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93 Cards in this Set

  • Front
  • Back
How often do Americans with symptoms seek medical care?
1/3
- Most people contend with illnesses at home with OTC meds and home treatment
What happens to a person's behavior when they are sick?
They assume the "sick role"
- Exemption from usual responsibilities
- Expectation of care by others
- Working toward becoming healthy
- Cooperating with health care personnel in getting well
What are the personality styles?
- Dependent
- Obsessive-Compulsive and type A
- Histrionic
- Narcissistic
- Paranoid
- Passive-Aggressive
- Schizoid
Which personality style has a need to be cared for by others, resulting in the desire for excessive attention from the physician during an illness?
Dependent personality style
Which personality style, during an illness, fears loss of control and may in turn become controlling during illness, characterized by time pressure (eg, feels rushed most of the time) and competitiveness, may also show hostility (which is associated with the development of coronary artery disease)?
Obsessive-Compulsive and type A
Which personality style, during an illness, may be dramatic, emotionally changeable, and approach the physician in an inappropriate sexual fashion during illness?
Histrionic
Which personality style, during an illness, has a perfect self-image, which is threatened by illness, and often feels superior to others and therefore may request that only the "top" physicians be involved in treatment?
Narcissistic
Which personality style, during an illness, often blames the physician for the illness and is overly sensitive to a perceived lack of attention or caring from the physician?
Paranoid
Which personality style, during an illness, asks for help but then does not comply with the physician's advice?
Passive-Aggressive
Which personality style, during an illness, becomes even more withdrawn?
Schizoid
How is it determined how and when information about an illness is given to a child?
The parents decide if, how, and when information is given
What should you do / not do for an angry patient?
- Do acknowledge the patient's anger
- Do not take the patient's anger personally (the patient is probably fearful about becoming dependent as well as of being ill)
What should you do / not do for a seductive patient?
- Do call in a chaperone
- Do gather information using direct rather than open-ended questions
- Do set limits on behavior you will tolerate

- Do not refuse to see the patient
- Do not refer the patient to another physician
What should you do / not do for a non-compliant patient?
- Do examine patient's willingness to change their health-threatening behavior; if they are not willing, you must address that issue
- Do identify the real reason for patient's refusal to comply or to consent to a needed intervention and address it (eg, fear)

- Do not attempt to scare the patient into complying (eg, showing frightening photos of untreated illness)
- Do not refer patient to another physician
What should you do / not do for a suicidal patient?
- Do assess seriousness of threat
- Do suggest patient remain in hospital voluntarily if threat is serious

- Do not release a hospitalized patient who is a threat to themselves (patients who are a threat to self or others can be held involuntarily)
What should you do / not do for a complaining patient?
- Do encourage them to speak to the other physician directly if patient complains about a relationship with another physician
- Do speak to own office staff if patient has a complaint about one of them

