1 - Psychiatry History and MMSE Flashcards
1
Q
What is the structure of a psychiatric history?`
A
- History of presenting complaint
- Past Psychiatric Hx
- Past Medical Hx and Drug Hx
- FHx (inc Children)
- Personal Hx
- Premorbid personality
- Risk assess
- MMSE
2
Q
How do you take a history of presenting complaint in Psychiatry?
A
- Onset
- Severity
- Duration
- Relieving/Aggravating symptoms
- Associated symptoms
3
Q
What are some good questions to ask when someone is presenting with ‘low mood’?
A
4
Q
How do you take a history of delusions?
A
- 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)
5
Q
How do you take a history of thought possession?
A
- 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?
6
Q
How do you take a history of hallucinations?
A
7
Q
How do you take a focused psychiatric history?
A
- 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?
8
Q
How do you take a personal history in psychiatry?
A
- 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
9
Q
How can you ask about pre-morbid personality?
A
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
10
Q
How do you do a risk assessment of suicide in a psychiatric history?
A
- 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?
11
Q
What is the difference between a hallucination and an illusion?
A
Hallucination - Perception of a stimulus that is not there
Illusion - Misinterpretation of a stimulus
12
Q
If someone tells you they are seeing things, what can be some organic causes rather than psychiatric causes?
A
- Lewy Body Dementia
- Brain tumour
- Temporal Lobe Epilepsy
13
Q
How do Psychiatrics examine patients like a medical doctor would?
A
Mental State Examination!!!!!!!
ASEPTIC
14
Q
What are the components of a mental state examination?
A
- Appearance and Behaviour
- Speech
- Emotion (Affect/Mood)
- Perception
- Thought
- Insight
- Cognition
- Risk to self and others - Can cover questions in mood
15
Q
What are you looking at in Appearance and Behaviour?
A
- State of dress
- Eye contact
- Psychomotor activity e.g agitated or retarded
- Rapport e.g over familiar
- Any abnormal behaviours?
16
Q
What are you looking at in speech in the MSE?
A
- Rate
- Rhythm
- Tone/Volume
- Pressurised speech?
- Formal thought disorder? e.g flight of ideas
17
Q
What are you looking at in emotion (affect and mood) in the MSE?
A
- Subjective (What they say)
- Objective (What we see) - e.g Euthymic, Euphoric, Reactive (normal) affect?
18
Q
What does affect mean in psychiatry?
A
The behavioural expression of mood, might not match up with mood
19
Q
What are you looking at in perception in the MSE?
A
- Delusions? (grandiose, persecutory)
- Hallucinations?
- Over valued ideas?
- Derealisation or Depersonalisation?
20
Q
What is a pseudo hallucination?
A
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
21
Q
What are you looking at in thought in the MSE?
A
- 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!!!!!
22
Q
What are you looking at in insight in the MSE?
A
- Does the patient understand they are unwell?
- Do they understand the purpose of the treatment?
- Attitude to treatment?
23
Q
What are you looking at in cognition in the MSE?
A
- Check orientation to place, person and time
- Consider MMSE
24
Q
How do you do a quick risk assessment in a mental state exam?
A
- Risk to self: suicide and self harm, financial risk from others and themselves
- Driving
- Risk to others
- Forensic History
25
What are some physical causes the following ‘psychiatric symptoms’?
26
What are some psychiatric causes of the following symptoms?
27
What are some psychiatric causes of the following symptoms?
28
If a patient has hallucinations and delusions, what psychological diagnoses can be ruled out?
Cannot be neurosis or a personality disorder
Has to be schizophrenia, an affective disorder, an organic disorder, or a paranoid state
29
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
30
What is a hallucinations and some examples of these?
Perception of a stimulus without any external stimulus
Can be visual, auditory, olfactory, proprioceptive
31
What are some examples of auditory hallucinations?
