How I assess insight in the mental status exam

[@danielkulinich4761]

Great insight into insight

[@ohboiherewego6831]

Good insight

[@jonicole7762]

“And yet, here we are” hit me so hard.

[@karlhenke91]

Bojack was one of the harshest television shows I've ever seen, and I was not prepared for it.

[@maxgiesken9488]

Dude, I know it’s not your core content per se but I’d love some more vids like this going through the less intuitive parts of the mental status exam. Definitely under taught and misunderstood by a lot of providers

[@annahernandez3690]

I would also appreciate this!!!

[@joschtuegs2562]

I’m an ER nurse and if every doctor I worked with was this good at explaining things (to his team and his patients), things would go so much smoother

[@fulltimeslackerii8229]

Sounds like you’re only at level 2 insight

[@aacc8466]

nice! I have had insight into insight but did not have a detailed out map to explain it to myself. I was not delusional about not having a full grasp of insight. I was not angry about it because I knew their was a gap of information missing. I knew if I could just get a better deal of understanding I could understand insight better. Not depressed about the situation because i had agency. And now I have learned with you the true meaning of insight. yay!

[@SD-fw9li]

Mind blown at your Connection to the stages of grief

[@sowbow21]

That scene from the show is too good. I recently came to befriend a depressed person online. Their depression and lack of willingness to do something about it- and no, not just that- he celebrated it- weighed down so much on me. In fact, it reminded of my own phase where I just took up a certain "sadness" as my personality and tried to colour every part of my life with it. I had some sort of fascination with "kms" for a long time- but now thankfully its just too absurd of a concept to me. I slowly stopped talking to them as I couldn't bear how they were resistant to my trying to influence them. I keep thinking compulsively/obsessively how I could say something just like from that scene to them. That would perhaps give me some closure. Whenever I care- Its always been worry- not actually "care". Although I've been aware of this for a while, I'm only now accepting I've to change this trait- and I'm slowly trying.

[@kat.celeste]

Omg your correlation to the five stages of grief at the end was like 🤯 I love when you info dump your psych knowledge, it’s clear to see you’re passionate about it

[@turnip1746]

to be frank i hadnt been a fan of the residency content thus far but the past few weeks has been an evolution, into you using your talent in communication to explain core psychiatry frameworks in a way that feels well adjusted, unburdened and enlightening (and maybe we saw some of the stages of grief in your journey to current content and contentment). This will help my own clinical practice. Thank you!

[@rachellllhines]

mans is helping me for my psych audition rotations

[@Pickle-hs5ts]

What an awesome breakdown! Thanks doc. 🔥

[@rade775]

feel like the last one is so rare i would just call that great insight

[@agent0422]

The doctor's hand writing is coming in nicely

[@UUwUU80]

It’s the ducky pen for me 😁

[@Citiesinmotionplayer]

Subscribed! I could listen to you talk about psych all day long

[@BenFlo-jn4mm]

These videos help me so much it's insane

[@sable428]

Great video Preston. Are there any books/resources you would recommend to someone who wishes to further learn about this specific topic? I've often said that psych is probably one of the most underrated, underappreciated, and probably one of the most important specialties out there (especially since covid), because one will inevitably interact with patients that have underlying mental health problems in some form regardless of one's specialty. And despite the fact that I plan on joining my local CVICU upon graduation in August, I still wish to grow my toolbelt for when I come stuff like this. So, any recommendations are much appreciated.

[@user-bv7jc]

This is fucking wild. I recently completed my psych rotation and this is hitting.

[@fisherbredrup]

More stuff like this. More people like you.

[@evanarents3299]

I’m going to use this, thank you

[@Jomonoes]

🤯 this is so good

[@XYZ-sq7ki]

Moving cities and getting out of culture that doesn’t resonate with my values absolutely cured my depression

[@wafasosal5317]

Enjoyed it Thank you !

[@eliad6543]

How about halfway between 3 and 4? "I know where the problem comes from and I'll try changing my behavior to fix it, I don't know if I have agency but I'll try changing my behavior and find out if I had agency or not based on how it goes"

[@edanclarke7899]

What is it referred to at 3:30? "Fained" insight? I couldn't catch that

[@katietatey]

Feigned = pretended / faked

[@J-qm1bo]

It seems like your agency caveat to the 4th level starts blurring the lines into the assessment judgment, no? Or do you count a verbal statement of a desire to change enough to satisfy the assessment of insight, and then any actual behavioral change is what you take into account for assessment of judgment?

[@itspresro]

They do begin to blur, good insight almost implies they are displaying good judgement

[@user-bv7jc]

@@itspresro Can you make a similar video about judgment as well? In my inpatient unit we chart Insight and Judgment together.

[@Idlaff]

Guess I didn’t have insight into insight 😂😅

[@forkkify]

Is it possible for a "day in the life of a psychiatrist" type of video? I know there's plenty of them already but I think you would probably put your own spin on it and make note of situations/challenges in that field that rarely get talked about. I'm trying to gather as much information about the specialty as I can since I am thinking of going into psychiatry myself.

[@waineph]

an idea: make a drawing about SSRI, SRNI and ketamine/esketamine and how they each hit the synapses and the biophysical pathways, is there something newer than ketamine already approved?

[@Zm4rf]

i read this as "how asses insight mental status exam" and was thoroughly confused

[@andrijamomcilovic8837]

Glad i wasnt the only one

[@m136dalie]

How do you think this relates to personality disorders? I feel like I've never met an EUPD patient that demonstrated any meaningful degree of insight

[@lobsterairsoft499]

Do you think it’s possible to make someone have insight, who currently has very little?

[@itspresro]

Yes, it’s hard, that’s why the entire field of therapy was invented

[@lobsterairsoft499]

@@itspresro thanks!