- Do not intervene in patient's relationship with another physician unless there is a medical reason to do so
- Do not blame the patient for problems with office staff
What about a patient can unconsciously increase or decrease compliance?
Their unconscious transference reactions to their physicians which are based in childhood parent-child relationships
How does patient intelligence, education, sex, religion, race, socioeconomic status, or marital status affect compliance?
They are not related to compliance
What is most closely related to how compliant a patient will be?
How well the patient likes the doctor - strength of this relationship is the most important factor in whether or not they will sue the doctor when an error or omission is made or when there is a poor outcome
What is the appropriate physical setting for a clinical interview?
- As private as possible
- No desk or other obstacle between patient and physician
- Eye level interaction (both seated)
What are the factors associated with increased compliance?
- Good physician-patient relationship
- Patient feels ill and usual activities are disrupted by illness
- Short time spent in waiting room
- Belief that benefits of care outweigh its financial and time costs
- Written diagnosis and instructions for treatment
- Acute illness
- Recommending only one behavioral change at a time
- Simple treatment schedule
- Older physician
- Peer support
What are the factors associated with decreased compliance?
- Poor physician-patient relationship
- Patient experiences few symptoms and little disruption of usual activities
- Long time spent in waiting room
- Belief that financial and time costs of care outweight its benefits
- Verbal diagnosis and instructions for treatment
- Chronic illness
- Recommending multiple behavioral changes at a time
- Complex treatment schedule
- Younger physician
- Little peer support
How does the physician-patient relationship affect compliance?
- Increased compliance = good relationship
- Liking the physician is the most important factor in compliance, it is even more important than the physician's technical skill
- Physicians perceived as unapproachable have low compliance from patients
How does the perceived symptoms of the patient affect compliance?
- Increased compliance = patient feels ill and usual activities are disrupted by illness
- Decreased compliance = few symptoms, little disruption of usual activities
- In asymptomatic illness (eg, HTN), only 1/2 of patients initially comply with treatment
- Many asymptomatic patients who initially complied have stop complying within 1 year of diagnosis
How does the time spent in the waiting room affect compliance?
- Increased: short time
- Decreased: long time
- Patients kept waiting get angry and fail to comply
How does the perception of benefits of care vs financial and time costs of care affect compliance?
- Increased compliance = belief that benefits of care outweigh financial and time costs
- Health Belief Model of health care
How does the delivery of diagnosis and instructions for treatment affect compliance?
- Increased compliance = written
- Decreased compliance = verbal
- Patients often forget what is said during a visit because they are anxious
- Asking patient to repeat your verbal instructions can improve understanding and increase compliance
How does the acuity of an illness affect compliance?
- Increased compliance = acute illness
- Decreased compliance = chronic illness
- Chronically ill people see physicians more often but are more critical of them than acutely ill people
How does the number of behavioral changes recommended affect compliance?
- Increased compliance = one recommendation
- Decreased compliance = multiple recommendations
- Recommending too many changes at once will reduce the likelihood that patient will make any changes
How does the treatment schedule affect compliance?
- Increased compliance = simple
- Decreased compliance = complex
- Compliance is higher when meds require once daily dosing, preferably with a meal
- More likely to forget to take meds requiring frequent or between meal dosing
How does the age of the physician affect compliance?
- Increased compliance = older physician
- Decreased compliance = younger physician
- Usually young physician age is only an issue for patients in the initial stages of treatment
How does the peer support affect compliance?
- Increased compliance = more peer support
- Membership in a group of people with a similar problem (eg, smoking) can increase compliance
What should you do if a patient appears dangerous or threatening?
Obtain backup (eg, hospital security)
What techniques can be used to establish rapport? Use?
- Support and empathy: express physician's interest, understanding, and concern for patient (eg, "You must have been really frightened when you realized you were going to fall")

- Validation: give value and credence to patient's feelings (eg, "Many people would feel the same way if they had been injured as you were")
What techniques can be used to maximize information gathering? Use?
- Facilitation: encourage patient to elaborate by a verbal question or body language, such as quizzical expression (eg, " And then what happened?")

- Reflection: encourage elaboration of answer by repeating part of previous response (eg, "You said that your pain increased after lifting the package?")

- Silence: increase patient's responsiveness (eg, waiting silently for patient to speak)
What techniques can be used to clarify information? Use?
- Confrontation: call patient's attention to inconsistencies in their responses or body language (eg, "You say that you are not worried about tomorrow's surgery, but you seem really nervous to me")

- Recapitulation: sum up all of the information obtained during interview to ensure you understand (eg, "Let's go over what you told me today...")
What is the function of direct questions?
Elicit specific information quickly in an emergency situation or when the patient is seductive or overly talkative
What is the function of open-ended questions?
More likely to aid in obtaining information about the patient and not close of potential areas of pertinent information; encourages patient to speak freely
A child is tested and is found to have an IQ of 90. What category of intellectual function best describes this child?

(A) Severely retarded
(B) Moderately retarded
(C) Mildly retarded
(D) Borderline
(E) Normal
Normal (90-109)
What are psychological tests used to assess?
- Intelligence
- Achievement
- Personality
- Psychopathology
What are the benefits of individual testing?
Careful observation and evaluation of that particular person
What are the benefits of group testing?
Efficient administration, grading, and statistical analysis
What is a test battery?
Looks at functioning of an individual in a number of different functional areas
What is "intelligence"?
Ability to understand abstract concepts; reason; assimilate, recall, analyze, and organize information; and meet the special needs of new situations
What is the term for a person's level of intellectual functioning?
Mental Age (MA)
What is the term for a person's actual age in years?
Chronological Age (CA)
What is the difference between Mental Age (MA) and Chronological Age (CA)?
- MA: person's level of intellectual functioning
- CA: person's actual age in years
How is the IQ determined?
(MA / CA) * 100 = IQ

MA = Mental Age
CA = Chronological Age

Highest CA used to determine IQ is 15 years
What determines IQ?
- Large extent determined by genetics
- Poor nutrition and illness during development can negatively affect IQ
- Results are influenced by cultural background and emotional response to testing situations
How does IQ change with age?
IQ is relatively stable throughout life, in the absence of brain pathology, and individual's IQ is essentially the same in old age as in childhood
What is a normal or average IQ?
Range of 90-109

