Lecture 1

Psychiatry Presented by Jimmy Santana, P.A. - C

Session Objectives Understand the complete psychiatric examination including the mental status exam Understand what belongs in each axis of the DSM- IV system

What Is the Mental Status Exam? A comprehensive survey of the current state of the patient’s mental functioning It assesses:. General presentation State of Consciousness Attentiveness Speech pattern Orientation Mood and affect Form of Thought Though Content Perceptual Ability Judgment Memory Intellectual Functioning

General Presentation What do you look for when evaluating the patient’s appearance? Posture Grooming Appearance for age Clothing

General Presentation How do you evaluate the patient’s behavior? Mannerisms Psychomotor agitation or retardation Tics

General Presentation How do you evaluate the patient’s attitude towards the examiner? Cooperative Seductive Hostile Defensive

Sensorium and Cognition What do you look for when evaluating the patient’s state of consciousness? Level of alertness Glasgow Coma scale [ 3(coma) to 14(completely alert)] Lethargy or sleepiness

Sensorium and Cognition How do you determine if the patient is oriented to person, place, and time? Person What is your name? Whom do you live with? Place Where are you now? Time What is the year, season, time of day?

Sensorium and Cognition How do you evaluate the patient’s memory? Immediate memory Ask to remember three words and question after 5 minutes Recent memory Ask about activities in the last 24 hours Remote memory Ask about place of birth, schools attended, or historical information that most people would know

Sensorium and Cognition How do you determine if the patient can concentrate and pay attention? Make sure that the patient pays attention to you without distractions Ask to repeat a string of three to six numbers forward and backwards Ask to spell the word WORLD backward

Sensorium and Cognition Evaluation of the patient’s cognitive abilities See if the patient can read and write (simple) Copy a simple drawing Concrete thinking (describe how a pear and an apple are alike) Abstract thinking (a rolling stone gathers no moss) Intelligence Factual knowledge(how many years are in the term of a U.S. president) Calculational ability (how much is 9 times 7)

Sensorium and Cognition Evaluation of patient’s speech Speech too loud or too soft Speech pressured (seems to push to speak quickly) Articulate clearly Deficiencies in language (show poor use of words or poor vocabulary)

Sensorium and Cognition Mood and Affect Feeling low, hopeless, helpless, suicidal (depression) Feeling high, euphoric, irritable (mania) Affect blunted, restricted, or flat (mood abnormalities) Congruent (mood and affect similar) Are the patient’s mood and affect appropriate to current situation

Thought Evaluation the patient’s form or process of thought: Do thought patterns make sense Do thought patterns follow each other logically Do thought patterns move rapidly from one to another (flight of ideas) Do thought patterns repeat over and over Do patient response to the rhyming sounds rather than the meanings of words

Thought Evaluation of patient’s thought content Patient can’t get thoughts out of head (compulsive or obsessive) Patient has fear of eating in public (phobias) Patient believes that he/she has cancer without physical evidence (hypochondriacal) Patient believes that someone is after him/her (delusional) Patient believes that someone on TV is talking about him/her (ideas of reference) Thoughts of suicide or homicide

Thought Patient’s perception Misinterpretation of reality (thinks a coat on a chair in a dark room is really a man) [illusions] False sensory perception (hearing voices or seeing insects) [hallucinations]

Thought Patient’s judgment Assess the appropriateness of patient’s behavior [what would you do if you found a stamped, addressed letter on the sidewalk?]

Thought Assessment of patient’s insights Determine whether the patient understands that he/she has a illness Determine whether the patient understands own contributions to the illness

Thought Patient’s reliability Using the patient’s responses, collateral information from friends or family to judge whether the patient is telling the truth or providing accurate information Patient’s level of impulse control Using the patient’s history and current behavior to assess whether the patient is able to control his/her aggressive and sexual impulses

Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition DSM IV is published by the American Psychiatric Association. Allows the diagnostic coding of specific psychiatric illness(es). The patient is coded along five axes. A definitive diagnosis can be made using only the first three axes.

Diagnostic and Statistical Manual of Mental Disorders, 4 th edition Axis I Clinical disorders Schizophrenia Panic disorder Major depression Other disorders Medication induced disorders Malingering

Diagnostic and Statistical Manual of Mental Disorders, 4 th edition Axis II Personality disorders Personal characteristics that may be overshadowed by the diagnosis in axis I, but that are longstanding and enduring and often have profound effect on patient functioning Mental retardation (IQ below 70) Dependent Avoidance Histrionic

Diagnostic and Statistical Manual of Mental Disorders, 4 th edition Axis III General medical conditions Physical illnesses that may be related to or affect the psychiatric problem Axis IV Psychosocial and environmental stressors Death of spouse or family member Job loss Divorce

Diagnostic and Statistical Manual of Mental Disorders, 4 th edition Axis V Global assessment of functioning (GAF) Quantification of how well the patient is functioning in everyday life GAF score of 91 – 100 indicate the patient is functioning in a superior fashion GAF score 1 – 10 indicate the patient is in serious danger of suicide or of hurting others

“ Next session’s topic is Drug and Alcohol abuse”

Lecture 1

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Lecture 1