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Psychiatry > History, MSE and Diagnosis > Flashcards

History, MSE and Diagnosis Flashcards

1
Q

Give an overview of the structure of a psychiatric history

A
  • Presenting Complaint(s)
  • History of the Presenting Complaint(s)
  • Past Psychiatric History
  • Past Medical History
  • Current and Recent Medication
  • Social History - alcohol & drug use; smoking; social circumstances; occupation
  • Family History
  • Personal History
    • Developmental milestones
    • Schooling/Education
    • Occupational history
    • Relationships
    • Pre-morbid Personality
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2
Q

What are the key things to ask about in the social history?

A
  • Social circumstances including occupation
  • Current financial situation/stressors
  • Smoking/Alcohol/illicit drug use
  • Current relationship/stressors
  • Children - contact
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3
Q

What things should you ask about when completing the alcohol/ illicit drug history?

A
  • Regular or intermittent
  • Amount (know the units)
  • Pattern
  • Dependence/ withdrawal symptoms
  • Impact on work, relationships, money, police
  • Screening questionnaires eg CAGE
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4
Q

What should you ask about in the personal history?

A
  • Developmental milestones
  • Early life
  • Schooling
  • Occupational
  • Relationships (sexual & marital history)
  • Financial
  • Friendships, hobbies and interests
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5
Q

What questions should you ask as part of the forensic history?

A
  • “Have you ever been in contact with the police? Charged with any crime?”
  • Offences including sentences
  • Recidivism- the tendency of a convicted criminal to re-offend.
  • Particular attention to violent or sexual crimes
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6
Q

How should you ask about pre-morbid personality?

A
  • Difficult to be comprehensive
  • Emphasis on consistent patterns of behaviour, interaction, mood
  • Importance of corroboration
  • “How would your best friend describe you as a person?”
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7
Q

What are the 10 aspects of the Mental State Examination?

A
  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight
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8
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on appearance

A
  • Height/Build
  • Clothing - appropriate/inappropriate, kempt, bizarre
  • Personal hygiene - clean/unshaven/malodorous
  • Make up, jewellery, accessories
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9
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on behaviour

A
  • Greeting
  • Non verbal cues
  • Gesturing - normal, expansive, bizarre
  • Abnormal movements - tremor, choreioathetoid movements, posturing, akathisia
  • Cooperative, rapport
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10
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on mood

A
  • Eye contact
  • Affect – objective manifestation of mood at i/v
  • Mood rating – subj & obj; rate out of 10;
  • Psychomotor function - retarded, agitated
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11
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on speech

A
  • Spontaneity
  • Volume - loud, quiet, poverty
  • Rate - pressured, slowed
  • Rhythm - rhyming and punning
  • Tone - monotonous, lilting
  • Dysarthria
  • Dysphasia - expressive/receptive
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12
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on thoughts

A
  • Close relationship to speech - external manifestation of thoughts
  • Phobias
  • Obsessions
  • Flight of ideas
  • Formal thought disorder – broadcast, echo, insertion, block, withdrawal
  • Knight’s move, derailment, loosening
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13
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on beliefs

A
  • Preoccupations
  • Over valued ideas
  • Delusional beliefs - fixed, false belief out of cultural context; extraordinary conviction
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14
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on percepts

A
  • Illusions
  • Hallucinations – pseudo, true
  • Many domains - auditory, visual, somatic/tactile, olfactory & gustatory
  • Specific types may be associated with certain conditions eg complex visual hallucinations in DLB
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15
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on suicide/homicide

A
  • Must always ask about suicidal thoughts
  • Ideation
  • Intent
  • Plans - vague, detailed, specific, already in motion
  • Also homicidal risk
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16
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on cognitive function

A
  • Orientation - time, place, person
  • Attention/concentration - throughout i/v
  • Short term memory - 3 objects; name & address
  • Long term memory - personal history
  • If any concerns - perform objective tests eg MSQ, MMSE, MOCA, FAS, Clock drawing, executive function tests
17
Q

The 10 aspects of the Mental State Examination are;

  1. Appearance
  2. Behaviour
  3. Mood
  4. Speech
  5. Thoughts
  6. Beliefs
  7. Percepts
  8. Suicide/Homicide
  9. Cognitive function
  10. Insight

Expand on insight

A
  • Best seen as spectrum
  • Very rarely 100% present/absent
  • Varies over time/illness
  • 3 questions –
  • Are symptoms due to illness?
  • Is this a mental illness?
  • Do they agree with treatment/Mx plan?
18
Q

How should you ask a patient about whether they experience hallucinations?

A
  • “I would now like to ask you a question which we ask to everybody. Do you ever seem to hear noises or voices when there is no one about and nothing else to explain it?”
  • “Also is that true of visions or other unusual experience which some people have with touch or taste or smell?”
19
Q

What does a mental state examination include?

A
  • Appearance and Behaviour
  • Affect
  • Mood
  • Speech
  • Thinking
  • Perceptual Anomaly
  • Cognitive function
  • Insight
  • Risk assessment including suicide/homicide
  • ALSO CONSIDER RESULTS OF PHYSICAL EXAM AND BLOOD and other TEST RESULTS
20
Q

What is a delusion?