IQ of 100 means MA and CA are approximately the same
MA = Mental Age
CA = Chronological Age
What is the standard deviation in IQ scores? Implications for understanding score?
- Standard deviation = 15

Scoring:
- 71-84: borderline intellectual functioning
- 50-70: mild mental retardation
- 35-55: moderate mental retardation
- 20-40: severe mental retardation
- < 20: profound mental retardation

(Person < 2 SD below mean (IQ < 70) considered mentally retarded; a person >2 SD above mean (IQ > 130) considered superior intelligence)
What is the most commonly used IQ test?
Wechsler Intelligence Tests
- Wechsler Adult Intelligence Scale-Revised (WAIS-R) is most commonly used IQ test
- 11 subtests: 6 verbal and 5 performance

- Wechsler Intelligence Scale for Children-Revised (WISC-R) used for children 6-16.5 years

- Wechsler Preschool and Primarily Scale of Intelligence (WPPSI) used for children 4-6.5 years
What are some related intelligence tests?
- Vineland Social Maturity Scale: evaluates skills for daily living (eg, dressing, using telephone) in mentally retarded and other challenged people (eg, impaired vision or hearing)

- Wisconsin Card Sorting Test (WCST) and Stroop Color Word Test assess executive function as well as ability to reason abstractly, solve problems, attend to a specific task while inhibiting interfering stimuli
What are the uses of achievement tests?
- Evaluate how well an individual has mastered specific subject areas, such as reading or math
- Used for evaluation and career counseling in schools and industry
What kind of tests rae the SAT, MCAT, and USMLE?
Achievement tests
What are the uses of personality tests?
Evaluate psychopathology and personality characteristics
How are personality tests categorized?
By whether information is gathered objectively or projectively
What are the characteristics of an "objective" personality test?
Based on questions that are easily scored and statistically analyzed
What are the characteristics of an "projective" personality test?
Requires the subject to interpret questions, responses are assumed to be based on the subject's motivational state and defense mechanisms.
What are the commonly used personality tests?
- Minnesota Multiphasic Personality Inventory (MMPI-2)
- Rorschach Test
- Thematic Appreciation Test (TAT)
- Sentence Completion Test (SCT)
Which personality test has the following characteristics? Uses?
- Objective test
- Patients answer 567 T or F questions about themselves
- Clinical scales include depression, paranoia, schizophrenia, and hypochondriasis
- Validity scales identify trying to look ill (faking bad) or trying to look well (faking good)
Minnesota Multiphasic Personality Inventory (MMPI-2)
- Most commonly used objective personality test
- Useful for PCPs because no training is required for administration and scoring
- Evaluates attitude of the patient toward taking the test

- Eg, "I avoid most social situations: T/F"
- Eg, "I often feel jealous: T/F"
Which personality test has the following characteristics? Uses?
- Projective test
- Patients are asked to interpret 10 bilaterally symmetrical inkblot designs (eg, describe what you see in this figure)
Rorschach Test
- Most commonly used projective personality test
- Used to identify thought disorders and defense mechanisms
Which personality test has the following characteristics? Uses?
- Projective test
- Patients asked to create verbal scenarios based on 30 drawings depicting ambiguous situations (eg, using this picture make up a story that has a beginning, a middle, and an end)
Thematic Appreciation Test (TAT)
- Stories are used to evaluate unconscious emotions and conflicts
Which personality test has the following characteristics? Uses?
- Projective test
- Patients complete sentences started by the examiner
Sentence Completion Test
- Used to identify worries and problems using verbal associations
- Eg, "My mother..."
- Eg, "I wish..."
- Eg, "Most people..."
What is the most commonly used objective personality test?
Minnesota Multiphasic Personality Inventory (MMPI-2)
What is the most commonly used projective personality test?
Rorschach Test
What kind of questions are asked during the psychiatric history?
- Mental illness
- Drug and alcohol use
- Sexual activity
- Current living situation
- Sources of stress
What variables does the mental status examination evaluate?
- General presentation (appearance, behavior, attitude toward interviewer, level of consciousness)
- Cognition (orientation, memory, attention, concentration; cognitive, spatial, and abstraction abilities; and speech)
- Mood and affect (described mood and demonstrated affect, match of emotions with current events)
- Thought (form or process of thought, thought content)
- Perception (illusions or hallucinations)
- Judgment and Insight
- Reliability
- Control of Aggressive and Sexual Impulses
What is the psychopathologic state of strong feelings of elation?
Euphoric Mood
What is the psychopathologic state of feelings of self-importance and generosity?
Expansive Mood
What is the psychopathologic state of being easily annoyed and quick to anger?
Irritable Mood
What is the psychopathologic state of normal mood with no significant depression or elevation of mood?
Euthymic Mood
What is the psychopathologic state of being subjectively unpleasant feeling?
Dysphoric Mood
What is the psychopathologic state of having an inability to feel pleasure?
Anhedonic Mood
What is the psychopathologic state of having alterations between euphoric and dysphoric moods?
Labile Mood (mood swings)
What is the psychopathologic state of having decreased displays of emotional responses?
Restricted Affect
What is the psychopathologic state of having strongly decreased display of emotional responses?
Blunted Affect
What is the psychopathologic state of having complete lack of emotional responses?
Flat Affect
What is the psychopathologic state of having sudden alterations in emotional responses not related to environmental events?
Labile Affect
What is the psychopathologic state of fright caused by real danger?
Fear
What is the psychopathologic state of having fright caused by imagined danger?
Anxiety
What is the psychopathologic state of having fright not associated with any specific cause?
Free floating anxiety
What is the psychopathologic state of being alert, able to follow commands, with normal verbal responses?
Normal consciousness and attention
What is the psychopathologic state of being unable to respond normally to external events?
Clouding of consciousness
What is the psychopathologic state of having abnormal sleepiness?
Somnolence
What is the psychopathologic state of responding only to shouting, shaking, or uncomfortable prodding?
Stupor
What is the psychopathologic state of being totally unresponsive?
Coma
A 12-year-old child who is having difficulty in school is given an intelligence test. The test determines that the child is functioning mentally at the level of an 8-year-old child. What category of intellectual function best describes this child?

