N2Wk2- 9-22 Hill Axis

Front 1

Describe the major features of the DSM-IV-TR

Back 1

It is a descriptive approach, primarily designed to describe the manifestations of mental illness, does not deal with causation and supposed to be a guide but not diagnostic
- also systematic description of disorders

Front 2

Name a limitation of the DSM-IV-TR

Back 2

no causation and many of the illnesses have overlapping symptoms

Front 3

Describe axis I

Back 3

The primary clinical disorder, and other conditions that
may be a focus of clinical attention (the focus for this lecture)

Front 4

Describe axis II

Back 4

Personality disorders and mental retardation (focus of the next lecture)

Front 5

Describe Axis III

Back 5

Physical disorders or general medical conditions that
are present in addition to the Axis I disorder. These may or
may not be related to the mental almost diagnosis.

Front 6

Describe axis IV

Back 6

Psychosocial and environmental stressors (divorce, financial problems, lost job, drugs)--> rated as mild moderate or severe

Front 7

Describe axis V

Back 7

Global Assessment of Functioning (GAF):

Front 8

Describe the GAF

Back 8

global assessment of functioning (axis V)
Takes into account social, occupational and psychological functioning
1-100 with 100 being highest function (narcissistic)

Front 9

For the GAF describe what
a. 100-91

Back 9

a. Superior functioning in a wide range of activities, life’s
problems never seem to get out of hand, is sought out by others
because of his or her many positive qualities. No symptoms.

Front 10

For the GAF describe what
a. 90-81

Back 10

a. Absent or minimal symptoms, good functioning in all areas,
interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.

Front 11

For the GAF describe a score
a. 80-71

Back 11

If symptoms are present they are transient and expectable
reactions to psychosocial stressors; no more than slight impairment in social, occupational, or school functioning.

Front 12

For the GAF describe a score
a. 70-61

Back 12

Some mild symptoms OR some difficulty in social, occupational,
or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.

Front 13

At what score of GAF would you need to be considered psychotic?

Back 13

30-21

Front 14

What score of GAF is usually hospitalized

Back 14

40 and below

Front 15

Suicidal people are at what range of GAF?

Back 15

20-11

Front 16

For the GAF score ranging from 31-69 what would you say is typical care?

Back 16

This patient is a candidate for
outpatient care ‐ either PHP (partial patient care), IOP (intensive out patient) or traditional outpatient

Front 17

For the GAF score ranging from 1-30 what would you say is typical care?

Back 17

inpatient care

Front 18

For the GAF score ranging from 70 or greater what would you say is typical care?

Back 18

In most cases, medical necessity is
not indicated because the patient is functioning too well to be a candidate for therapy.

Front 19

Example of documentation that outlines pt with axis of care...

Back 19

Axis I: Major Depressive Disorder, single
episode, severe without psychotic features
Alcohol Abuse
• Axis II: Borderline Personality Disorder
• Axis III: Cirrhosis
• Axis IV: Loss of job, and social supports
• Axis V: GAF is 53, current

Front 20

What are the main aspects of delirium?

Back 20

– General medical condition (MCC infection or metabolic)
– Substance‐induced
– Substance‐withdrawal
– Multiple etiologies

Front 21

very common for making geriatrics abuse (dementia cause)

Back 21

dyphenhydramine (DM) used in benadryl
- anticholinergic

Front 22

Delirium Due to a General Medical Condition criteria

Back 22

- Reduced level of consciousness and difficulty focusing, shifting or sustaining attention.
– Cognitive change (deficit of language, memory, orientation, perception) that a dementia cannot better explain.
– Rapidly onset (hours to days) and tend to vary during the day.
– confirmed by hx and physical that cause was medical condition

Front 23

difference between criteria of delirium for substance intoxication type versus general medical condition

Back 23

– The symptoms developed during Substance Intoxication or
they are caused by the use of a medication

Front 24

MCC substance cause of delirium

Back 24

alchohol and opiates
- also diphenhydramine or benadryl

Front 25

DSM Criteria for Schizophrenia

Back 25

characterized by disturbance in thought, perception, affect, behavior, and communication that last longer than 6 months
At least 2 of the following
- delusions
- hallucinations
- speech showing incoherence
- severly disorganized or catanic behavior
- paranoia
-

Front 26

Requirements for major depressive episode

Back 26

At least 5 of the following, during the same 2‐week period, representing a
change from previous functioning; must include either (a) or (b):a) Depressed mood, (b) Diminished interest or pleasure, (c) Significant weight loss or gain, (d) Insomnia or hypersomnia, (e) Psychomotor agitation or retardation, (f) Fatigue or loss of energy, (g) Feelings of worthlessness, (h) Diminished ability to think or concentrate; indecisiveness, (i) Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide B. Symptoms do not meet criteria for a mixed episode (ie, meets criteria for both manic and depressive episode).