A

“ a delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction.”

Examples

  • grandiose
  • paranoid (correctly persecutory)
  • hypochondriacal
  • self referential
21
Q

How should you ask a patient whether they are experiencing a delusional belief?

A
  • E.g. Persecutory delusion screening question:
  • “Is anyone deliberately trying to harm you, e.g. trying to poison you or kill you?”
  • Differentiation partial and full delusions
  • “Even when you seem to be most convinced, do you really feel in the back of your mind that it might not be true, it might be your imagination?”

​

22
Q

What are the signs of thought disorder and linkage of thoughts?

A
  • A pattern of interruption or disorganization of thought processes is broadly referred to as formal thought disorder, and can be described more specifically as
  • thought blocking,
  • fusion,
  • loosening of associations,
  • tangential thinking,
  • derailment of thought, or knight’s move thinking.
23
Q

Abnormal possession of thoughts; thought alienation.

Commonly reported in schizophrenia

  • Thought insertion and withdrawal
  • Thought blocking
  • Thought broadcasting

How should you ask a patient whether they are experiencing this?

A
  • “Can you think clearly or is there any interference with your thoughts?
  • “Can anyone read your mind?”
  • “Is anything like hypnotism or telepathy going on?”
24
Q

What are the 3 types of perceptual anomalies?

A
  1. Hallucinations
  2. Pseudohallucinations
  3. Illusions
25
Q

There are 3 types of perceptual anomalies;

  1. Hallucinations
  2. Pseudohallucinations
  3. Illusions

What are hallucinations?

A
  • Have the full force and clarity of true perception
  • located in external space
  • no external stimulus
  • not willed or controlled

May include any of the 5 special senses

  • auditory or visual
  • tactile
  • olfactory and gustatory
26
Q

How can you assess cognitive function?

A
  • Orientation - time, place, person
  • Attention/concentration - throughout i/v
    • Standard concentration test is Reversed Months DNOSAJJMAMFJ
  • Short term memory - 3 objects or name & address
  • Long term memory - personal history
  • If any concerns - perform objective tests eg MSQ, MOCA, MMSE, FAS, Clock drawing, executive function tests
27
Q

What is insight?

A
  • This should be conceptualised as a spectrum; rarely 100% absent or present.
  • Three questions can indicate the place on this continuum:
    • Do you think you are ill?
    • If you are ill is it a mental illness?
    • If you are ill and it is a mental illness do you agree broadly with the current treatment plan?
28
Q

According to the ICD 10 diagnostic criteria, that are the key symptoms of a depressive episode?

A

Key symptoms:

  • persistent sadness or low mood;and/or
  • loss of interests or pleasure
  • fatigue or low energy

at least one of these, most days, most of the time for at least 2 weeks

if any of above present, ask about associated symptoms:

  • disturbed sleep
  • poor concentration or indecisiveness
  • low self-confidence
  • poor or increased appetite
  • suicidal thoughts or acts
  • agitation or slowing of movements
  • guilt or self-blame

the 10 symptoms then define the degree of depression and management is based on the particular degree

  • mild depression (four symptoms)
  • moderate depression (five to six symptoms)
  • severe depression (seven or more symptoms, with or without psychotic symptoms)
29
Q

The Key symptoms of depression are:

  1. persistent sadness or low mood; and/or
  2. loss of interests or pleasure
  3. fatigue or low energy

at least one of these, most days, most of the time for at least 2 weeks

if any of above present, ask about associated symptoms:

  1. disturbed sleep
  2. poor concentration or indecisiveness
  3. low self-confidence
  4. poor or increased appetite
  5. suicidal thoughts or acts
  6. agitation or slowing of movements
  7. guilt or self-blame

the 10 symptoms then define the degree of depression and management is based on the particular degree

How many symptoms would someone with mild depression display?

A

4

30
Q

The Key symptoms of depression are:

  1. persistent sadness or low mood; and/or
  2. loss of interests or pleasure
  3. fatigue or low energy

at least one of these, most days, most of the time for at least 2 weeks

if any of above present, ask about associated symptoms:

  1. disturbed sleep
  2. poor concentration or indecisiveness
  3. low self-confidence
  4. poor or increased appetite
  5. suicidal thoughts or acts
  6. agitation or slowing of movements
  7. guilt or self-blame

the 10 symptoms then define the degree of depression and management is based on the particular degree

How many symptoms would someone with moderate depression display?

A

5-6

31
Q

The Key symptoms of depression are:

  1. persistent sadness or low mood; and/or
  2. loss of interests or pleasure
  3. fatigue or low energy

at least one of these, most days, most of the time for at least 2 weeks

if any of above present, ask about associated symptoms:

  1. disturbed sleep
  2. poor concentration or indecisiveness
  3. low self-confidence
  4. poor or increased appetite
  5. suicidal thoughts or acts
  6. agitation or slowing of movements
  7. guilt or self-blame

the 10 symptoms then define the degree of depression and management is based on the particular degree

How many symptoms would someone with severe depression display?

A

7 or more, with or without psychotic symptoms

Psychiatry (21 decks)

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