(A) Severely retarded
(B) Moderately retarded
(C) Mildly retarded
(D) Borderline
(E) Normal
Mildly mentally retarded
(IQ = 8/12 * 100 = 66)

Scoring:
- 71-84: borderline intellectual functioning
- 50-70: mild mental retardation
- 35-55: moderate mental retardation
- 20-40: severe mental retardation
- < 20: profound mental retardation
A physician examines a severely depressed 75-year-old woman. The woman relates that she feels so low that she cannot enjoy anything in her life, and that even win- ning the state lottery would not make her feel any better. The best description of this patient’s mood is

(A) anhedonic
(B) dysphoric
(C) euthymic
(D) labile
(E) euphoric
The answer is A.
This severely depressed 75-year-old woman is showing anhedonia, the inability to feel pleasure, a characteristic of severe depression. Euphoric mood is an elated mood while euthymic mood is a normal mood, with no significant depression or eleva- tion. Dysphoric mood is a subjectively unpleasant feeling. Labile moods (mood swings) are alterations between euphoric and dysthymic moods.
For evaluating the self-care skills of a 22-year-old woman with an IQ of 60 for placement in a group home, what is the most appropriate test?

(A) Thematic Apperception Test (TAT)
(B) Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)
(C) Wechsler Intelligence Scale for Children-
Revised ( WISC-R)
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) Wide Range Achievement Test (WRAT)
(G) Beck Depression Inventory-II (BDI-II)
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test
The answer is E.

The Vineland Social Maturity Scale is the most appropriate test for evaluating the self-care skills of this woman with mental retardation for placement in a group home.
For evaluating depression in a 54-year-old male patient using a self-rating scale, what is the most appropriate test?

(A) Thematic Apperception Test (TAT)
(B) Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)
(C) Wechsler Intelligence Scale for Children-
Revised ( WISC-R)
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) Wide Range Achievement Test (WRAT)
(G) Beck Depression Inventory-II (BDI-II)
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test
The answer is G.
For evaluating depression in this patient using a self-rating scale, the most appropriate test is the Beck Depression Inventory-II (BDI-II). In the Raskin Depression Scale the patient is rated by an examiner.
The most appropriate test for evaluating abstract reasoning and problem solving in a 54-year-old female patient is the

(A) Thematic Apperception Test (TAT)
(B) Minnesota Multiphasic Personality
Inventory-2 (MMPI-2)
(C) Wechsler Intelligence Scale for Children-
Revised ( WISC-R)
(D) Rorschach Test
(E) Vineland Social Maturity Scale
(F) Wide Range Achievement Test (WRAT)
(G) Beck Depression Inventory-II (BDI-II)
(H) Raskin Depression Scale
(I) Wisconsin Card Sorting Test
The answer is I.

The Wisconsin Card Sorting Test is the most appropriate test for evaluating abstract reasoning and problem solving in a patient. In this test a patient is asked to sort 128 response cards that vary in color, form, and number.