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ACHEWS- MENTAL STATUS - Appearance/Behavior →Cognition/Cooperation → Hallucinations/Perceptions → Emotions →Words/Speech → Suicidality/Safety → risk assessment
AIMS (Abnormal Involuntary Movement Scale) → Tardive dyskinesia /
movement disorders (from antipsychotics).
B12 Why would a provider order a B 12 level? - Poor nutrition - Dementia - Delirium - Psychosis - Fatigue - Personality changes B12 elevation can occur due to what factors? - Leukemia - CKD - Liver disease - Some cancers (liver) - Polycythemia vera - Congestive heart failure - Diabetes - Obesity - COPD Basophils What do basophils do? can ↑ with myeloproliferative diagnosis , Basophils release histamine and other mediators, playing a role in allergic reactions and defense against parasites.
BDI ( Beck Depression Inventory) → Self-reported depression symptoms.
Blood sugar What is the most reliable indicator of a patient’s blood sugar status if they have been taking a 2 nd^ generation antipsychotic? A1C (HbA1c) BS High/low BS – delirium - Atypical antipsychotic agents cause abnormal glucose tolerance which may develop DM - Pt should have fasting glucose done at reg intervals BUN What are some likely causes of a decrease in blood urea nitrogen (BUN)? Malnutrition and liver disease BUN --- Increased BUN indicate uremia – s/s lethargy and delirium Calcium- Low serum calcium levels- s/s depression delirium and irritability -- Low levels may be caused by laxative abuse (some eating d/o) or hypoparathyroidism - High levels - s/s depression, psychosis and weakness - High levels caused by hyperparathyroidism
CAPS (Clinician-Administered PTSD Scale) → Post-traumatic stress disorder
symptoms.
CBC w/ differential --- WBC, differential (types of WBC), hemoglobin and platlet Circumstantiality- Disturbance in the associative thought and speech processes in which a patient digresses into unnecessary details and inappropriate thoughts before communicating the central idea. Observed in schizophrenia, obsessional disturbances, and certain cases of dementia. See also tangentiality. clang association - Association or speech directed by the sound of a word rather than by its meaning; words have no logical connection; punning and rhyming may dominate the verbal behavior. Seen most frequently in schizophrenia or mania.
Denial- Defense mechanism in which the existence of unpleasant realities is disavowed; refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety.
DIAGNOSTIC INTERVIEW goal? - The goal of the diagnostic interview is to
establish an accurate diagnosis, assess risk, understand the patient’s
problems, and guide treatment planning while building rapport.
DIFFFERENTIAL D/O What is the purpose of a differential diagnosis? - prioritized list to test. DIGFAST - mania EBP What are the benefits and advantages for using evidence-based practice guidelines?
- improve quality of care - Facilitate consistent, evidence-based decisions - Document clinical rationale ELECTROLYTE BUFFER Which electrolyte serves as a buffer within the cell itself? Phosphate False positive BS - Identify what might create a false positive blood sugar value above
-Medications – e.g., corticosteroids, thiazide diuretics, beta-blockers, atypical antipsychotics -Recent food intake (non-fasting sample) -Stress response (illness, surgery, trauma, MI → stress hormones raise glucose) -Improper sample handling or lab error FALSE POSITVE PREGNANCY What might cause a false positive pregnancy test? Lab interference/contamination - Heterophile antibodies or cross Reactivity If result conflicts with clinical picture: repeat with serum HcG ot different assay fMRI – provides information about regional brain function FOLATE stored in what part of the body? Liver FOLATE A false elevation of folate may occur when? Hemolyzed specimens FOLATE and B12 - Levels can be low w/ poor nutrition especially alcoholics - Low levels- s/s dementia, delirium, psychosis, fatigue and personality FORMAL neuropsychological assessment domains - Interview - Intellectual Functioning - Attention - Memory - Language - Visuospatial functions
- Sensory and Motor functions - Executive Functions - Psychological Factors
- Assessment of Effort and Motivation
GAD-7 (Generalized Anxiety Disorder-7) → Anxiety symptoms (esp.
generalized anxiety).
