Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > History and MSE > Flashcards

History and MSE Flashcards

1
Q

What are the headings of a psychiatric history ? (7)

A
  1. introduction
  2. presenting complaint
  3. history of presenting complaint
  4. past medical history
  5. past psychiatric history
  6. Family history
  7. Personal history - which includes birth and childhood, education, sexual history, occupational history, substance use, forensic history, premorbid personality and social circumstances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components of the introduction of a psychiatric history ?

A
  1. doctors introduces himself
  2. check how the patient wants to be addressed
  3. inform patient on why they might have been referred to psychiatrist
  4. describe the process of the psychiatric history, including how long it will take
  5. confidentiality and risk
  6. consent to proceed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the aim of the presenting complaint ?

A
  1. documents the reasons the patient has asked for help
  2. opended ended questions are essential
  3. generally short and may consist of a list of complaints
  4. record the patients own words
  5. the presenting complaint can also give clues to insight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

for each complaint what is further explored in the history of presenting complaint?

A
  1. when it started?
  2. precipitants
  3. development over time
  4. what has helped and what has made it worse?
  5. associated symptoms
  6. impact on function and change from previous function
  7. also important to screen here for other symptoms which may not have been reported: anxiety and obsessional symptoms, depression, psychosis, substance use, suicidal ideation/behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is included in the past medical history ?

A
  1. past and current medical conditions and illness (physical illness can trigger psychiatric symptoms and vice versa. Explore the psychological effects of the illness on the patient)
  2. current medication and any side effects (medical treatments can produce psychiatric symptoms as unwanted side effects like mood and psychotic symptoms on high dose steroids)
  3. substance abuse (document all medical complications of and treatments for alcohol and/or drug misuse
  4. self harm and suicide attempts (detail medical treatment given)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what should be explored in past psychiatric history ?

A
  1. previous symptoms and episodes of illness; what symptoms did they experience ? were they similar to current symptoms? did they seek help ? what treatment (BioPsychoSocial) was offered? Were they referred to psychiatry? was admission required?
  2. Past biological and psychological interventions; describe details of the previous treatments? what helped? any side effects of medication?
  3. How was their Health and function between episodes ?
  4. Self harm and suicidal behaviour; details of past thoughts of self-harm and suicidal thoughts. Details of actual self-harm and suicidal behaviour. Did they seek help? How were they treated? Past behaviour is an important determinant of current and future behaviour. exploring past self harm and suicidal behaviour is an important component of risk assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do you want to explore in personal history ?

A
  1. Birth and childhood; birth details, developmental milestones, family atmosphere, childhood traits, friends, physical/emotional/sexual abuse
  2. education; highest level of academic achievement, relationships with teachers and peers, bullying, truancy/school refusal, can explore in more detail about each level (primary, secondary, college)
  3. sexual history and relationships; orientation, details of past/current relationships, details of children if any and the quality of relationships with them
  4. occupation; details of past and current employment including, how long? why they left? ever fired-details, relationships with co-workers and management
  5. Substance use; details of alcohol and drug use including past and current, how much of a role are substances playing in current symptoms and presentation ?
  6. Forensic history; interactions with the police including warnings and arrests, court appearances and convictions, history of fighting and violence, sexual crimes
  7. Premorbid personality; ask the patient how you would describe yourseld? How would others describe you? How do you cope with stress? Explore predominant or baseline mood - is it stable or changeable, explore quality of relationships with friends, colleagues and co-workers, explore leisure activities, interests and hobbies, may need collateral history. remember personality may change due to chronic illness
  8. Social circumstances; accomodations details-rented or owner occupier, house mates, social supports, income/social welfare details/medical card, debts/financial difficulties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what do you want to explore in the family history ?

A
  1. age, employment status, health, psychiatric history (formal and informal) and substance use history of all family members
  2. impact of poor health or substance misuse within the family on patient
  3. quality of relationships within family
  4. may choose to include details of domestic violence and or experiences of emotional/physical/sexual abuse here (or in personal history)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the elements included in personal history?