Front 27

a. Bipolar I

b.

Back 27

manic, hypomanic, depressed

Front 28

Types of bipolar disorders

Back 28

Bipolar I disorder
– manic, hypomanic, depressed
• Bipolar II disorder
• Cyclothymic disorder
• Bipolar disorder, not otherwise specified
• Mood disorder, not otherwise specified

Front 29

What is DSM-IV criteria for manic episode of bipolar disorders

Back 29

Have to have manic and depressive episodes
– A distinct period of abnormally and persistently elevated, expansive, or irritable mood,
lasting at least 1 week (or any duration if hospitalization is necessary)

Front 30

What are the classifications for anxiety disorders

Back 30

• Panic disorder without and without
agoraphobia
• Generalized anxiety disorder
• Specific phobia
• Obsessive‐compulsive disorder
• Posttraumatic stress disorder
• Acute stress disorder

Front 31

Name the somatoform disorders

Back 31

kinda pain disorders without reasons for pain
• Somatization disorder- many body systems involved
• Conversion disorder
• Pain disorder
• Hypochondriasis-
• Body dysmorphic disorder
• Somatoform disorder, NOS

Front 32

What type of overall catagory are body dysmoprhic disorders
Describe briefly

Back 32

somatoform disorders-
people see things on their body that are not there

Front 33

Describe conversion disorder diagnostic

Back 33

neurological disorder caused by somatoform psychological disorder
- traumatic event could cause

Front 34

Factitious disorders

Back 34

voluntary control of symptoms, self injected feces or saliva, bizarre or unusual symptoms
(munchausen by proxy)- for the purpose of having the other person assume the sick role

Front 35

Dissociative disorders

Back 35

• Dissociative amnesia- come out dazed (24 syndrome with Jack Bauer's wife)
• Dissociative fugue
• Dissociative identity disorder- multiple personality disorder, often survivors of sexual abuse
• Depersonalization disorder
• Dissociative disorder, NOS

Front 36

Describe the sleep disorders

Back 36

• Primary insomnia
• Primary hypersomnia
• Narcolepsy
• Breathing related sleep disorder
• Circadian rhythm sleep disorder
– shift work type, jet lag type, delayed sleep phase
• Parasomnias
– Nightmare, sleep, terror, sleepwalking
• Other sleep disorders
– Due to general medical condition or psychiatric condition

Front 37

Describe the impulse control disorders

Back 37

• Intermittent explosive disorder
• Kleptomania
• Pyromania
• Pathological gambling
• Trichotillomania- more of an OCD- eyebrow pulling
• Impulse control disorder, NOS

Front 38

Describe the adjustment disorders

Back 38

Short lived due to an event that occurred
• Adjustment disorder with depressed mood
• Adjustment disorder with anxiety
• Adjustment disorder with mixed anxiety and depressed mood
• Adjustment disorder with disturbance of conduct
• Adjustment disorder with mixed disturbance
of emotions and conduct

Front 39

1. What should you always think when treating psych disorders?

Back 39

1. Psychiatric disorders should be considered real, neurobiological illnesses

2. break up the stigma that it is different from diabetes or cancer

Front 40

Diagnostic criteria for personality disorders

Back 40

a. Experience and behavior deviating markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
b. inflexible pattern judged across a broad range of personal and social situation
c. pattern leads to distress
d. long pattern of behavior
- cannot be diagnosed in person under 18

Front 41

For the personality disorders what are they grouped into?

Back 41

a. cluster A- ("weird" - odd or eccentric disorders)
b. Cluster B (dramatic, emotional or erratic disorders) BAD
c. Cluster (anxious or fearful disorders)

Front 42

Describe the three cluster A personality disorders

Back 42

– Paranoid personality disorder: characterized by irrational suspicions and mistrust of others.
– Schizoid personality disorder: lack of interest in social relationships, seeing no point in sharing time with others.
– Schizotypal personality disorder: characterized by odd behavior or thinking.

Front 43

Describe the four cluster B personality disorders

Back 43

– Antisocial personality disorder: pervasive disregard for the
law and the rights of others.
– Borderline personality disorder: extreme "black and white"
thinking, instability in relationships, self‐image, identity and
behavior.
– Histrionic personality disorder: pervasive attention‐seeking
behavior including inappropriate sexual seductiveness and
shallow or exaggerated emotions
– Narcissistic personality disorder: a pervasive pattern of
grandiosity, need for admiration, and a lack of empathy.

Front 44

pervasive attention‐seeking
behavior including inappropriate sexual seductiveness and
shallow or exaggerated emotions

Back 44

histrionic personality disorders

Front 45

extreme "black and white" thinking, instability in relationships, self‐image, identity and behavior.

Back 45

borderline personality disorder

Front 46

pervasive disregard for the law and the rights of others.

Back 46

antisocial personality disorder

Front 47

a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.

Back 47

Narcissistic personality disorder

Front 48

Dependent personality disorder

Back 48

pervasive
psychological dependence on other people.

Front 49

social inhibition,
feelings of inadequacy, extreme sensitivity to
negative evaluation and avoidance of social
interaction

Back 49

Avoidant personality disorder Cluster C

Front 50

characterized by rigid conformity to rules, moral codes and excessive orderliness. (medschool students)

Back 50

Obsessive‐compulsive personality disorder (not the
same as obsessive‐compulsive disorder):

Front 51

A pervasive pattern of detachment from social relationships
and a restricted range of expression of emotions in
interpersonal settings, beginning by early adulthood and
present in a variety of contexts, as indicated by four (or more)
of the following:
– Neither desires nor enjoys close relationships, including being part of a
family almost always chooses solitary activities.
– Has little, if any, interest in having sexual experiences with another
person takes pleasure in few, if any, activities.
– Lacks close friends or confidants other than first‐degree relatives
appears indifferent to the praise or criticism of others.
– Shows emotional coldness, detachment, or flattened affectivity

Back 51

schizoid personality disorders

Front 52

Conduct disorders in under 18 triad

Back 52

1. Urinate in public/ on animals
2. beat animals
3. light fires

Front 53

Borderline personality disorders includes

Back 53

complete extremes of like/disliking with very impulsive (cutting, threats, gestures)
- very manipulative
-

Front 54

Chances are if you walk into the room and patient has teddy bear or tweety bird shirt think?

Common pattern with people with these?

Back 54

borderline personality disorder

- sexual abuse or emotional abuse

Front 55

With personality disorders what is best treatment?

Back 55

Rarely respond to medications
- main form of therapy is psychotherapy (cognitive, dialectical)

Front 56

What are the three systems evaluated from psych interview?

Back 56

1. Biological systems- anatomical disease
2. psychological systems- personality in experience of illness
3. social systems- cultural environmental experiences

Front 57

What are the 3 main functions of the medical interview?

Back 57

1. determining the nature of the problem
2. developing and maintaining a therapeutic relationship
3. communicating information and implementing a treatment plan

Front 58

Describe the two types of psychiatric interviewing

Back 58

1. Insight-Oriented (Psychodynamic)- o Illicit unconscious conflicts, anxieties, and defenses.
2. Symptom-Oriented (Descriptive)- o Emphasizes classification of patient complaints and dysfunctions as
defined by specific diagnostic categories.

Front 59

What are the four big differences between a psych interview vs. med/surg

Back 59

Other Differences:
1. Stigma (Associated with being diagnosed with psychiatric disorders.)
2. Communication-Barriers (Due to disorders of thinking.)
3. Oddities in Behavior
4. Impairments of Insight and Judgment

Front 60

Difference in psychiatric vs. med/surg intervew goals

Back 60

Goals of Psychiatric Interviews:
1. Recognition of the Psychological Determinants of Behavior
2. Symptom Classification

Front 61

What are the outlines of a clinical examination of the psychiatric pt eval?

Back 61

a. Identifying Data
b. Chief Complaint
c. History of Present Illness
d. Past Illnesses
e. Family History
f. Personal History (Social history)
g. Mental Status Exam
h. Diagnosis/Impression
i. Psychodynamic Formulation- causes of patients breakdown, influences in the patients life that contribute to present disorders
j. Treatment and Plan