1. The primary function of carbohydrates in the body is to provide a. sweetness. b. satiety. c. energy. d. dietary fiber. ANS: C The most important function of carbohydrates in the body is to provide energy. Unrefined sources of carbohydrate do provide di

Chapter 5  Behavior/Mental Health Assessment and Modification for Age Changes have also occurred in the classification of somatic syndromes in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) of 2013. When patients have “distressing somatic symptoms plus abnormal thoughts, feelings, and behaviors in response to these symptoms,” contains 26 questions and takes up to 10 minutes to complete.25 The DSM-5 acknowledges the diagnostic challenges facing primary care providers and has reduced the total number of disorders as well as their subcategories in the reclassification of Somatic Symptoms and Related Disorders. Patient Indications for Mental Health Screening Medically unexplained physical symptoms—more than half have depression or anxiety disorder Multiple physical or somatic symptoms or “high symptom count” High severity of the presenting somatic symptom Chronic pain - Chronic pain may be a spectrum dis-order in patients with anxiety, depression, or somatic symptoms. Symptoms for more than 6 weeks Physician rating as a “difficult encounter” Recent stress Low self-rating of overall health Frequent use of health care services Substance abuse Personality Disorders. Patients with personality disorders can also display problematic office behaviors that escape diagnosis. The DSM-5 characterizes these disorders as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.” . These patients have dysfunctional interpersonal coping styles that disrupt and destabilize their relationships, including those with health care providers. High-Yield Screening Questions for Office Practice Depression - Over the past 2 weeks, have you felt down, depressed, or hopeless? - Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)? Anxiety - Anxiety disorders include generalized anxiety disorder, social phobia, panic disorder, posttraumatic stress disorder, and acute stress disorder. - Over the past 2 weeks, have you been feeling nervous, anxious, or on edge? - Over the past 2 weeks, have you been unable to stop or control worrying? - Over the past 4 weeks, have you had an anxiety attack—suddenly feeling fear or panic? Illness Anxiety Disorder (Replaces Hypochondriasis in DSM-5) - Whiteley Index: 14-item self-rating scale Substance-Related and Addictive Disorders - CAGE questions adapted for alcohol and drug abuse Multidimensional - PRIME-MD (Primary Care Evaluation of Mental Disorders) for the five most common disorders in primary care: depression, anxiety, alcohol, somatoform, and eating disorders; 26-item patient questionnaire followed by clinician evaluation; takes approximately 10 minutes. - PRIME-MD Patient Health Questionnaire, available as patient health questionnaire for self-rating; takes approximately 3 minutes. A: Odd or Eccentric Disorders ●Paranoid - Distrust and suspiciousness ● Schizoid - Detachment from social relations with a restricted emotional range ● Schizotypal - Eccentricities in behavior and cognitive distortions; acute discomfort in close relationships B: Dramatic, Emotional or Erratic Disorders ● Antisocial - Disregard for, and violation of, the rights of others ● Borderline - Instability in interpersonal relationships, self-image and affective regulation; impulsivity ● Histrionic - Excessive emotionality and attention seeking ● Narcissistic - Persisting grandiosity, need for admi-ration and lack of empathy C: Anxious or Fearful Disorders ●Avoidant - Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation ● Dependent - Submissive and clinging behavior related to an excessive need to be taken care of ● Obsessive–compulsive - Preoccupation with orderliness, perfectionism, and control Borderline Personality Disorder. Patients with borderline personality disorders are especially challenging. These patients show “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.” They make “frantic efforts to avoid real or imagined abandonment” and show recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Recognition of borderline features is essential for patient understanding, reduction of patient self-harm, and referral for expert evaluation. In the DSM-5, delirium and dementia fall under the new category of neurocognitive disorders, based on consultation with expert groups. Dementia is classified as a major cognitive disorder; a less severe level of cognitive impairment is now mild neurocognitive disorder, which applies to younger individuals with impairment from traumatic brain injury or HIV infection.  Normal VS. Abnormal Findings and Interpretation  Speech Patterns  Mental Status Examination The Mental Status Examination: Appearance and behavior Speech and language Mood Thoughts and perceptions Cognition, including memory, attention, information and vocabulary, calculations, abstract thinking, and constructional ability The Mental Status Examination consists of five components: appearance and behavior; speech and language; mood; thoughts and perceptions; and cognitive function. Cognitive function includes orientation, attention, memory, and higher cognitive functions such as information and vocabulary, calculations, abstract thinking, and constructional ability. Prepare the patient for formal testing and explain your rationale. Appearance and behavior: Level of Consciousness: Lethargic patients are drowsy, but open their eyes and look at you, respond to questions, and then fall asleep. Obtunded patients open their eyes and look at you, but respond slowly and are somewhat confuse. Posture and Motor Behavior: Look for tense posture, restlessness, and anxious fidgeting; the crying, pacing, and hand-wringing of agitated depression; the hopeless slumped posture and slowed movements of depression; the agitated and expansive movements of a manic episode. Dress, Grooming, and Personal Hygiene: Grooming and personal hygiene may deteriorate in depression, schizophrenia, and dementia. Excessive fastidiousness may be seen in obsessive–compulsive disorder. One-sided neglect may result from a lesion in the opposite parietal cortex, usually the nondominant side Facial Expression: Note expressions of anxiety, depression, apathy, anger, elation, or facial immobility in parkinsonism. Manner, Affect, and Relationship to People and Things: Watch for the anger, hostility, suspiciousness, or evasiveness of patients with paranoia; the elation and euphoria of mania; the flat affect and remoteness of schizophrenia; the apathy (dulled affect with detachment and indifference) of dementia; and anxiety or depression. Hallucinations occur in schizophrenia, alcohol withdrawal, and systemic toxicity Speech and Language: