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30 Cards in this Set
- Front
- Back
Case Presentation Order
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Identifying Data
HPI ROS Past Psychiatric History PMH Family Psychiatric History Past Social History MSE Working Diagnosis Differential Diagnosis Formulation Workup Treatment Prognosis |
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Past Psychiatric History
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Diagnosis
Somatic Treatments Past Treatments Hospitalizations Previous SI Previous HI Alcohol and Drug History What has worked best |
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PMH
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Medical Problems
Medications Allergies Seizures Head Injuries |
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Social History
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Developmental History
Educational Level Current Family Employment and Disability Military History Legal History Abuse History |
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Case Presentation Differential Diagnosis
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Organic Etiologies
Psychosis Anxiety Affective Substance Somatoform ADHD TD BIQ/MR |
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Organic Etiology Differential Diagnosis
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Medication Interactions (from OTC, withdrawal, herbals, or illicit drugs)
HIV and ARC Encephalopathy (from Ca, Na, Mg, renal, or LFTs) MS Seizures Autoimmune and Connective Tissue Diseases Endocrine (thyroid or pancreas) |
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GAF
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90-100 – never symptoms
80-90 – no symptoms 70-80 – expected symptoms 60-70 – mild symptoms 50-60 – moderate symptoms 40-50 – serious symptoms 30-40 – severe impairments in multiple areas / reality testing impairments 20-30 – behavior influenced by reality testing impairments 10-20 – danger of harm; self-care compromised; gross impairments 1-10 – persistent danger; hygiene care non-existent |
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Formulation Elements
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Introduction
Strengths Liabilities |
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Biological Formulation Introduction
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Anatomical, structural, and molecular substrates of disease and the effect on the patient’s biological functioning
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Biological Formulation Strengths
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Physical conditioning
Nutritional status Stable medical problems |
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Biological Functioning Liabilities
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Genetic predisposition
Medical conditions Drug effects (both prescription and illicit) Early life trauma and kindling |
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Psychological Formulation Introduction
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Treatment of the effects of psychodynamic factors, motivation, and personality on the experience of and reaction to illness
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Psychological Formulation Strengths
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Intelligence
Willingness to accept help Religion |
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Psychological Formulation Liabilities
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Low self-esteem
Impulsive behaviors Losses Drives Narcissistic injuries Defense mechanisms Cognitive distortions |
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Social Formulation Introduction
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Examines cultural, environmental, and family influences on the expression of and experience of illness
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Social Formulation Strengths
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Skilled
Employed Educated Financially solvent Needed by someone |
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Social Formulation Liabilities
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Stresses (occupational, partner, etc)
Lacking support network |
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Case Presentation’s Workup Plan
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Safety (be dramatic)
Review of Medical Records (with the patient’s permission) Ancillary Data Labs (“my usual practice is to shotgun, but in this case I am specifically looking for…”) Serial Examinations and Interviews (“It goes without saying that I would interview for longer and schedule further interviews) Imaging Studies |
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Elements of the Treatment Plan
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Identification of the Goals of Treatment (both short- and long-term)
Psychoeducation Biological Psychological Social |
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Short-Term Treatment Goals
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Physical safety of all involved in the care of the patient
Engagement in treatment which will lead to compliance Alleviation of primary symptoms |
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Long-Term Treatment Goals
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Development of autonomy
Responsibility awareness Foster and further insight Social skills training |
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Elements of Psychoeducation
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Signs and symptoms of illness
Meaning of mental illness Mental health resources (especially emergency psychiatric resources) Relapse prevention |
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Goals of Biological Treatment
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Rapid alleviation of symptoms
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Elements of Biological Treatments
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Somatic treatments
Light therapy |
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Goals of Psychological Treatments
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Foster autonomy, insight, and responsibility awareness
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Psychodynamic Psychotherapy
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Believes current behavior, emotions, capacities for functioning, and patterns of relationships are deeply influenced by one’s experience throughout life
“The past shapes the present through known and unknown factors” Treatment takes place through verbal interaction between patient and therapist in an effort to elucidate unconscious past forces that affect current emotions and behavior Paced between one to five sessions per week |
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Interpersonal Psychotherapy
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Focuses on the social role and interpersonal interactions in the patient’s past and current life experiences
Does not address internal conflict or defense mechanisms Helps to build current capacity to function by a focus on one or two problem areas and strategies to build ways of dealing with current and future problems Generally used as a short-term treatment model for depressed patients |
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CBT
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“What you think influences what you feel”
Seeks to identify the negative and faulty automatic thoughts and transform them to more realistic/rational thoughts - gather evidence of validity - refute assumptions Requires an action plan for change - homework - desensitization - increasing pleasurable activities |
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Goals of Social Treatments
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Manipulate the environment to assist the patient in the alleviation of symptoms
Answers the question of “Who will support them after they leave the office?” |
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Elements of Social Treatments
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Environmental manipulation (partial, ward, outpatient)
Work/school limitations Psychoeducation for significant others OT for work/rest/play balance and life skills learning |