objective observations of clinician
• Includes subjective descriptions given by pt
• Utilized to establish dx, develop tx, & monitor progress
• “snap shot in time”

Answer 16

MSE (mental status exam)

Question 17

What 3 PE components should you also always include in a PE of a psychiatric interview along w/ MSE?

Answer 17

• Cardiac
• Pulmonary
• Vitals

Question 18

• Situation where feelings, desires, and expectations of one person are unconsciously redirected and applied to another.
• Give example

Answer 18

• Transference
• (maternal transference)

Question 19

• Provider unconsciously projects his/her feelings towards a pt

(provider develops attachment to pt)

• What should you avoid??

Answer 19

• Counter-transference
• Avoid entanglement

Question 20

Many psychiatric disorders are “familial.”

What else is familial?

Answer 20

The patient’s response to tx

Question 21

What are the 6 major components of an MSE?

Answer 21

1. Appearance/Behavior
2. Speech/Language
3. Mood/Affect
4. Thoughts/Perceptions
5. Insight/Judgement
6. Cognition

(SAMTIC)

Question 22

• The ability to focus/concentrate over time on particular stimulus or activity.
• An inattentive person is easily distractible and may have difficulty giving a hx or responding to questions
• Give an example

Answer 22

• Attention
• Ex: pt on cell phone

Question 23

• The process of registering or recording info, tested by asking for immediate repetition of material, followed by storage or retention of info.

Answer 23

Memory

Question 24

Cover minutes, hours, or days

Answer 24

Recent / Short term memory

Question 25

Refers to intervals of years

Answer 25

Remote / Long term memory

Question 26

* Awareness of personal **identity**, **place**, and **time** * Requires both **memory** and **attention**

Answer 26

Orientation

Question 27

* Sensory awareness of objects in environment & their interrelationships (external stimuli) * Refers to internal stimuli such as dreams or hallucinations

Answer 27

Perceptions

Question 28

* The logic, coherence, and relevance of the patient's thought as it leads to selected goals * "How people think"

Answer 28

Thought processes

Question 29

* What the patient thinks about (level of insight & judgement)

Answer 29

Thought content

Question 30

* Awareness that sxs or disturbed behaviors are normal or abnormal * Ex: distinguishing between daydreams and hallucinations that seem real

Answer 30

Insight

Question 31

* Process of comparing & evaluating alternatives when deciding on course of action * Reflects values that may/may not be based on reality & social conventions of norms

Answer 31

Judgement

Question 32

* A fluctuating pattern of observable behaviors that express subjective feelings or emotions through tone of voice, facial expression, & demeanor * Give 4 examples * "visualized by provider"

Answer 32

* Affect * Flat, blunted, labile, inappropriate

Question 33

* A more pervasive and sustained emotion that colors the person's perception of the world * May be: _euthymic_ (normal range), _elevated_, _dysphoric_ (unpleasant = sad/anxious/irritable) * "Patient describes this"

Answer 33

Mood

Question 34

* A complex symbolic system for expressing, receiving, & comprehending words * As with consciousness, attention, and memory, what is essential for assessing other mental functions?

Answer 34

Language

Question 35

* Assessed by _vocabulary,_ _fund of info_, _abstract thinking_, _calculations_, _construction of objects_ that have 2 or 3 dimensions

Answer 35

Higher cognitive functions (mini mental status exam)

Question 36

Level of consciousness which can be _associated w/ substance abuse_

Answer 36

Hyper-alert

Question 37

Opens eyes, looks at you and _responds appropriately to stimuli_

Answer 37

Alert

Question 38

"_drowsy_" - opens eyes, looks at you, _responds to questions, then falls asleep_

Answer 38

Lethargic

Question 39

Opens eyes, looks at you, _responds slowly and somewhat confused_

Answer 39

Obtunded

Question 40

Arouses w/ painful stimuli, slow or absent verbal responses, _lapses into unresponsive state when stimuli cease_

Answer 40

Stupor

Question 41

Unarousable w/ eyes closed

Answer 41

Coma

Question 42

* Comprehension intact * Unable to speak to varying degrees * (Pt can point to nose when prompted to do so) * (Pt can write words)

Answer 42

Expressive aphasia (Broca's)

Question 43

* Comprehension not intact * Fluent, but nonsensical speech

Answer 43

Receptive aphasia (Wernicke's)

Question 44

Combination of receptive & expressive aphasia

Answer 44

Global aphasia

Question 45

Aphasias are common with which 3 things?

Answer 45

* Strokes (MCA - medial cerebral artery) * Trauma * Mass lesions

Question 46

Impairment of language ability

Answer 46

Aphasia

Question 47

* Prevalent emotional states the pt communicated to you * Often placed in "quotes" * duration * Appropriate given the situation

Answer 47

Mood

Question 48

Themes tht occupy the patients thoughts and perceptual disturbances

Answer 48

Thought content