From ANCC Review
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| Appearance includes | overall appearance related to age and culture, hygiene and grooming, style, appropriateness of clothing for age, weather and occasion, posture and mannerisms, psychomotor excitation and slowness
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| Behavior Includes | General behavior - impulsivity, passive, hostile, fearful. Motor behavior - pacing, lethargy, catatonic. Attitude toward clinician and willingness to cooperate.
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| Emotion includes | mood and affect
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| Mood is | internal feelings that influence behavior
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| Examples of mood provided | depressed, suspicious, elated, irritable, angry, euthymic
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| Affect is | the emotional expression variation - found in face, voice, use of body movements
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| Examples of affect provided | flat, guarded, inappropriate, blunted, restricted, labile
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| Thought Processes and Content include | ability to use words to communicate, stream of thought, continuity of logical progression of thought, content of thought.
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| Thought processes include | continuity/org. of ideas - problems w word finding, processing abstract ideas, blocking, unexpected thought stoppage. Consider flow & rhythm - slowed or racing thoughts. Logical coherency, amount - excessive/poverty of speech, language/meaning deficits
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| Evaluation of thought content includes | Suicide, Homocide, Delusions, Phobias, Obsessions, Insight, Judgement
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| Evaluation of thought content - suicide | plan, intent, opportunity means
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| Evaluation of thought content - Homicide | victim, realistic plan
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| Evaluation of thought content - delusions | fixed, false beliefs - control : can control others thoughts or someone has control over their thoughts
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| Evaluation of thought content - phobias | intense, unreasonable fear
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| Evaluation of thought content - obsessions | intrusive, repetitious
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| Evaluation of thought content - insight | realization of the problem. The extent of the individuals awareness, willingness to look at role in maintaining the symptoms, awareness of behavioral consequences - lifestyle changes needed for coping
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| Evaluation of thought content - judgement | decision making, realistic foresight. realistic decision making based on current level of knowledge and realistic understanding of options - resources, strengths and limitations.
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| Definition of delusion as provided by ANCC | False beliefs that cannot be dislodged by logic or contradictory evidence, not congruent with normative culture or religious beliefs.
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| Delusions - of reference | other people's thoughts words or actions refer to self
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| Delusions - of persecution | other people have malevolent intentions towards self or are conspiring against the person
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| Religious Delusions | unrealistic special relationship with God
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| Nihilistic Delusions | destruction of self, world, body part
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| Grandiose Delusions | special or gifted, powerful or important without factual support
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| Language & Thought Processing - Clanging* | choice of words based on similar sound, not associated ideas
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| Language & Thought Processing - Echolalia* | repetition of other peoples words or phrases
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| Language & Thought Processing - Neologisms* | creation of new words that don't make sense
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| Language & Thought Processing - Word Salad* | disorganized, senseless progression of words
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| Language & Thought Processing - Perseveration | tedious repetition of the same words or ideas regardless of stimuli
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| Language & Thought Processing - flight of ideas/loose association | ideas are not logically connected, abrupt changes in topic
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| Language & Thought Processing - thought blocking | interruption or delay in thought processing, not related to lack of concentration, distraction or anxiety
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| Language & Thought Processing - tangential | pt goes of on a tangent not related to subject
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| Language & Thought Processing - circumstantial | pt answers questions about everything related to question and finally gets to the point
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| Language & Thought Processing - confabulation | pt recalls false memories - could be part of disease processes - dementia
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| Disurbances of Perception - depersonalization | A sense of alienation from normal identity, as though one has become an outside observer with no control of one’s own mental or physical processes.
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| Disurbances of Perception - derealization | The false sensation that one’s surroundings have become unfamiliar or unreal.
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| Disurbances of Perception - illusions | A distorted perception of reality; unlike delusions, illusions are generally shared by most people, as in a 3D “hidden picture” puzzle. - breeze blows curtain - think someone is behind it
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| Disurbances of Perception - deja vu, jamais vu | A false sense of visual familiarity in a situation. The term means “already seen” in French.
The strange feeling that one does not recognize a familiar situation. Literally means “never seen” in French.
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| Disurbances of Perception - flashbacks | involuntary recurrent memory
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| Disurbances of Perception - hallucinations | can be auditory/visual/olfactory/tactile
command, pervasive, episodic with stress
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| Auditory hallucinations are found in | psychiatric disorders
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| visual hallucinations are more common in | cognitive and organic disorders
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| olfactory and tactile hallucinations are more common with | drug use, medical conditions
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| Mood congruent tends to occur in | depression*
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| Mood incongruent tends to occur in | schizophrenia*
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| Disturbances in sensorium and cognition are related to | organic dysfunction due to meds, substance abuse, cognitive disorder
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| Assess memory recall for | immediate, recent and remote
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| Assess orientation to | person, time and place
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| Assess concentration through | serial 7s - keep in mind educational level
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| Assess abstract thinking through | proverb interpretation
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| Two short tests to check cognitive impairment | MMSE (Folstein) and SLUMS (St. Louis University MSE)
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| Scoring on the MMSE is | 25-30 Normal
21-24 Mild cognitive d/o
16-20 Moderate cognitive d/o
<15 severe cognitive disorder
or mild and severe cut offs of 24 and 18
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| Anything below __ on the MMSE is an indicator of dementia.* | 24
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| This test has greater sensitivity than the MMSE | SLUMS
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| The Clock Drawing Task is incorporated into which test | SLUMS
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| Scoring on the SLUMS | w HS education
27-30 Normal
21-26 Mild Neurocog Impairment
1-20 Dementia
<HS education
25
20
<20
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| This can be used as a rapid screening for dementia | the clock drawing test (11:10 or 8:20)
4 points total
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