History taking, MSE and descriptive psychopathology Flashcards
What are the aspects of a psychiatric history that need to be covered in addition to the normal history structure?
- Past psych history
- Birth and developmental history
- Forensic history
- Personal history
- Pre-morbid Personality
- Current social circumstances
What are the different aspects of the mental state examination?
- Appearence/Behaviour
- Mood
- Speech
- Thoughts
- Abnormal Beliefs
- Abnormal Perceptions
- Suicide/Homicide
- Cognitive Function
- Insight
When assessing appearence and behaviour as part of the MSE, what are you looking at?
Appearence, attitude and activity
- Appearence - Height/build, prominent features, level of consciousness, apparent age, position and posture, eye contact, facial expressions
- Attitude - Degree and type of co-operativeness
- Activity - Voluntary/involuntary movements (intensity), tic mannerisms, compulsions
When assessing mood as part of the MSE, what are you looking at?
- Eye contact
- Affect
- Mood rating
- Psychomotor function - retarded, agitated
When assessing speech as part of the MSE, what would you be assessing?
- Spontaneity
- Volume (sound and quantity)
- Rate
- Rhythm
- Tone
- Coherence
- Repitition
- Relevance
When assessing thoughts as part of the MSE, what would you be looking at?
- Thought process/form
- Thought content
When describing thought form/process, what would you be looking at?
- Connectedness - loose, tangential, flight of ideas
- Presence of peculiarities - blocking, neologisms, clang associations
When assessing thought content, what would you be looking at?
- Predominant topics/issues
- Preoccupations, ruminations, obssessions
- Suicidal/homicidal ideation
- Phobias
- Any other content
When assessing Abnormal beliefs as part of the MSE, what would you be looking for?
-
Delusional beliefs
- Thought interference
- Reference/persecution
- Control/passivity
- Nihilistic/grandiose
When assessing abnormal perceptions as part of the MSE, what would you be looking at?
- Illusions
- Hallucinations - pseudo, true
- Depersonalisation, derealisation, deja vu
When assessing suicidal/homicidal thoughts as part of the MSE, what would you want to look at?
Must ALWAYS ask about thoughts
- Ideation
- Intent
- Plans - vague, detailed, specific, already in motion
- Reasons for/against
Also homicidal risk
When assessing cognitive function as part of the MSE, what things would you be looking at?
- Orientation - time, place, person
- Attention/concentration
- Short term memory - 3 objects, name and address
- Long term memory - personal history
When assessing insight as part of the MSE, what would you be looking at?
Varies over time/illness
- Are symptoms due to illness?
- Is this a mental illness?
- Do they agree with treatment/mx plan?
What is formulation?
Contextualisation of the patient’s symptoms in a broader, personalised by identifying the 4 P’s (Predisposing, Precipitating, perpetuating and protective factors)
A formulation focuses on a prediction of how a patient might react to a new situation or psychotherapy, unlike DDx which categorises the illness into a diagnositc label.
DDx can be regarded as the 5th P - PROBLEM
When asking about depression, what should you ask about?
- Are you feeling low/depressed?
- Is life worht living?
- Can anything give you pleasure?
- How are your energy levels?
- Sleep and appetite
- Concentration
- Low confidence
- Libido
When asking about mania, what would you ask?
- Do you have more energy than normal?
- Can you focus?
- Are you having difficulty settling?
- Spending more than usual?
- Increased libido?
When asking about psychosis, what would you ask about?
- Has anything odd or unusual been happening recently?
- How do odd ideas occur?
- Are thoughts being interfered with?
- Do you feel anyone is controlling you?
- Is anyone putting thoughts into your head?
- Do people have access to your thoughts?
- Do you hear voices when no one is around?
- Do you see things others can’t?
When asking about drug and alcohol use, what would you want to ask about?
- What do you take?
- How much? How often? For how long?
- How much do you spend on it?
- How is it impacting on your life?
- Has your use changed recently?
- Withdrawal signs?
When asking about anxiety, what would you ask about?
- Any worries/anxieties?
- Are you always anxious/come and go?
- What causes this?
- What physical symptoms do you experience?
- How do you manage the anxiety?
What are classes of non-verbal behaviour?
- Gaze and mutual gaze
- Facial expression
- Smiling, blushing
- Body attitude
What are signs of auditory hallucinations?
- Inexplicable laughter
- Silent and distracted while listening to voices
- Random, meaningless gestures
What are signs of depressed mood?
- Hunched, self-hugging posture
- Little eye contact
- Downcast eyes
- Tears
- Slow thought, speech and movement
What are signs of anxious behaviour?
- Fidgeting, trembling
- Nail-biting
- Shuffling feet
- Squirming in the chair
- Sits on edge of chair
What is the definition of a delusion?
An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument, typically as a symptom of mental disorder.
What is affect?
This refers to the immediate expression of emotion. Examples include blunted affect and incongruent affect
What is mood?
Refers to emotional experience over a more prolonged period of time
What does the term euthymic mean?
Normal non-depressed, reasonably positive mood
What is hyperthymia?
An extremely happy mood
What does dysthymic mean?
Low/depressed mood
What does the term apathetic mean?
Showing or feeling no interest, enthusiasm, or concern.
What does the term dysphoric mean?
Profound state of unease or dissatisfaction.
What is an illusion?
A perception that occurs when a sensory stimulus is present but is incorrectly perceived and misinterpreted, such as hearing the wind as someone crying
What is the definition of a delusion?
An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument, typically as a symptom of mental disorder.
What is the difference between a primary and secondary delusion?