A
  1. birth and childhood
  2. education
  3. sexual history
  4. Occupation
  5. Substance use
  6. Forensic history
  7. premorbid personality
  8. current social circumstances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

information from birth and childhood?

A
  1. birth details
  2. developmental milestones
  3. family atmosphere
  4. childhood traits
  5. Friends
  6. physical/emotional/sexual abuse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

information about education ?

A
  1. primary, secondary, college
  2. highest level of academic achievement
  3. relationships with teachers and peers
  4. bullying
  5. truancy, school refusal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

information about sexual history and relationships?

A
  1. Orientation
  2. details of past/current relationships
  3. details of children if any, and quality of relationships
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

information about occupation ?

A
  1. details of past and current employment
  2. how long?
  3. why they left?
  4. ever fired-details
  5. relationships with co-workers and management
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

information about substance use?

A
  1. details of alcohol and illicit drug use - past and current
  2. how much of a role are substances in current symptoms and presentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

information about forensic history ?

A
  1. interactions with the police - warnings/ arrests
  2. court appearances and convictions
  3. history of fighting and violence
  4. sexual crimes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

information about premorbid personality?

A
  1. explore personality prior to this episode of illness; looking for information about the traits, and behaviours that have persisted since adolescents and make the person who they are
  2. ask the patient - how would you describe yourself? how would others describe you? How do you cope with stress
  3. explore the predominant or baseline mood - is it stable or changeable?
  4. explore quality of relationships with friends, colleagues and co-workers
  5. explore leisure activities, interests and hobbies
  6. personality can change during an episode of illness and collateral history may be important if availabke
  7. personality may also change due to chronic psychiatric illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

information about current social circumstances ?

A
  1. accommodation details- rented or owner occupier
  2. house mates
  3. social supports
  4. income/ social welfare/ medical card
  5. debts/ financial difficulties
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a mental state examination in general terms?

A

this is a ‘here and now’ observation and examination of the patient

17
Q

what are the headings of the MSE?

A
  1. Appearance
  2. behaviour
  3. affect
  4. Speech
  5. Thought form
  6. Mood
  7. Thought content
  8. perception
  9. Cognition
  10. Insight
18
Q

what do you want to describe in terms of APPEARANCE on MSE?

A

describe;
1. attire
2. grooming
3. weight
4. self care
5. Tatoos
6. self-harm scars
7. any physical evidence of drug abuse

19
Q

what do you want to describe in terms of BEHAVIOUR on MSE?

A
  1. how well does the patient engage with the assessment process
  2. are they able/willing to develop rapport?
  3. are they forthcoming regarding answers to questions? are they guarded?
  4. what about motor behaviour? can they sit calmly for the duration of the assessment ? is there evidence of psychomotor agitation or retardation
  5. how appropriate is their behaviour ? is there evidence of disinhibition ? is there evidence of overfamiliarity?
20
Q

what do you want to know in terms of AFFECT on MSE?

A
  1. describe the emotional tone you observed. is the patient happy, sad, anxious, suspicious, irritable, angry
  2. describe the range of affect. is it reactive ? restrictive or expansive?
  3. is their affect congruent to their mood and or thought content ?
21
Q

what do you want to know in terms of SPEECH on MSE?

A
  1. describe the speech under rate, tone, volume and quantity (psychopathology terms such as pressure of speech and alogia may be used here)
    - if there are no obvious abnormalities, you may describe speech as normal. otherwise avoid using the term normal in the MSE
22
Q

what do you want to know in terms of THOUGHT FORM on MSE?

A
  1. can you follow the patients’ train of thought?
  2. are they thoughts appropriately linked and goal directed ?
  3. is there evidence of flight of ideas, loosening of associations, knights move thinking or word salad?
  4. is there evidence of tangential or circumstantial thought form ?
    - make sure to give examples
23
Q

what do you want to know in terms of MOOD on MSE?

