Clinical Psychiatry

1
Clinical Psychiatry

• Thursdays
• 930-1200 (most days)
• Exams
• Moody Medical Library 2nd Floor

2
Course Overview

• Outline
• Objectives
• Project 1
• Project 2
• Faculty
• Textbook
• Evaluation Grading Bonus
• Attendance

3
Models of Disease Interviewing

• Biological system
• Psychological System
• Social system

4
Meaning of Being Sick

• Illness Behavior
• Sick Role
• Product of the Medical System
• Secondary Gain

5
Doctor-Patient Models

• Active-passive
• Teacher-student
• Mutual participation model
• Friendship model

6
Effective Interviews

• Assessment of Problem
• Develop and maintain therapeutic relationship
• Communicate Information
• Implement Treatment Plan

7
Interviewing Techniques

• Clinical Interviewing
• Develop Relationship/Problem Identification
• Biopsychosocial History
• Decision Tree/History and data gathering
• Rapport
• Diagnoses and Feedback
• Techniques
• Prognosis Plan
• Difficult Patients
• Differential Diagnosis
• Chapter 1

8
Clinical Examination

• Mental Status Examination
• Appearance Attitude toward Examiner Speech
  Characteristics Psychomotor Mood Affect
  Perception Thought Process Thought Content
  Sensorium Cognition Concentration Attention
  Reading and Writing Visuospatial Ability
  Abstract Thought Information Intelligence
  Judgment Insight
• Chapter 1

9
Assessment

• Psychiatric Disorder
• RoS
• Physical Exam
• Nature of the Complaint
• Adverse Reactions
• Medical Referrals from Psychiatrists

10
Laboratory Tests

• Neuroendocrine
• Thyroid Cortisol Suppression Kidney and Liver
  function
• Blood Tests
• STDs
• Psychotropic Medications
• Lithium but not most
• Provocation of Panic Attacks
• Sodium Lactate (72)
• Lumbar Puncture
• Cognitive Changes due to CNS Infection
• Substance Abuse
• Random or purposeful

11
Typical Signs Symptoms in Psychiatric Illness

• Consciousness
• Emotion
• Motor behavior
• Thinking
• Speech
• Perception
• Memory
• Intelligence
• Chapter 3

12
Classification Systems

• ICD-10
• DSM-IV
• Axis I - Clinical Disorders
• Axis II - Personality Disorders
• Axis III - General Medical Conditions
• Axis IV - Psychosocial Stressors
• Axis V - GAF
• Chapter 5

13
Global Assessment Functioning

• Most commonly used with DSMIV (Axis V)
• Clinicians Judgment of patients overall level
  of functioning (100-0)

14
Mental Health Stats

• 30 of population has a diagnosable mental
  disorder (2008 Surgeon General)
• 300 Billion annual cost of untreated mental
  illness. (NIMH 2006)
• 30 Billion a year in absenteeism and poor work
  performance (MIT 2006)
• No federal law that requires employers to provide
  adequate health insurance for mental health
  (2001)
• 2002 Labor HHS Education appropriations bill
  called for parity. Passed in 2008 but has not
  implemented for the most part.
• 2009 US Citizens continue to experience
  decrease in health and mental health coverage