[@pkos91]

tired: level zero, poor insight wired: delulu no cap

[@thelastonequesqueca8982]

I do think you're well intentioned here, and I get the overall gist of what you're saying but I think the jump of wanting to change to making behavioural change isn't just insight, and suddenly a person can change. Someone may exist in freeze states, may need more safety around them, may have inhibitory shame states, may live in a highly restrictive environment that doesn't allow them to make changes. I get perhaps this isn't the correct place and the point here is education within a short clip, which I appreciate. However, I think sometimes trying to outline biteize simplifications of things can make it seem like you're either not aware of or accepting of complexity of people's experience outside of models and categorisations that our current basic medical school teaching imposes on them. I guess that understanding and nuance develops with time though. I've never been a fan of - this pathway (which no one who has gone deeply into it can claim to understand) seems to be linked to this, but I will present this as a deep understanding and confidently assert that there this drug is the best treatment

[@riccardoneri2037]

So, who died?

[@mindango4092]

Is insight a good predictor of response to medication or therapy? And if so for which conditions? Or is it more a measure of response to medication or therapy?

[@itspresro]

It can be both, for psychosis someone can gain insight in real time (days) as their antipsychotics start to work. For something like depression insight can improve slowly over time (weeks to months) with both meds and therapy

[@jamesburton1050]

I think a lot of people are on number 1 and have no clue there's an actual issue!

[@agent0422]

I keep seeing people "objectively" dumber than me and far less self-aware than me who smh have better agency. Anyway

[@misteratoz]

🤔....i definitely need therapy

[@jacobthiessen7027]

My man is trying to take on UWorld for my main study materials for psych 😂

[@spencerhayden]

I hate this because it burdens a patient with an overexpectation upon the patient to generate an entire universe of evidence relevant to the rubric you’ve imposed upon them- WITHOUT THEM KNOWING IT. Mental Status examinations are essentially admissible in court just through a handful of brief conversations! The pressure of communicating sound judgement from a patient to a doctor is unbelievable.

[@spencerhayden]

In the United States, you as a doctor will be able to take away citizens’ 2nd amendment rights after a 5250 hold if a patient does not have an “ability to understand and appreciate [mental illness as its been superimposed to them]” … FOR LIFE.

[@szxnv]

:)

[@myboatforacar]

What about people whose lives do genuinely suck? The proverbial homeless guy with severe arthritis living under a bridge and dumpster diving, for example.

[@itspresro]

This discussion is confined to the “psych” portion of the bio-psycho-social model

[@myboatforacar]

​@@itspresro Sweet! Thanks for answering! Love what you're doing!

[@catBoi_Finnbjorn]

...and yet here I am living in a red state that wants me dead... Nah, living in Riyadh with the religious police beheading people is completely fine! /s The rubrik presented is not a great interpretation and representation on insight. Specifically mentioning a person's living conditions and city as 'not a problem' is not a great example. Instead Denial is better represented as thinking the problem is you 'just need a new shiny car, or to go shopping, or drugs and alcohol' is better. The problem here I think is this feeling this video and so many others give of putting all the 'disease' or 'disorder' onto a depressed person and saying it's ALL their behavior. I've lived that life, it doesn't work. People see me as a problem. In the political sphere, it's infuriating to see them ignore my recommendations of how to improve things, start harm reduction, instead saying things are 'ok' with the community/city/state gov. I don't think you're trying to say that. I think I know where the problem is, and I think there's not a lot of agency to fix things in medicine or government. As far as I've come I've quit medicine, abandoned hopes for change here in the USA, and am going to pursue things elsewhere where there's community instead of working in and being crushed by the institutions that are the living embodiment of resistance to change. You can't change it from the inside. Also e.g. 1. "I'm not depressed I have tons of reasons to be happy! such as thinking the pandemic is over" 2. "Why should I have to wear a mask? IT'S OVER! It's not like I'm sick or at risk! Stop being dramatic!" 3. "If I don't wear a mask, but keep my distance, I'll avoid CoVid and be fine. I don't have to mask so long as everyone else is ok with it, and they're not masking." 4. "It's just like the flu. It's not that serious. Yet I feel so bad, and I can't shake this idea despite pretending everything is fine. " 5. "I realize now that wearing masks, a respirator, is important for the safety of others and myself. Infectious disease doctors are right. It's immoral to not wear a respirator and I can be a risk to others and hurt them if I don't."

[@thelastonequesqueca8982]

To be honest I agree, I like this guys' videos in general, and I think he is clearly well intentioned but I do think he has a very basic understanding of the complexity of how people work, how information is interpreted, what gets in the way of behavioural change, states of being etc-it's not just a matter of suddenly having insight stage and being able to change. I feel like this video is targeted at a very targeted specific subgroup of people. The other video on schizophrenia was similarly very typical of medical school teaching - pathway and the word dopamine=information processing and paranoia and that is presented as though that is what a complete understanding is. No insight into the nature of information spaces, how paranoia may link with a number of genetic and epigenetic changes in information processing at micro sub synaptic spaces-just very simple dopamine pathway not working=give drug that affects dopamine. Honestly quite disappointing, makes me worry for the field if I'm honest

[@m136dalie]

The evidence for mask wearing is not strong. The best available RCT shows a relative risk reduction of only 10% and was done before vaccination became widespread. There's no evidence that widespread mask usage in a society where most individuals are vaccinated for the disease leads to a meaningful reduction in morbidity/mortality. Telling people they're "immoral" for not doing something that has limited evidence is childish.

[@user-xy4ff5yp7b]

Wow I’m 1 minute in and this advice is so bad and is not culturally sensitive at all.