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