The Patient Interview
How do you establish patient rapport?
What is
Be calm and mindful; Use Good listening skills
"Switzerland" face/eye contact/body language
Ask simple and precise questions
Avoid distractions
Persistent, excessive anxiety regarding general life events
F>M; average age of dx 20yrs
Lasts 6mos+
May present with somatic complaints
What is Generalized Anxiety?
This class of drugs is 1st line for the anxiety, depression, OCD and some eating disorders
What is SSRIs?
Involves deliberate production of physical or
psychological symptoms, motivated by external gain.
Patients try to express vague, poorly defined complaints and claim that sxs cause great distress and impaired functioning.
What is Malingering?
The inability to experience pleasure or enjoyment from activities that were previously rewarding.
What is anhedonia?
This is how you create a safe space for a patient when interviewing
What is ask about pronouns
Discuss patient confidentiality/HIPAA
Door open or closed
Does pt want/need others in the room?
Intense fear of social or performance situations in
which embarrassment in front of others may occur
What is Social Phobia?
This medication is a subtle anxiolytic and can be used safely in pts with hx of substance abuse.
Non sedating.
Can be dosed BID-TID or even used prn
What is Buspirone (BusPar)?
Preoccupation with the belief of having or contracting a serious illness.
Normal bodily sensations are misinterpreted as manifestations of disease.
Patients fear persists even though medical investigation reveals no cause
What is Illness Anxiety Disorder (Hypochondriasis)?
This is a screening tool that patients complete to determine if depressive sxs are present.
Can be administered before or during clinical exam.
What is PHQ-9
OR
Beck’s Depression Inventory?
The handbook clinicians and psychiatrists use to diagnose psychiatric disorders
What is DSM 5?
Most widely used anxiolytic
MOA: Enhance GABA
Schedule IV - risk of addiction
Withdrawal sxs include anxiety, rebound insomnia,
agitation, tremors, sweating, palpitations
What are Benzodiazepines?
This non-psychiatric drug class can be used in patients with anxiety and social phobia to reduce associated somatic sxs
What is Beta Blockers?
A psychiatric disorder characterized by symptoms affecting sensory or motor function.
Signs and sxs are inconsistent with patterns of known neurologic diseases or other medical conditions.
"La Belle indifference"
What is Conversion Disorder?
Aka: Functional neurological symptom disorder
Variation of depression that carries a unique power to modify speech, distort movement and create odd behaviors.
Bizarre mannerisms or posturing
• “wavy flexibility"
What is Catatonic Depression?
Questions should be _____ ended.
What is
Open-ended
Period of extreme anxiety that peaks in 10 minutes, declines within 30 minutes, rarely lasts >1hour
May have definable trigger or come out of nowhere
What is Panic attack?
MOA: Potent antagonist of serotonin, NE & histamine
activity
Sedation & weight gain especially at lower dose
Commonly used in elderly patients who have insomnia and/or anorexia
Available in Solu-tab formulation
What is mirtazapine (Remeron)?
Pts with somatic disorder tend to be this GENDER with onset most commonly occurring in this AGE group.
What is FEMALE and Adolescence?
*CHILDHOOD* mood disorder
- inconsistent with developmental level
- Severe irritability (verbal/physically aggressive
outbursts)
- Occurs at least 3x/wk
>1yr
In 2+ settings
What is
Disruptive Mood Regulation Disorder?
Data collected from sources other than the patient is known as this
What is collateral information?
Intense fear of being in situations where escape might be difficult or help may not be available if panic or other incapacitating symptoms occur
What is Agoraphobia?
New medication ZURZUVAE (zuranolone)
Mimic a derivative of progesterone
onset of action Day 2-3
Given to treat this disorder
What is Post Partum Depression?
Pt displays intentionally fake signs and symptoms (medical or psychiatric)symptoms.
Primary motivation being to assume the sick role.
Usually starts in early adulthood.
What is Factitious Disorder?
Pts with this depressive disorder may experience
Weight gain
Oversleeping
Reactive mood to positive events
leaden paralysis
Oversensitivity to interpersonal rejection
What is Atypical Depression?