Clinical Assessment in Psychosis Flashcards
What are the steps in a standard psychiatric assessment?
Individuals history Mental state Collateral information Physical examiniation Diagnosis or Formulation Risk assessment Plan
What are the major differences between history and mental state?
History is fairly stable and mental state is dynamic
Story vs phenomenology
Long vs short
So length and language
What are the components of Psychopathology?
Mood Insight Speech Cognition Risk Appearance and Behaviour Perceptions Thoughts
Why do we use systems in assessment?
-Systematic: Rigorous in defining Not forgetting -Communicate with Professionals -Allows provisional diagnosis/formulation -Allows monitoring of change
What are some of the criteria for delusional diagnosis?
Must be fixed and false,
Must be culturally inappropriate
What are the three common delusional types?
paranoid: most common
Nihilistic: Dying and things being unreal
Grandiose: Positive mood and status
What is a major challenge with regards to psychotic symptoms opposed to depression or anxiety?
Much harder to empathise with.
What are three categories of psychotic symptoms that are difficult to relate to?
Ideas of passivity: Made actions, feelings or thoughts being controlled
Ideas of reference: Media or medium is talking to you
Thought: Insertion, withdrawal, broadcast and Echo.
What is the difference between delusions and formal thought disorder?
Delusions still follow a coherent structure, formal thought disorder has content that is normal, but an incoherent order, words, sentences and paragraphs.
What are some key questions to ask when someone is having AH?
Are the voices 2nd or 3rd Person?
Are there commands?
How do you resist the commands?
What are we looking at through judging insight and how can insight be harmful?
Patients ability to be aware of their difficulties or limits
Levels of severity not dichotomy.
Recovery insight is issue as it can lead to depression, shame, self harm
What are the differing ways we can categories risk assessments?
Static vs Dynamic factors
Categories: Self/Others/Vulnerability/Neglect/Absconding
Need for rich details
What are some common concerns in assessment for a doctor/clinician?
Violence
Lack of insight
Non-engagement
Unusual symptoms
What are some key points to keep in mind when assessing someone?
If you feel unsafe, get out and get support.
Empathise
Don’t push people into areas they don’t want to go
What are some of the Challenges in assessing someone with psychosis?
1: Appearance and behaviour can’t be asked. We assess someones mental state by asking their mood, thoughts, cognition and then insights. Appearance and Behaviour and speech come out as a result.
2: How to ask about delusions? Patients don’t know what is false, but they do know what ideas cause them trouble or disagreements.
3:Why Auditory?
Because we are well versed at spontaneously generating speech.