* Thoughts spoke aloud
* Second-Person
* Third person
32
What is a hypnagogic and hypnopompic hallucination?
Hearing a voice calling our name on going to sleep or waking up
33
What are some organic disorders that might cause hallucinations?
* Alcohol withdrawal
* Charles Bonnet Syndrome
34
How can you tell the difference between an obsessional thought and a hallucination?
If the voice or thoughts are their own then it cannot be a hallucination
35
What are the four characteristics of conventional normal thought processes?
1. Thought stream
2. Thought content
3. Thought form
4. Thought possession
Normal thought begins, continues, reaches a goal in a logical manner without veering off track or leaping between disconnected points
36
What are disorders of the following parts of thought:
* Thought stream
* Thought content
* Thought form
* Thought possession
* **Thought stream:** flight of ideas, most thoughts are not carried to completion before being overtaken
* **Thought content:** delusions
* **Thought form:** Derailment, Omission, Fusion, Substitution
* **Thought possession:** Thought insertion, Thought withdrawal, Thought broadcast
37
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!')
38
What is the definition of the following:
* Neologisms
* Pressure of speech
* Logoclonia
* Obsessions
**-Neologisms:** Coining of new words that are only understood by the patient
**-Pressure of speech:** Increased quantity and speed of speech. Common in mania.
**-Logoclonia:** A patient repeats the last syllable of a word or phrase.
**-Obsessions**: Repetitive and senseless thoughts or behaviours that are recognised as irrational by the patient but which they feel unable to resist.
39
What is the definition of the following:
* Monomania
* Echopraxia
* Depresive retardation
* Stupor
**-Monomania:** A preoccupation with a single subject to a pathological degree
**-Echopraxia:** A patient imitates another person's movements. It is an automatic process
**-Depressive retardation:** A psychomotor retardation associated with low mood. Thoughts, speech and movement become slowed
**-Stupor:** Patients are unable to speak or move but remain fully conscious. A severe form of depressive retardation
40
What is the definition of the following syndromes:
* Capgras Delusion
* Ekbom's Syndrome
* Cotard Delusions
* Othello Syndrome
**Capgras delusion:** delusion that either oneself or another person has been replaced by an exact clone.
**Ekbom's syndrome:** delusional belief where a patient feels that they are infested with parasites. They often complain of feeling "crawling" in the skin. It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders
**Cotard delusions:** belief that a patient is dead, non-existent or 'rotting'. Happens in psychosis but can appear as a result of parietal lobe lesions.
**Othello syndrome:** strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim. It is associated with alcohol abuse, psychosis and right frontal lobe damage
41
What is a formal thought disorder?
Disorganised thinking as evidenced in speech, associated with schizophrenia and psychosis.
## Footnote
**_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
42
Can you have insight in psychosis?
NO - only partial
43
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
44
Which risks are considered when assessing someone under the Mental Health Act?
**Risks to self:** e.g. suicide, malnutrition, vulnerability.
**Risks to others:** e.g. direct harm to others, unsafe driving
**Risks of further deterioration of mental health:** e.g refusing treatment.
45
What is a side effect with Aripiprazole?
Akathisia
46
How often do you need an FBC to look at leucocytes with Clozapine?
Weekly for first 18 weeks of treatment, then fortnightly until one year, and then monthly indefinitely
47
What is the difference between the DSMV and ICD10?
DSM is developed by the American Psychiatric Association, the ICD is developed by the World Health Organisation
48
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
49
What is the difference between mania and hypomania?
Mania has marked functional impairment but hypomania does not
50
What is important to screen for in a depression history?
* Psychotic symptoms
* Risk (always sign post first)
* Previous episodes of mania
51
What is a really important question to ask in psychosis?
SUBSTANCE ABUSE???
52
What is
* AO
* CRT
* PIER
53
What is the difference between Munchausen's syndrome and Malingering?
Malingering has secondary gain e.g disability benefits
Munchausen has no apparent reason
