Class Notes 4

GAD-2

You can screen for core anxiety symptoms by administering the first 2 questions (GAD-2) from the 7-item generalized anxiety disorder scale (GAD-7) listed in Fig. 5.2. Scores on the GAD-2 range from 0 to 6; a score of 0 suggests that no anxiety disorder is present, whereas a score ≥3 is suggestive of

So, you do GAD-2, if more than ≥3 you do GAD-7 GAD-7, for patients with a known anxiety disorder scores of 5, 10, and 15 represent mild, moderate, and severe levels of anxiety. A score of 8 or greater indicates the need for further evaluation in a patient without a known anxiety disorder.

Patient Health Questionnaire-2 (PHQ-2)

If the person has a score of 2 or greater on the PHQ-2, the full PHQ-9 should be administered17)

PHQ-9

Important: If question 10 is answered “somewhat difficult” or greater, it indicates functional impairment. A PHQ-9 score of 5 to 9 = minimal symptoms; 10 to 14 = minor depression; 15 to 19 = major depression, moderately severe; ≥20 = major depression, severe. Treatment recommendations and follow up for each score are available in the literature. It grows on a scale of 4

So 5-9, 10-14, 15-19, 20-….

Minimal, Minor, Major, Severe

Ask Suicide-Screening Questions (ASQ)

Suicide is the 10th leading cause of death in North America, and the rate of suicide in the United States has increased every year since 2000 1. Suicide is 4 x more in males

A precise suicide plan to take place in the next 24 to 48 hours using a lethal method constitutes high risk. Asking about suidical thoughts does not increase suicidal behavior Posture must be intact when sitting and walking, otherwise is considered that something is wrong. Apathy: lack of motivation, interest, and emotion.

Restless, fidgety movement or hyperkinetic appearance occurs with anxiety. Apathy and psychomotor slowing occur with depression and dementia. Think in old people. Abnormal posturing and bizarre gestures occur with schizophrenia.

schizophrenia = Crazy crazy, needs hospital.

Facial grimaces may occur with pain. Involuntary tics can occur with neurologic disorders

Eccentric dress combination and bizarre makeup occur with schizophrenia or manic syndrome.

Bizzarre: Very weird and unpleasant. Drugs change dilation of pupil

Brain tumors will change pupil symmetry (One small, other big)

Meticulously dressed and groomed appearance and fastidious manner may occur with obsessive-compulsive disorders.

Dysphonia is abnormal volume, pitch Agraphia (inability to communicate through writing)

1.Appearance: Posture and Body movements/ Dress Grooming and hygiene/ Pupils 2. Behavior: Level of consciousness/ Facial expression and Speech / Mood and affect 3. Cognitive function: Orientation Judgment/ Attention span /Recent and remote memory and New learning /

4. Thought process: Thought process Thought content/ Perceptions/ Screen for suicidal thoughts

Perform the Mini-Mental State Examination, MoCA, or the Mini-Cog

|

Neurological

1. CN - 12 pairs, Spinal nerve - 31 pairs

The peripheral nervous system carries sensory (afferent) messages to the CNS from sensory receptors, motor (efferent) messages from the CNS out to muscles and glands, and autonomic messages that govern the internal organs and blood vessels. Afferent (Skin or ogan → CNS) Efferent (CNS - ORGANS)

Cerabral cortes ⇒ t looks like “gray matter”

Brain Lobes Frontal = Personality, behavior, emotion, intellectual, Parietal = sensation, Occipital = vision, Temporal = hearing, taste, smell Wernicke area in the temporal lobe is linked to language comprehension. Broca area in the frontal lobe mediates motor speech.

Thalamus ⇒ Respiration center. Controls temperature.

Breathing:

• The medulla provides the automatic, rhythmic drive for breathing.
• The hypothalamus modifies this drive depending on emotional states, stress, and homeostatic needs.

atrophy ⇒ less organ size, lose of function ⇒ older adults 1. Atrophy = weakness

Brain atrophy is normal in healthy aging

Seizures occur with epilepsy Tremor is an involuntary shaking, less than seizures. Paresthesia is an abnormal sensation (e.g., burning, tingling).

screening neurologic examination Mental Status

Cranial nerves

Motor Function

Reflexes

Sensation Anosmia—Decrease or loss of smell (A Nose)

Papilledema with increased intracranial pressure you loose vision

1. Nystagmus = wigling of the eye

1. Rapid alternating movement Test= finger to finger, finger to nose, heel to shin

Ataxia ⇒ No coordination of movements 1. Babinski sign - plantar reflex (sensation), Stretching (push/pull) of plantar - motor

1. CN IX and X - both for swallowing

hemiplegia—spastic or flaccid paralysis of one side (right or left) of body and extremities;

paraplegia—symmetric paralysis of both lower extremities;

quadriplegia—paralysis in all four extremities.

Paresis—weakness of muscles rather than paralysis.

1. hemi (half), para (for) both legs, quad (quatro) 4

Fasciculation ⇒ Moscle twitching but there is no actual movement of any body part. All tremors disappear while sleeping.

1. Decorticate - flexion, Decerebrate - extension 1. Thrombus - blockage that doesn't move, Embolus - a kind of blockage that moves?

GLAUCOMA -Increase pressure

Cataract

Normal TM scarred:

Perforated septum