A
  1. describe mood under subjective and objective
  2. subjective - ask the patient
  3. objective - based on your history and examination
  4. objective mood may be elated or depressed
  5. elated mood may be hypomanic or manic
  6. depressed mood may be mild, moderate severe, or severe
  7. is the mood congruent to affect and thought content
24
Q

what do you want to know in terms of THOUGHT CONTENT on MSE?

A
  1. what is on their mind?
  2. are they preoccupied ? is there a theme?
  3. cognitions may be positive or negative and reflect baseline core beliefs or be symptoms of an affective or anxiety disorder
  4. is there evidence of obsessional thinking?
  5. is there evidence of overvalued ideas or delusions
  6. use appropriate psychopathology terms to describe and give examples or refer to earlier description
  7. risk assessment - do they have thoughts of self-harm? do they have suicidal ideation. Explore suicidal planning and intent. Do they have thoughts of harming anyone else?
25
Q

what do you want to know in terms of PERCEPTION on MSE?

A
  1. document hallucinations here (use appropriate psychopathology terms to describe and give examples or refer to earlier description
26
Q

what do you want to know in terms of COGNITION on MSE?

A
  1. can they concentrate on the assessment process and answer questions appropriately ?
  2. can they remember relevant dates from their personal history
  3. if yes to the above, it is sufficient to report cognition is grossly intact. If no, perform a MMSE or MOCA. >65 - routine to perform MMSE or MoCA
27
Q

what do you want to know in terms of INSIGHT on MSE?

A
  1. what does the patient think is wrong with them?
  2. do they think they have a mental illness?
  3. what other explanation do they have?
  4. are they able to consider the role of substances and personality traits in their presentation ?
28
Q

what is the formulation ?

A
  1. clinical summary of the important aspects of the history and MSE.
  2. Its aim is to answer the question - why has the patient developed these particular symptoms at this particular time
  3. is essential for the differential diagnosis and the creation of a management plan
29
Q

what is included in the Formulation ?

A

also can include protective factors

30
Q

examples of biological factors in formulation?

A
  1. past history of mental illness
  2. medical illness
  3. age
  4. substance use
  5. medication for illness
  6. Gender
  7. Family history of mental illness
  8. compliance with psychotropic medications
31
Q

examples of psychological factors in formulation ?

A
  1. history of parenteral neglect
  2. premorbid personality traits
  3. history of emotional, physical or sexual abuse
  4. poor coping skills
  5. recent psychological stressor
32
Q

examples of social factors in formulation?

A
  1. childhood history of financial or social adversity
  2. housing
  3. social supports
  4. finances
  5. parenteral separation
33
Q

define precipitating factors

A

factors that help to explain why this person became unwell NOW

34
Q

define perpetuating factors

A

factors that are impeding a patients recovery

35
Q

define protective factors

A

those that will aid in their recovery

36
Q

define predisposing factors

A

those that put a person at risk of mental illness

37
Q

what investigations are considered in psychiatry beyond history and examination (MSE) ?

A
  1. blood tests (anemia, hypothyroidism, potential effects of alcohol abuse)
  2. psychological assessment to explore personality traits and assess suitability for psychotherapy
  3. collateral history from GP or a family member
  4. ECG as a baseline before prescribing psychotropic medication
  5. EEG and brain imaging to exclude organic causes of psychosis
  6. Urine drug screen and alcometer if deemed relevant
38
Q

in general what approach is used for treatment in psychiatric patients ?

A

BioPsychoSocial

39
Q

what are examples of biological treatments ?

A
  1. Psychotropic medication
  2. management of substance abuse
  3. management of contributing medical conditions
  4. Electroconvulsive therapy
40
Q

what are examples of psychological treatments ?

A

supportive
psychotherapy
talking therapies

41
Q

what are examples of social treatments?

A

help and support with: accommodation, finances, occupation

Psychiatry (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions