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Year 4 Psych > History and Examination > Flashcards

History and Examination Flashcards

1
Q

What is the pneumonic of MSE?

A

All Sane Men Think That Pizza Is Italian

Appearance & behaviour
Speech
Mood
Thought Form
Thought Content
Perception
Insight
IQ (cognition)
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2
Q

Outline what features are assessed in appearance

A

Distinctive features
- Age, gender, ethnicity etc

Clothing
Posture / gait
Grooming / hygiene
Evidence of self-harm

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3
Q

Outline what features are assessed in behaviour

A

Eye contact
Facial expression
Psychomotor activity - tremors / ticks / twitches / retardataion
Body language / gestures / mannerisms
Level of arousal - calm / agitated / aggression
Ability to follow requests
Rapport / engagement

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4
Q

Outline what features are assessed in speech

A

Rate of speech - pressured / slowed

Rhythm and fluency - articulate / clear / slurred

Quantity - minimal / excessive / complete absence

Volume

Tone - monotonous / tremulous

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5
Q

Outline what features are assessed in mood and affect

A

Mood = sustained state of pt’s inner feelings (weeks - months)

  • How are you feeling?
  • What is your current mood?
  • Have you been feeling low / depressed / anxious lately?

Affect = observable expression of a pt’s inner feelings

  • Quality of affect: sad / agitated / hostile, euphoric / animated
  • Range of affect: restricted / normal / expansive
  • Intensity: normal / blunted / flat
  • Fluctuations: labile
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6
Q

Outline what features are assessed in thought form

A

Speed - accelerated / racing / retarded

Flow / coherence:
Linear - in a logical order
Incoherent - makes no logical sense
Circumstantial - lots of irrelevant / unnecessary details but returns to answer question
Tangential - moves from one thought to the other that relate in some way but never get to the point
Flight of ideas - increased number of ideas, produced at a rapid pace
Perseveration - repetition of a particular response despite absence / removal of stimulus

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7
Q

Outline what features are assessed in thought content

A

Abnormal beliefs / delusions

Obsessions - pt aware they are irrational but obsessive thoughts continue to enter their head

Overvalued ideas - eg perception of weight in anorexia

Suicidal thoughts

Homocidal / violent thoughts

Thought possession

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8
Q

What questions can be asked to assess thought content?

A

Whats been on your mind recently?
Are you worried about anything?
Do things seem unreal to you?
Are there any thoughts you have had a hard time getting out of your head?
Do you think anyone is trying to harm you?
Do you have any beliefs that aren’t shared by others you know?
Do you ever think about ending your life?
Have you ever felt that life is not worth living?
Have you ever attempted to end your own life?
Do you ever think about harming people?

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9
Q

What is assessed in thought possession?

A

Thought insertion
- Do you think people can put ideas in your head?

Thought withdrawal
- Have you ever felt like people have removed / erased things / memories from your mind?

Thought broadcasting
- Do you ever feel like others can hear what you’re thinking?

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10
Q

Outline what features are assessed in perception

A

Hallucinations
Pseudo-hallucinations
Illusions
Delusions

  • Do you ever see, hear, smell, feel or taste things that are not really there?
  • Did you think this was real at the time?
  • Do you still believe it was real?
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11
Q

Outline what features are assessed in IQ (cognition)

A

Orientation

  • Time
  • Place
  • Person

Attention and concentration

Short term memory

Detailed testing eg AMTS, MMSE, ACE-III

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12
Q

Outline what features are assessed in insight

A

Is the pt able to recognise they have a problem or what they are experiencing is abnormal?

What does the pt think is the cause of the problem?

Does the pt want help with their problem?

(+ judgement - eg what would you do if you could smell smoke in your house?)

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13
Q

Outline a psychiatric hx

A 
Presenting Complaint
History of presenting complaint
Past psychiatric history
Past medical history
Drugs history
Family history 
Personal history
Social history
Substance Abuse
Forensic history
Pre-morbid personality
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14
Q

Outline presenting complaint

A

Demographics: name, age, marital status, children, employment, housing

In pt own words eg “I’m hearing voices”

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15
Q

Outline history of presenting complaint

A

Expand on each presenting symptoms

Screen for: depression, anxiety, psychosis, alcohol

Risk: self and others

What is the effect of problems on:

  • Relationships, work, social life
  • Functioning (work, dressing, cooking)

Treatment: type, compliance, benefit

  • Primary care
  • Hospital
  • Follow up
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16
Q

Outline past psychiatric history

A

Have you ever experienced anything like this before? Expand

First contact with GP

First contact with psychiatric services

Number of previous admissions
- When, where, duration, symptoms, treatment, follow-up

Ask about DSH, ECT, depts and MHA

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17
Q

Outline PMH

A

General health / see GP for anything regularly

  • DM, asthma etc
  • Head injury
  • Operations
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18
Q

Outline drug history

A

Medications

  • Name
  • Durations
  • Dose (adequate trial?)

OTC / self medicated

Aids to compliance

Allergies

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19
Q

Outline family history

A

Draw family tree
- Parents, siblings, ?extended family

Names, ages, where they live, personality, occupation

Contact and quality of relationship

Health - medical and physical

20
Q

Outline personal history

A

1) Birth and childhood
2) Education
3) Employment
4) Relationships

21
Q

Outline birth and childhood in personal history

A

Birth - any problems

Upbringing

Happy or not?

