1 - Psychiatry History and MMSE Flashcards
What is the structure of a psychiatric history?`
- History of presenting complaint
- Past Psychiatric Hx
- Past Medical Hx and Drug Hx
- FHx (inc Children)
- Personal Hx
- Premorbid personality
- Risk assess
- MMSE
How do you take a history of presenting complaint in Psychiatry?
- Onset
- Severity
- Duration
- Relieving/Aggravating symptoms
- Associated symptoms
What are some good questions to ask when someone is presenting with ‘low mood’?
How do you take a history of delusions?
- Is anything in particular on your mind?
- Anything out of the ordinary happening that you can’t explain?
- Could there be another explanation? (can they shake the thought)
How do you take a history of thought possession?
- Is anything interfering with your thoughts?
- Do you feel in control of your thoughts and actions?
- Do you feel that your thoughts are your own?
TELL ME MORE ABOUT THAT, HOW CAN THAT HAPPEN?
How do you take a history of hallucinations?
How do you take a focused psychiatric history?
- Any previous hospital admissions? How many? How long for? (MHA or Informal)
- Ever seen GP before?
- Previous Treatments e.g drugs and therapy (Were they effective?)
- Felt like this before but not sought help?
How do you take a personal history in psychiatry?
- Infancy
- Birth
- Developmental milestones (did you walk and talk at the right ages or were you a slow developer?)
- Serious illness in early life (were you a healthy child or often in hospital?)
2. Adolescence and Education
- Who did you live with?
- How was school for you?
- Friendships? Bullying?
- Qualifications?
- Attitude to school?
3. Occupational History
- Start from leaving school
- How long did they work in each job?
- Why did they move on?
- Relationship with boss and co-workers?
4. Relationship History
- Current relationship - how would they describe it?
- Other relationships - why do they think it failed?
5. Alcohol, Drugs and Forensic Hx
- Alcohol - When they started, how much, period of heavy consumption?, period of abstinence? (any withdrawals during this?
- Smoking - CANNABIS
- Drugs
- Ever injected?
- Ever been in trouble with the police?
6. Current Social Circumstances
- Ask about state of house e.g mould
- Financial situation e.g debts, benefits
- Support network?
- Change in circumstance? e.g loss of job
How can you ask about pre-morbid personality?
Can only really get this from third party
- Ask them to describe what other people would say about them in the past?
- What were you like before?
- Ask them what impact their experiences have had on them and how is has changed them as a person
How do you do a risk assessment of suicide in a psychiatric history?
- Have you ever thought of harming yourself? If yes have you harmed yourself?
- Have you ever thought of harming others?
- Do you feel like life is worth living?
- Has it ever gotten so bad that you have thought of ending your life?
- Have you made any plans?
- Have you attempted it?
- What stops you from going through with it?
What is the difference between a hallucination and an illusion?
Hallucination - Perception of a stimulus that is not there
Illusion - Misinterpretation of a stimulus
If someone tells you they are seeing things, what can be some organic causes rather than psychiatric causes?
- Lewy Body Dementia
- Brain tumour
- Temporal Lobe Epilepsy
How do Psychiatrics examine patients like a medical doctor would?
Mental State Examination!!!!!!!
ASEPTIC
What are the components of a mental state examination?
- Appearance and Behaviour
- Speech
- Emotion (Affect/Mood)
- Perception
- Thought
- Insight
- Cognition
- Risk to self and others - Can cover questions in mood
What are you looking at in Appearance and Behaviour?
- State of dress
- Eye contact
- Psychomotor activity e.g agitated or retarded
- Rapport e.g over familiar
- Any abnormal behaviours?
What are you looking at in speech in the MSE?
- Rate
- Rhythm
- Tone/Volume
- Pressurised speech?
- Formal thought disorder? e.g flight of ideas
What are you looking at in emotion (affect and mood) in the MSE?
- Subjective (What they say)
- Objective (What we see) - e.g Euthymic, Euphoric, Reactive affect?
What does affect mean in psychiatry?
The behavioural expression of mood, might not match up with mood
What are you looking at in perception in the MSE?
- Delusions? (grandiose, persecutory)
- Hallucinations?
- Over valued ideas?
- Derealisation or Depersonalisation?
What is a pseudo hallucination?
Involuntary sensory experience vivid enough to be regarded as a hallucination, but which is recognised by the person experiencing it as being subjective and unreal
What are you looking at in thought in the MSE?
- Form (you): Can patient talk logically in response to questions asked
- Content (them): What is the patient thinking about? Do they have any worries? Do they have any delusional beliefs?
SUICIDE RISK ASSESS HERE!!!!!
What are you looking at in insight in the MSE?
- Does the patient understand they are unwell?
- Do they understand the purpose of the treatment?
- Attitude to treatment?
How do you do a quick risk assessment in a mental state exam?
- Risk to self: suicide and self harm, financial risk from others and themselves
- Driving
- Risk to others
- Forensic History
What are some physical causes the following ‘psychiatric symptoms’?
What are some psychiatric causes of the following symptoms?
What are some psychiatric causes of the following symptoms?
What is a delusion and some examples of these?
A fixed false belief that is unshakeable even when there is evidence against the belief
Examples: Persecutory, Grandiose, Reference, Erotomanic, Hypochondriacal
Delusions can be mood congruent e.g depressed person believes he is rotting away, but Schizophrenia often mood incongruent with horrific beliefs discussed without distress
What is a hallucinations and some examples of these?
Perception of a stimulus without any external stimulus
Can be visual, auditory, olfactory, proprioceptive
What are some examples of auditory hallucinations?
- Thoughts spoke aloud
- Second-Person
- Third person
What is a hypnagogic and hypnopompic hallucination?
Hearing a voice calling our name on going to sleep or waking up
What is the definition of the following:
- Formal Thought Disorder
- Compulsions
- Flight of Ideas
- Word Salad
Formal thought disorder: Disorganised thinking as evidenced in speech
Compulsions: Repetitive and stereotyped behaviours that are seemingly purposeful.
Flight of ideas: A stream of accelerated thoughts which jumps rapidly from topic to topic; often aimless with no clear direction.
Word salad: Severe formal thought disorder where the patient uses words nonsensically (e.g. ‘Purple monkey dishwasher? Thursday!’)
What is a formal thought disorder?
Disorganised thinking as evidenced in speech, associated with schizophrenia and psychosis.
Specific thought disorders include:
Circumstantiality: patient moves onto different topics but there is a train of thought that can be followed. They eventually return to the original topic
Derailment: The conversation moves randomly from one topic to another
Poverty of speech: A lack of spontaneous speech
Perseveration: The repetition of words or ideas when another person attempts to change the topic
Thought blocking: The patient suddenly halts in their thought process and cannot continue
If asked in an OSCE what is the treatment for a psychiatric disorder e.g depression, what should you say?
VERY IMPORTANT CARD
USE BIOPSYCHOSOCIAL MODEL AND RISK ASSESS INPATIENT/OUTPATIENT
ANTIDEPRESSANTS PLUS CBT BUT SOCIAL SUPPORT
What is a Nihilistic delusion?
Common in the elderly with depression with psychotic symptoms
They think a part of their body is dead or rotting
What is
- AO
- CRT
- PIER
