substance abuse - AIcohoi/Substance abuse CAGE: can change...

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Unformatted text preview: AIcohoi/Substance abuse CAGE: can change up depending on substance ° Cut — Ever felt you ought to cut down on your drinking? - Annoyed — Have people annoyed you by criticizing yoor drinking? ' Guilt — Ever felt bad or guilty about your drinking? ° Eye Opener — Ever had an eye-opener to steady nerves in the AM? Alcohoi/Substa nce abuse - Answering yes to 2 questions suggests abuse ' Answering yes to 3 or more confirms PthfiEwhflD - A overarching questionnaire covering 5 of the most common disorders in primary care ~— Depressioa ~ Anxiety — Alcohoi —— Somatoform — Eating disorders — See handout on Bb 5/19/2011 5/19/2011 History ' While taking the history, there are two components — The answers they give to the questions you ask —— The way they answer those questions During the history, you should assess alertness, orientation, memory, attention, mood, insights and judgment. — See list on p 141 Ciues in the history Depression - Can accompany serious medical illness ~Young, female, single, divorced, seriously or chronically ill or bereaved — Famiiy history History cities Suicide — More that half of all patient who have committed suicide have Visited their PCP in the prior month. - 10»40%in the East week. W ‘ ' ' -- Depression or other mental disturbances, or substance abusers (over 96%) ' — $>rior suicide attempts; family history of suicide, mental disorder, or substance abuse; family vioiance; firearms in the home, incarceration — Ask specificaiiy about suicidal thoughts, plans, 5/19/2011 Clues in the history mm ' Alcohol/Substance abuse mm“ -— Extensive coorelation between substance abuse and mental disorders and suicide W — Social history — Family history mw-—————-——m-—-—--m--——-———_.—.. Clues in the history WM Character disorders (includes schizophrenia, m paranoid, antisocial, borderline, etc) — Frequent visits with somatic complaints not W medicaiiy found -— Common in others disorders like depression, WW anxiety, substance abuse. m Frequent loss of jobs, difficulty with interpersonal W relationships m 1/3 report experience of sexual abuse m Mental Status WWW Overlap with Neuro Mental status exam -— iVlay fee-i reIUCtant because of what pt may think... Should include all the following components: — Apperance and behaviour W ~ Speech and ianguage — Mood —« Thoughts and perceptions — Cognitive function: memory, attention, info and vocab, etc. Mm“..— 5/19/2011 Appearance and Behavior ' Level of conciousness — Lose interest in conversation, fall silent. m Posture and motor behavior — Dress, grooming, personai hygiene w Facial expressions — Manner, affect Speech and language Rate Loudness Quantity Articulation Fluency an Hesita ncies, disturbed inflections, malformed words, circumlocutions (substituting words) Mood * I-iow do they feei? - How do they normally feel? - intense vs lackadaisicai. 10 5/19/2011 Thought and perception “WWW - Assessed the entire history, looking for m — Logic, reievance, organization and coherence of patients words W Patterns of speech Wm - Patterns of speech that suggest disorders of the thought process w C§rcumstantielity —- Bereiiment (loosening of associations) m Fiight of ideas w incoherence w Blocking -— Confabutation WWW—- — Perseverao'on — See pg 149 for fuit iist Thought content MW ' Abnormalities in content: “W —~ Compulsions — Obsessions mm m Phobias - Ahxieties -- Delusions 11 Delusions Delusions of persecution Delusions of grandeur Delusions ofjealousy Delusions of reference When people are upset, they sometimes have certain thoughts go through their mind, does this ever happen to you? Perceptions - Illusions - Hailucinations Insight and Judgement - Insight —- What seems to be the problem today? —- What brings you in today? - Judgement —~ How are you going to manage when...? 5/19/2011 12 5/19/2011 Cognition ".mequ ' Orientation m —— Time W Person W —- Place ~ Be skiiifui when asking Cognition Wm - Attention m — Serial 7'; - 5:38" the word "worici" backword mung—*H, - Remote memory - Birthdays, anniversaries, names of schoois attended ' Recent memory — Today's weather, today’s appointment time Cognition MW - Newiearning ability W ~— Say three words, ask patient to repeat, then ask what three words were about 3-5 min later mm 13 9 Higher cognitive functions Caicu§afing Information and vocabuiary — Name 5 large cizies, East 4 presidents, etc Abstract thinking - What does “don't cuunt your chickens before they are hatched” mean? - Similarities: 3 orange and an apple Constructabiiity - Draw ciock, shapes 5/19/2011 14 5/19/2011 Higher cognitive functions W Calculating Wmuummm information and vocabulary — Name 5 iarge cities, last 4 presidents, etc Mm Abstract thinking — What does "don't count your chickens before they W are hatched" mean? ~ Simiiarities: 3 orange and an apple Constructabiiity —- Draw clock, shapes m 14 ...
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substance abuse - AIcohoi/Substance abuse CAGE: can change...

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