Introduction to Psychiatric Interview and MSE Flashcards
What are the components of a psychiatric interview?
- Presenting complaint
- History of presenting complaint
- Past psychiatric history
- Past medical history
- Current medication/drug history
- Family history
- Personal and social history
- Substance use history (drugs/alc)
- Pre morbid history
- Forensic history
What can you ask in ‘past psychiatric history’?
- Ever previously seen a psychiatrist?
- Past hospital admissions?
- Medications / side effects?
- Any previous psychological therapies?
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What can be asked in the family history?
- Significant illnesses in family (physical or mental)
- Are you in contact with family?
- What was it like growing up in the family?
- Who were you closer to: mother or father?
- What was the relationship between your parents like?
Looks at genetic and environmental factors
What can you ask in personal and social history?
- Birth and pregnancy
- Early development - were milestones achieved?
- Childhood abuse
- School - academic achievements, friendships, bullying
- Who is at home to support?
- Affect of illness on relationships?
- Do they have children?
- Finances
What does the ‘pre morbid personality’ part of the interview mean?
- How were they before they became unwell?
- Collateral history from others
What does ‘forensic history’ consist of?
- Offences
- Arrests
- Cautions
- Charges
- Court appearances
- Convictions
- Sentences
- Probation officer
What does the Mental State Examination consist of?
- Appearance and behaviour
- Speech
- Mood
- Thoughts
- Perceptions
- Cognition
- Insight
What should we look for in appearance and behaviour?
- Appropriateness of dress
- Unkempt?
- Ethnicity, age, sex, eye/hair colour
- Eye contact - intense, withdrawn?
- Restlessness, agitation, abnormal movements
- Alert / confused?
What do we need to look for in terms of establishing rapport with patients in a MSE?
- Cooperative?
- Guarded?
- Suspicious? Overly friendly?
What do we look for in speech?
- Rate
- Tone
- Volume
What is the difference between mood and affect?
Mood is like the climate, affect is the weather.
Mood is the sustained emotional state, it can be objective or subjective (1-10 scale, euphoric, depressed etc).
The affect is how you perceive the patient’s emotional state by their nonverbal behaviour - the affect may be incongruent with mood.
What 3 things do we look for in a patient when assessing their affect?
- Type
- Stability
- Congruity
What are the two components we look at when dealing with a patient’s thoughts?
- FORM - stream of thought
- CONTENT - thought posession
What is clanging?
The use of alliteration and punning, noticed for when looking at flight of ideas in patient thoughts.
What features are we looking for when observing continuity in form?
- Derailment, loosening of associations
- Tangentially
- Perseveration
- Thought blocking
What do we look for in the thought content of a patient?
- Delusions
- Possession
- Obsessions
- Over-valued ideas
- Pre-occupations and ruminations
- Suicidal and homicidal ideation
What are delusions? Examples?
- “false, unshakable, belief that is out of keeping with the patient’s social and cultural background”
- control, persecution, jealousy, religious, love, infestation etc
How can you ask about delusions?
- “Do you feel under the control of some force or power other than yourself?” … [how, who, why]
- “Do people seem to do things in a special way so as to convey a meaning to you?”
- “Do things seem to be specially arranged?”
- “Is anyone deliberately trying to harm you?”
- “Are you very important or prominent person?”
- “Do you have any special powers/abilities?”
What are the 4 things you can ask about in terms of thought possession?
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Thought insertion
- “Are thoughts put into your head that aren’t your’s?” -
Thought withdrawal
- “Do your thoughts ever seem to be taken out of your head as though someone external was removing them?” -
Thought broadcasting
- “Are your thoughts broadcast so that others know what you are thinking?” -
Thought blocking
- “Do you ever experience your thoughts stopping quite unexpectedly / left empty-minded?”
What things should you explore with a patient about their suicidal ideas and plans?
- Is there hope/plans for the future?
- What stops them from acting on thoughts?
- Protective factors? (religion, social, children, pets)
- What are they planning
- Final acts?
- Triggers?
What should be looked for in perceptual abnormalities?
- Hallucinations
- Illusions
- Depersonalisation
- Derealisation
How can you ask a patient about hallucinations?
- Have you heard noises or perhaps voices when nobody else has been around?
- How many voices are there?
- Do you recognise them?
- Can you make out what they say?
- What did you see?
- Do they speak to you or about you?
- Do they tell you to do things?
- Are you able to resist?
What is depersonalisation?
The feeling that you are no longer yourself. Subjectively unpleasant experience.
- “Have you yourself felt unreal, that you were not a person, not living in a world?”
- “Or that you were outside yourself looking at yourself?”
What is derealisation?
The feeling that the world around you is somehow unreal
- “Have you had the feeling recently that things around you were unreal?”
- “As if everything was an imitation of reality?”
How do you test for cognition in a MSE?
- Orientation (time/place/person)
- Concentration + attention
- Memory (mini mental state exam)
What is meant by looking for ‘insight’?
- What does the patient think is happening?
- Do they think they are unwell?
- What do they think will help?
- Do they think medical or psychological treatment will be useful?