- Primary - delusions arising directly from disordered mental state e.g. schizophrenia. Tends to arise with no previous experiences to account for it
- Secondary - delusions which arise as understandable reactions within the context of their current affect/preoccupation
What is the difference between between mood incongruent and mood congruent delusions?
- Mood congruent - affective delusions (e.g. nihilistic, grandiose)
- Mood incongruent - does not fit with apparent mental state e.g. horrific beliefs discussed without comensurate distress
What are delusions of persecution?
Theme of being followed, spied on and conspired against with a belief that the persecutors intend to cause harm.
What is the difference between subjective and objective signs?
Subjective is described by the patient, objective is described by the external observer
What is the difference between primary and secondary psychopathology?
Primary symptoms arise directly from disordered mental states, and cannot be fully understood. Secondary symptoms occur as understandable reactions to the patients current affect.
What is meant by the form of an abnormal symptom?
The type of experience attributable to the underlying mental conditions e.g. primary delusions, hallucinations
What is meant by the content of a symptom?
The composition of the symptom which is richly illustrative of the patient’s internal world
What is a hallucination?
Experience in any sensory modality (visual, auditory, olfactory, proprioceptive) without any external stimulus.
Characteristically felt to occur in the external world along with other objects, have the same qualities as everything else, and cannot consciously be manipulated or stopped
What is an auditory hallucination?
https://www.youtube.com/watch?v=0tn8xLQY53U
Can be simple (hisssing noise) or complex (voices, music). Voices can be friendly/pleasent or aggressive, unfamiliar
What is a second-person hallucination?
https://www.youtube.com/watch?v=xh06HsxBXqI
A voice talking directly to the person or giving them instructions
What is a third-person hallucination?
Voices heard arguing or giving a running commentary just before, simultaneously or after a person’s action
What are the four broad characteristics of conventional thought process?
- Thought stream - speed, quality, quantity
- Thought content - composition of thought
- Thought form - Formation and coherence of thinking
- Thought possession - thought to be their own thought
What are disorders of thought stream?
- Flight of ideas
- Retardation of thinking
What are disorders of thought content?
- Delusions
- Overvalued ideas
What are disorders of thought form?
- Derailment
- Omission
- Fusion
- Substitution
- Tangential thinking
What is thought derailment?
Also known as Knights move thinking/loosening of association
A symptom of schizophrenic thought disorder in which there is a total break in the chain of association between the meaning of thoughts. The connection between the two sequential ideas is apparent neither tot the patient nor the examiner
What is thought omission?
All or part of the thought is absent without reason
What is thought fusion?
Thoughts are fused together
What is tangential thinking?
Talking past or around the point as thoughts diverge from the topic
What are disorders of thought possession?
- Thought insertion
- Thought withdrawal
- Thought broadcasting
What is thought alienation?
Subjective experience of one’s own thoughts being under the control of an outside agency
What is thought insertion?
Foreign thoughts placed into one’s mind
What is thought withdrawal?
Thoughts suddenely disappearing - having been taken by external force
What is thought broadcasting?
Thoughts being transmitted to everyone around them - as though being played by radio
What is a formal thought disorder?
Refers to disorganized thinking as evidenced by disorganized speech
What is poverty of speech?
General lack of additional, unprompted content seen in normal speech
What is tangentiality?
A pattern of speech characterized by oblique, digressive, or irrelevant replies to questions; the responses never approach the point of the questions
What is verbigeration/”word salad”?
Where speech is reduced to a senseless repetition of sounds and phrases (this is more of a disorder of thought form)
What are neologisms?
Words and phrases invented by the patient or a new meaning to a known word
What is thought blocking?
Refers to the sudden arrest in the flow of thoughts. The previous idea may then be taken up again or replaced by another thought.
What is concrete thinking?
Seen as a literalness of expression and understanding, with failed abstraction. Can be tested by the use of proverbs.
What is flight of ideas?
Subjective quickening of thoughts so most are not carried to completion before being overtaken
What is retardation of thinking?
Slowing of the train of thought although it remains goal directed
What is pressure of speech?
Tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener.
What are nihilistic delusions?
A depressive delusion that the self, part of the self, part of the body, other persons, or the whole world has ceased to exist.
What is the defintion of agitation?
A state of restless overactivity, aimless or ineffective
What is the defintion of anhedonia?
Loss of ability to derive pleasure from experience
What is the definition of apathy?
Loss of interest in own surroundings
What is the defintion of anxiety?
An unpleasant emotion in which thoughts of apprehension or fear predominate
What is the defition of depression?
An unpleasant emotion in which sadness or unhappiness predominates
What is the definition of a stupor?
A state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking. On recovery can describe clearly events which occurred whilst stuporose
What is the defintion of catatonia?
https://www.youtube.com/watch?v=_s1lzxHRO4U
A state in which a person becomes mute or stuporous or adopt bizarre postures. Features include flexibilitas cerea - limbs moved passively by observer into positions where they are retained for hours on end
What is psychosis?
A breakdown in the boundary between a patient’s internal personal experience and external reality (ego-boundary)
What are delusions of reference?
A delusional belief that external events or situations have been arranged in such a way as to have particular significance for, or to convey a message to, the affected individual.
E.G. The patient may believe that the tele ision news item are referring to him/her
What is confabulation?
The process of describing plausibly false memories for a period for which the patient has amnesia.
Occurs in Korsakoffs psychosis, dementia
What are paranoid delusions?
Strictly speaking this describes self-referential delusions. This is very similar to persecutory delusions
What are persecutory delusions?
Delusional beliefs that one’s life is being interfered with in a harmful way