GLUCOSE TOLERANCE TEST ---Identify factors that might interfere with the results of a glucose tolerance test (GTT). L-Dopa administration, Improper fasting (eating or drinking before the tests, Medications (e.g., corticosteroids, thiazide diuretics, oral contraceptives, atypical antipsychotics, phenytoin) , Acute illness, infection, or stress,
LABS Identify the purpose of doing laboratory studies in psychiatry. Rule out medical causes of psychiatric symptoms (e.g., thyroid disease, infections, electrolyte imbalances, vitamin deficiencies) - Establish baseline values before starting psychotropic medications (e.g., lithium, antipsychotics, valproate). - Monitor medication safety and side effects (e.g., liver function with valproate, renal/thyroid function with lithium, CBC with clozapine). - Assess comorbid conditions that may affect psychiatric care (e.g., diabetes, cardiovascular disease, substance use). - Guide treatment decisions by providing objective biological data. LAPSE- memory- language- attention- perceptual motor- social motor – executive function LATEX ALLERGY Identify populations that may be at high risk for developing a latex allergy. -
- Patients and healthcare providers can become sensitive to latex through repeated skin or mucous membrane contact to by inhaling aerosolized glove allergens LEFT HEMISPHERE hemisphere brain damage. – Aphasia - Right -left disorientation - Finger agnosia - Dysgraphia (aphasic) - Dyscalculia (number alexia) - Constructional apraxia (details) - Limb apraxia leukocytosis or leukopenia – some psych meds can cause LITHIUM Before beginning treatment with lithium, what are the recommended baseline labs? BMP/Creatine , TSH , Pregnancy test , EKG Liver disease causes high levels of ammonia - Causing hepatic encephalopathy -s/s lethargy delirium - liver disease – results in lowered plasma protein - causes some drugs to be less protein bound - increasing their level of activity – including both intended effects and side effects MAGNESIUM Low magnesium levels can occur in which diagnostic population(s)? Alcoholics Magnesium - Low levels =agitation confusion delirium convulsions and coma
- levels may be low in patients with alcohol abuse MALINGERING How can you determine if a patient is malingering?
- determine whether patients are not fully honest about their symptoms. MMSE – Global cognitive screen---- orientation, attention, recall MRI Describe MRI methodologies. - distinguish gray and white matter better than CT scans do and allow visualizations of smaller brain lesions as well as white matter abnormalities. - MRI methodologies include T1/T2-weighted imaging (anatomy/lesions), FLAIR (periventricular lesions), DWI (acute stroke), SWI (blood/iron), fMRI (brain activity), and MRA (vessels). MRI – provides information about brain structure MRS – provides information related to brain chemistry and metabolism Neologisms - New word or phrase whose derivation cannot be understood; often seen in schizophrenia. It has also been used to mean a word that has been incorrectly constructed
but whose origins are nonetheless understandable (e.g., head shoe to mean hat), but such constructions are more properly referred to as word approximations. NEUROPSYCH Identify reasons why a patient may need to be referred for neuropsychological assessment. - Refer for neuropsych when progressive memory decline + impaired IADLs/unclear baseline, or cognitive complaints where profiling will change care. NORMAL RANGE LABS What is the best way to educate a patient about “normal” range lab results? Use institution-specific ranges; interpret in context (symptoms, meds) , Trends beat single values; compare to prior labs , Normalize and educate: what the value means and when to recheck
PANSS (Positive and Negative Syndrome Scale) → Schizophrenia ( positive,
negative, and general psychopathology symptoms).
PCL-5 (PTSD Checklist for DSM-5) → Self-report measure of PTSD symptoms.
PDSS (Panic Disorder Severity Scale) → Panic disorder (frequency and
severity of attacks).
PHOSPHATE What disease states can produce high levels of phosphate? IMPROPER PARATHYROID FUNCTION , Kidney disease and uremia Hypoparathyroidism Hypocalcemia Milk-alkali syndrome- burnette syndrome Excessive vit D intake Fractures healing Bone tumors Addison disease Acromegaly Liver disease Cardiac resuscitation Phosphate - levels may be raised or lowered by improper parathyroid function - levels lowered and eating disorders - Levels drop quickly in malnourished people begin to eat again because of recovery PHOSPHATE Which electrolyte serves as a buffer within the cell itself? Phosphate
PHQ-9 (Patient Health Questionnaire-9) → Depression screening and
severity.
Platelet count may lower with some psych meds POSTPRANDIAL URINE What is a postprandial urine sample? - Used for glucose determination, diabetic monitoring. Collected 2 hr after a meal. POTASSIUM Identify the clinical disorders associated with a low potassium level? Loss of GI and bilitary tracts Kidney K excretion and reduced K intake Diarrhea, vomiting and sweating Starvation and malabsorption Bartter syndrome Draining wounds Alcoholism PREVELANCE refers to the number of existing cases of a disease at a specific period of time in a given population Projection - Unconscious defense mechanism in which persons attribute to another those generally unconscious ideas, thoughts, feelings, and impulses that are in themselves undesirable or unacceptable as a form of protection from anxiety arising from an inner
SIGECAPS - depression SMART approach to goal development in treatment planning? - Specific - Measurable- - Achievable-- Relevant- - Time bound- SPECIFIC GRAVITY When would specific gravity be increased?
- Specific gravity of urine increases with conditions causing concentrated urine, such as dehydration from diarrhea, vomiting, or excessive sweating, as well as certain medical issues like heart failure, diabetes mellitus (due to glucose in urine), kidney problems, or syndrome of inappropriate ADH secretion (SIADH) specific gravity (HIGH ) (AM sample)--- Dehydration specific gravity(LOW) + colorless --- High fluid intake or diabetes insipidus SPECIFITY refers to the ability of a test to correctly identify indivuals who do not have the disease. Sublimation - Unconscious defense mechanism in which the energy associated with unacceptable impulses or drives is diverted into personally and socially acceptable channels; unlike other defense mechanisms, it offers some minimal gratification of the instinctual drive or impulse. SYPHILLIS How long does it take for antibodies for syphilis to appear in blood? - 1 to 2 weeks after exposure, but it can take up to 3 months for some tests to reliably show a positive result. Tampering clues --- Temp off, creatinine too low, extreme SG THREATENING - Approaches include establishing rapport, ensuring privacy, normalizing the topic, using direct but nonjudgmental language, progressing gradually from general to specific, and responding with empathy. TREATMENT PLAN What are the benefits of developing a treatment plan - Individualize to abilities, values, context, culture; document strengths to leverage TREATMENT PLAN important functions - Translate assessment into measurable, time-bound goals and matched interventions. TREATMENT PLAN -- What characteristics considered when developing - Identify and leverage pt strengths TRIGLYCERIDES What populations are known to have elevated levels of triglycerides? - schizophrenics URINE - Clear or almost colorless urine may occur due to what? - high fluid intake, diuretics, diabetes insipidus, or uncontrolled diabetes mellitus URINE SAMPLE Why would a urine sample need to collection first thing in the morning? - most concentrated and least affected by diet or hydration, improving test accuracy. URINE SAMPLE List some ways a patient may attempt to alter a urine sample
- dilution, substitution, chemical adulterants, temperature tricks, and timing manipulation.
Urine test How long can the following be detected in urine: Alcohol: <24 hrs, Marijuana: 1-3 days (occasional) to weeks (chronic) , Benzodiazepines: 3 days (longer if long acting high dose) Amphetamine: 48 hrs URINE TEST Which urinary test is the most informative regarding hydration status?
- Urine specific gravity and urine osmolality VDRL screen - test preformed in the case of dementia pts -- test used to detect syphilis infection - long-standing syphilis infection can cause dementia- like symptoms WBC - Increase WBC as well as a left shirt in differential – may indicate infection or development of neuro malignant syndrome WBC Elevated white blood cells found in what conditions? - Infection - neuroleptic malignant syndrome WCST – Executive function/problem-solving ---- Non-bedside Y - BOCS – OCD severity ---- Track response
YMRS (Young Mania Rating Scale) → Severity of mania (bipolar disorder).
