Basic principles and assessment Flashcards
Components of basic psychiatric assessment
HOPC Past psych history Personal Hx Social Hx (esp substance use) Family Hx Forensic Hx Past medical Hx, DHx, allergies
Components of mental state examination
Appearance and behaviour Speech Thoughts Mood Perception Cognition Insight
Key points when asking about current psychiatric treatment
Side effects + adherence
Any recent changes to meds in general
Injections/depots
Allergies
Key questions to ask in PMHx for females?
Obstetric/menstrual Hx + associated psychiatric pathology
Minimum information to be obtained from FHx
Hx of self-harm/suicide (sudden unexpected death)
Any children living in household
Parents, siblings, children - relationship + medical condition
Key parts of personal Hx
Walk + talk milestones School/childhood Current and past occupation, aspirations Any horrible/frightening experiences? Exposure to suicide in friends/family? Do you have a partner at the moment? Who knows you best I could talk to?
Components of appearance/behaviour in MSE
Eye contact Rapport Psychomotor retardation/agitation Evidence of SH Personal hygiene Kemptness
Components of speech in MSE
Quantity (pressured, paucity)
Rate, tone, volume
Components of thoughts in MSE
Form: Thought disorder, flight of ideas
Content: Over-valued ideas, delusions, obsessions
Components of mood in MSE
Subjective + objective
Mood, constancy, congruency
Anhedonia is key!
Thoughts of self-harm/suicide
Definition of delusion
A belief firmly held on inadequate grounds, not appropriate to culture, not amenable to contrary evidence
Definition of over-valued idea
A preoccupying belief (with some logical basis) that dominates thoughts/actions despite recognising unreasonableness/evidence to the contrary
Common types of delusion
Persecution Control Thought possession (insertion, withdrawal, broadcasting) Reference Love Grandiosity (common in BPD) Nihilistic
Definition of obsessions
Intrusive thoughts that are repetitive, recognised as unreasonable, have no logical basis, enter mind despite resistance. Ego-dystonic.
Components of perception in MSE
Deceptions: Hallucinations and illusions
Distortions: Hyperacusis and hypoacusis
Depersenalisation and derealisation (do you feel detached from yourself or the rest of the world?)
Distinction between hallucination and illusion
Hallucinations occur in the absence of stimuli
Characterising hallucinations
Modality (Auditory most common psych)
Content (who is talking? What are they saying? 1st/2nd/3rd person)
Inside or outside (c.f. pseudo-hallucinations in EUPD)
Situations where hallucinations are normal
Hypnogogic
Hypnopompic
Normal grief reaction
Components of cognition in MSE
Concentration
Orientation
Memory
Assessing insight in MSE
What do you think of your Dx, X?
What do you think has been happening?
Do you think you need treatment?
Static risk factors for suicide
Male
Recent life crisis
Hx of self-harm/exposure to self-harm or suicide
Hx of drug/alcohol misuse
Dynamic risk factors for suicide
Marital status
Living arrangements
Occupation
Plans: Intent, lethality, access to means, finalising arrangements
Psych disorder: Mood, personality, schizophrenia
Protective factors for suicide
Strong religious faith
Family support
Children at home
Sense of responsibility
Risk factors for harming others
Plan, intent, lethality, access to means Hx of violence Psych illness Hx of trauma/abuse Substance misuse
What is the care programme approach
Model for community psychiatric care
Components of CPA
Detailed assessment: identifying psychiatric, medical, and social needs
Key worker: CPN or social worker responsible for coordination + administration of treatment and reporting back any changes/liaising with other agencies
Care plan: Drawn up in consultation w/ service user + nearest relative
Regular review: Usually 6-monthly
Risks to consider
To self, from self: Self-harm, self-neglect, misuse of medication, substance misuse
To treatment: Non-compliance, absconsion
From others: Violence, exploitation
To others: Driving, fire-setting, violence, sexual offending, damage to property
To children: Safeguarding concerns
