Hx Taking, MSE & Diagnosis Flashcards
What is pre-morbid personality?
How would friends have described you and how has that changed
What screening questionnaire is typically used for alcohol consumption?
CAGE
Speech can be ..?.. in schizophrenia
BLUNTED
What should be included in a MSE
Appearance & Behaviour
Affect
Mood
Speech
Thoughts & Beliefs
Perceptual anomaly
Suicide/Homicide
Cognitive function
Insight
Also consider results of physical exam & blood & other test results
How can speech be described?
Spontaneity
Volume - loud, quiet, poverty
Rate - pressured, slowed
Rhythm - rhyming and punning
Tone - monotonous, lilting
Dysarthria
Dysphasia - expressive/receptive
What is the difference between an illusion and a hallucination?
Illusion=misperception of a real stimulus
Hallucination=perception in the absence of a stimulus
What are the types of hallucination?
True
Pseudo
What questions are used to assess insight?
Are symptoms due to illness?
Is this a mental illness?
Do they agree with treatment/Mx plan?
What is Mood classed as and how can it be monitored?
MOOD generally held to be the patient’s subjective report on their current mood state in terms of how they rate themselves from depressed through euthymic (neutral) to elated.
Self rating scale “where 0/10 is the most depressed you have ever felt and 10/10 is best” is helpful as a baseline record and for longitudinal comparison through treatment.
What is affect and what types are observed?
AFFECT held to be the emotions conveyed and observed objectively during interview in terms of
- Types of affect observed; anxiety, anger, euphoria etc
- Range and reactivity of affect. Range from flattened to labile. Record reactivity to themes.
- Congruity of affect i.e. observation of congruity to themes; may be grossly incongruous in schizophrenia.
NB Term “blunted affect” almost pathognomic of schizophrenia.
What 4 sections of thinking should be asked about and considered?
Speed and tempo of thoughts
Types of thoughts demonstrated
Linkage and thought form
Possession of thoughts
What do different thinking speeds show?
Decreased speed of thought e.g. in severe depression may see psychomotor retardation.
Slowing with limited content termed “Poverty” of thought is a negative symptom of schizophrenia and is also seen in dementia and some other organic brain diseases.
Conversely in hypomania or mania there may be “flight of ideas” with rapid speech to the point of incoherence.
What different types of thoughts are displayed at MSE?
Preoccupations
Phobias
Obsessions
Overvalued ideas e.g. hypochondriacal ideas or body image distortion in eating Disorder.
Delusions
- Primary
- Secondary
What is a delusion and what are examples of it?
“ 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
What is delusional perception a characteristic of?
Schizophrenia