Close to who?

22
Q

Outline education in personal history

A

Dates of schools attended

Mainstream school?

Enjoy?

Friends / bullied?

Subjects / teachers liked?

Behaviour problems, expelled, truancy

Academic

Aspirations

23
Q

Outline employment in personal history

A

For each job:

  • Type
  • When
  • Duration
  • Enjoy?
  • Why leave

Longest job?
Current job?
- Pay and promotion

24
Q

Outline relationships in personal history

A

For each relationship:

  • Name
  • Age
  • Duration
  • Good / bad?
  • Why end?
  • On-going contact
  • Children

First partner
List other long term partners (>6mnths)
Longest relationship

Current partner:

  • Character traits
  • Sexual history
25
Outline social history
``` Housing Typical day Relationships ADL Support Occupation Finances Hobbies (+ driving?) ```
26
Outline substance misuse
Smoking Alcohol - CAGE Illicit drugs: - What - How - Amount - ££ - Duration - Impact
27
Outline forensic history
Any contact with criminal justice system? Drink-driving Convictions or sentences Violence or aggression
28
Outline pre-morbid personality history
1) Forming and maintaining relationships - Family / friends / partner 2) Character traits - Would you say you're trusting? Suspicious? Caring 3) Predominant mood - How would you describe your mood most of the time? 4) Reaction to stress - When you're under pressure, how do you cope? 5) Hobbies 6) Religion or spirituality
29
What tools can be used to assess cognition?
Informal used for screening (deficits not diagnosis): - AMTS - MMSE Formal used for diagnosis: - ACE-III (addenbrooke's cognitive examination)
30
What 5 domains are assessed in cognition?
1) Orientation 2) Attention and concentration 3) Memory 4) Language 5) Construction / visuospacial
31
How is orientation assessed?
Time - day, date, month, year Place - building, city, country Person - name, age, DOB, address
32
How are attention and concentration assessed?
20 - 1 backwards Count back from 100 in 7s
33
How is memory assessed?
Antegrade - learning now information and being able to recall it Retrograde - recall of previously learning information eg monarch, important historical dates
34
How is language assessed?
Preservation Confabulation Word finding problems
35
How is visuospacial / construction assessed?
Drawing interescting pentagons Draw a cube
36
What is a pneumonic for remembering domains of cognition?
Only The Prettiest People Can Actually Make Love Continuously ``` Orientation Time Place Person Concentration Attention Memory Language Construction ```
37
Outline AMTS
1) How old are you 2) What is your DOB 3) What is the year now? 4) What is the time now (nearest hr) - Ask to remember 24 west street 5) Where are we? What is the building? 6) Who is the current monarch? 7) Date of WW1 8) Count backwards from 20-1 9) Tell me two people in the room / what they do for a living 10) Recall the address given / 10
38
How are scorings classified for ACE-III?
> 88 = normal 83 - 87 = inconclusive <73 = low
39
Outline risk assessment
Have you ever thought about hurting yourself in any way? - If so, how? - If they ever have then how did they do it, how did they feel when they were doing it? Have you ever thought about suicide? Have you ever thought about harming others? - In psychosis, can ask "have you ever thought about taking measures to protect yourself at all?" Risk from others: - Do you feel safe at home / in your relationship? - Has anyone in your family / partner ever hurt you in any way
40
What structure is used when performing a psychosocial examination in a child / young person?
HEADSS assessment 1) Home and environment 2) Education and employment 3) Activities 4) Drugs and alcohol 5) Sexuality and relationships 6) Suicide and depression
41
Outline home and environment in a HEADSS assessment
Who are they living at home with at the moment? Do they get on well with everyone at home? Who do they get on best with? Do they feel safe at home? Do they share a room or a bed with anyone?
42
Outline education and employment in a HEADSS assessment
Are you in school / college? Which year? Do you enjoy school? What do you enjoy most / the last? How are you doing at school? Do you have friends at school? What do you do ay break and lunch time? What do you want to do when you finish school? Do you work / have a job? How much?
43
Outline activities in a HEADSS assessment
What do you do for fun? Where / when? Do you spend time with friends / family? Hobbies? TV / reading / sports?
44
Outline drugs and alcohol in a HEADSS assessment
Have you ever tried alcohol? If so when, with who, how often? Have you ever tried drugs? If so when, with who, how often? Does anyone in the house smoke? Lots of teenagers have tried smoking, have you ever tried?
45
Outline sexuality and relationships in a HEADSS assessment
Are you in a relationship about them? Can you tell me more about them - age, how did they meet, how old are they? Lots of young people in relationships develop intimate relationships with their girlfriend/boyfriend, how have you handled this part of the relationship? Have you ever had sex, with who and when? What contraception did you use?
46
Outline suicide and depression in a HEADSS assessment
How is life going in general? How would you describe yourself? How do you think others would describe you? Do you ever feel negatively about yourself? Do you every feel worried about your weight? Do you ever feel like life isn't worth living? Have you ever thought about hurting or killing yourself, have you ever hurt yourself in any way? Also screen for sleep disorders, appetite/eating changes, abuse

Year 4 Psych (10 decks)

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