History taking and MSE Flashcards
What is the basic structure of a psych hx?
HPC
Past psych hx - treatment, therapy, admissions, diagnoses, seen the GP, had these sx before and not found help, how they’ve responded to treatment in the past
SH - trauma, childhood? schooling? employments? relationships
PMH
DH
FH and personal hx - relationship w family
Premorbid personality - like before unwell and how others described them?
Forensic history
What is involved in the personal hx in psych?
- Infancy and early childhood - pregnancy and gestation, any time in hospital away from mum, develop milestones, who they lived w when young, siblings, any trauma
- Adolescence and eduction - bullied? friends? bully? uni? how they did academically?
- Occupational record - job to job? unemployed?
- Sexual development and relationships - abusive or supportive? lots of relationships? any themes? first relationship?
- Alcohol/drugs - do they use any? any evidence of dependence?
- Forensic - any contact w the police? in jail or on probation?
What qs about sx?
Onset
Severity
Duration
Aggravating and relieving
Associated sx
What are some qs to ask about low mood?
How are you feeling? How is your mood?
- How long and when did you last feel normal?
- Anything in particular troubling you? To blame? Worried about what other people think?
- Enjoy things? How do you see the future?
- Have you felt this before?
- Ever felt the opposite? (eg. manic/high)
- Has anyone else noticed?
What are some qs for risk assesment?
Do you feel life is worth living?
Has it every gotten so bad that you’ve thought about harming yourself/ending your life?
What stops you from going through w it?
What are some qs to ask for psychosis?
Delusions - anything out of the ordinary? anything you can’t explain? anything worrying? how do you know? how long have you known about it? could there be any other explanation? taken any steps to protect yourself?
Formal thought disorder - can you control your thoughts? is anyone interfering w your thoughts?
Hallucinations - ever heard things you can’t explain? ever hear voices? can you describe it? how many and where do they come from? do they ever tell you to do things? can you resist them?
What is a Mental State Exam?
Snapshot of persons mental state at the time of assessment
What is the structure of MSE?
Appearance and behaviour
Speech
Mood - subjective and objective
Thought - form and content
Perceptions
Cognition
Insight
Risk
What are some things to look at in appearance and behaviour?
Appearance - well kept? Clothing? Personal hygiene, weight, appropriately dressed
Behaviour:
Eye contact - intense or reduced and avoidant
Level of rapport - quick and easy or guarded
Psychomotor retardation - slowing of speech and body movements
Psychomotor agitation - increased?
Distracted, responding to unseen stimuli
Facial expression and body language
Abnormal movements - tremors, tics, lip smacking, akathisias, rocking, extrapyramidal signs
What is there to look for in speech?
Rate, rhythm, vol, fluency and tone
Formal thought disorder - painstaking to get to the point, tangential, loosening or no connection between thoughts, words created by pt (neologisms), flight of ideas, pressured speech, thought blocking
What is there to look for in mood?
Subjective - how do they describe their mood and use scale?
Objective - what was their mood to you?
Affect - emotional responsiveness - blunted? flat? inappropriate? labile? - their expressions eg. smiling when crying. Apparent emotion and range of affect
What is there to look for in thought?
Form - delusion? paranoid/overvalued idea? obsessive rumination or intrusive thought? phobia?
Content of the thought - suicidal, homicidal
Thought possession - insertion, w drawal, broadcasting
What is there to look for in perception?
Illusion - misinterpretation
Hallucination - no ex sensory stim but perceiving something
Pseudo hallucinations
Depersonalisation - one outside of his or her self
Derealisation - vague sense of unreality
What is there to look for in cognition?
Orientation to time, place, person eg. AMT, MoCA, MMSE
What is there to look for in insight?
Persons understanding of their experience, do they believe they are unwell?
Attitude to treatment?
