Assessment

Question 1

Questions to answer during initial assessment

Answer 1

1. Do they have mental illness? Problem? Diagnosis 2. Most suitable treatment 3. Treatment setting required 4. Concurrent social/health problems needing urgent attention before psychiatric 5. Expected outcome of treatment

Question 2

Overview of assessment procedures

Answer 2

1. Psychosocial 2. MSE 3. MMSE 4. General outcome measure 5. Relevant assessment questionnaires/checklists

Question 3

Psychosocial assessment

Answer 3

1. ID individual= name, age, sex, address, languages, GP, marital, education, occupation 2. Presenting complaint= what? timeline? interference in functioning? why now? precipitants? 3. HPC= a)specific symptoms, duration. b)Onset/exacerbation + illicit substances/physical illness/social stressors, c)emotional/thought/behaviour/appetite/sleep/sex drive, d)suicidal ideation + risk (intent, means, access), treatment history+response 4, Personal history + drug history (inc effects/allergies/adverse events) 5. PMHx 6. Premorbid 7. FHx

Question 4

Components of personal history

Answer 4

1. Early child/adolescent= adjustment, parental/sibling relationships, physical illness, loss, abuse, abuse/neglect, behavioural 2. Education/work= problems in school/learning, best/longest job, reason for changing, satisfaction 3. Marital/relationship= status, number, duration, quality, break ups/reasons 4. Current relationship with others 5. Children= age, physical/mental health 6. Illegal activities/violence= police, record

Question 5

Components of premorbid personality

Answer 5

1. Describe self prior to episode 2. Temperament/mood 3. Character traits 4. Confidence 5. Ambitions and aspirations 6. Social relationships with friends/family/workmates

Question 6

What is form of thought in MSE

Answer 6

Amount of thought and rate of production

Continuity of ideas ->tangential, derailment, loosening of association, distractable, irrelevance, circumstantiality, echolalia, thought blocking

Disturbance in language/meaning->neologisms

Question 7

Components of sensorium and cognition in MSE

Answer 7

LOC Memory->immediate, recent, remote Orientation TPP Concentration->serial 7s Abstract thinking

Question 8

What to describe in appearance and behaviour

Answer 8

1. Physical appearance
2. Reaction to situation (hostile, friendly, withdrawn, seductive, guarded, uncooperative)
3. Motor behaviour

Question 9

Poverty of speech

Answer 9

-ve spontaneous speech

Brief, monosyllabilic

Question 10

Pressured speech

Answer 10

Fast, difficult to interrupt, loud, difficult to understand

Question 11

Types of mood

Answer 11

Euthymic

Dysthymic

Depressed

Euphoric

Childish

Silly

Labile

Suspicious

Fearful, hostile, irritable, self contemptuous

Question 12

Types of affect

Answer 12

Normal

Restricted -ve intensity/range

Blunted ++-ve intensity/range

Flat absence of emotional expression

Question 13

Clanging

Answer 13

Words chosen for sound not meaning->puning and rhyming

Question 14

Difference between echolalia and perseveration

Answer 14

Echolalia is repetition of others’ speech

Perseveration is repetition of own speech

Question 15

Difference between derailment and word salad

Answer 15

In derailment the disturbance occurs outside of clauses whereas in word salad the disturbance occurs within clauses

Question 16

What is thought disorder

Answer 16

Disturbance in expression of thoughts->affects grammar, structure, syntax, logic

Question 17

What is word approximations

Answer 17

Words put together in unconventional ways to represent a specific meaning

Question 18

What is delusional mood

Answer 18

Feels environment has changed in some way-> do you ever get the feeling something odd is going on you can’t explain?

Question 19

Delusions of reference

Answer 19

Events/peoples action or words refer to them

Do people seem to say things that have a double meaning? Do people drop hints about you?

Is there an experiment going on to test you out?

Do things seem to be specially rearranged?

Question 20

Delusions of control/influence or impassivity

Answer 20

Feelings, actions, impulses controlled by external force

Do you feel you are under the control of person/other force?

Do you feel as though you are a robot/zombie with no will of your own?

Question 21

Common delusions of schizophrenia

Answer 21

Persecution

Mood

Reference

Control, impassivity

Question 22

Components to ask about for thought content

Answer 22

Delusions

Suicidality, homicidality

Obsessions, antisocial, fears, hypochondriacal, preoccupations

Question 23

Hallucinations on falling asleep and waking

Answer 23

hypnogogic

Hypnopompic

Question 24

Types of perceptual disturbances

Answer 24

Hallucinations

Derealisation->environment feels unreal, immitation of reality

Depersonalisation->outside looking at yourself, part of body doesn’t belong

Heightened perception

Dulled perception

Question 25

Describe clouding of consciousness, coma, deliriu, somnolence, stupor

Answer 25

Clouding->lack clear mind

coma-> unconsciousness

delirium->bewildered, confusion, restless, disorientation

somnolence->abnormal drowsiness

stupor->lack of reaction/awareness of surrounding

Question 26

Quick test of memory

Answer 26

Immediate->repeat numbers forward and backward

Short->current affair

Long->personal history

Question 27

How to quickly test abstract things

Answer 27

Concepts, extract characteristics, intepret

A bird in the hand is worth two in the bush

Question 28

Twelve scales covered in Health of the Nation Outcome Scales

Answer 28

1. Aggression/disruptive behaviour
2. Suicidal thoughts/injurious behaviour
3. Drug/alcohol
4. Memory, orientation, understanding
5. Physical disability
6. Mood, hallucinations, delusions
7. Other
8. Social relationships
9. Housing
10. Wider social environment

Question 30

World Health Organisation Disability Assessment Questionaire Twelve-Item

Answer 30

1. Understanding and communication
2. Self-care
3. Mobility
4. Interpersonal relationships
5. Work and household roles
6. Community and civic roles