Mental state examination and psychiatric assessment Flashcards
A&B - looking for? (9)
Age / ethinicity Clothes and accessories Self care and hygiene Evidence of self harm Eye contact Posture Facial expression Psychomotor - retardation / agitation Ability to establish a rapport
3 aspects to affect
Quality
Range
Intensity
Speech 3 parts
Rate, Volume and tone
Thought form 2 parts
Speed and flow / coherence
Circumstantial thought form =
get to the point but takes a while
Tangential =
flight of ideas with little connection
Thought content, what things to look out for? (5)
Delusions / abnormal beliefs Obsessions Over valued ideas Suicidal thoughts Homicidal / violent thoughts
Two aspects to abnormal perceptions
subjective and objective
types of hallucinations (4)
Auditory
Visual
Tactile
Olfactory / gustatory
Risk assessment section
Harm to self
Harm to others
Vulnerability
Quantify the risk in 3 ways
How iminent?
How likely?
Severity
What to screen for in a psychiatric history?
- low mood
- elevated mood and increased energy
- dellusions and hallucinations
- anxiety
- obsessions / compulsions
3 important points for PMH?
Head injury / surgery
Neuroconditions
Endocrine abnormalities
How long does generalised anxiety have to last for a formal diagnosis?
For at least 6m around a range of events / activities
Physical causes to exclude in anxiety
Hypertension
Angina
Asthma
Excessive caffeine
How long should benzodiazepines be used in generalised anxiety?
2-4 weeks
First line medication in generalised anxiety?
SSRIs
3 core symptoms of depression
Low mood
Loss of interest / pleasure
Fatiguability
5 biological symptoms of depression
Early morning waking Depression worse in the morning Marked loss of appetite Psychomotor retardation / agitation loss of libido
5 cognitive symptoms of depression
Reduced concentration / memory Poor self esteem Guilt Hopelessness Suicidal thoughts / self harm
Minimum duration of depression for a diagnosis?
2 weeks
How many core symptoms needed for a diagnosis of depression?
2
ICD - 10 scoring for depressive disorder
Mild - 4
Moderate - 5-6
Severe - 7+
7 non core symptoms of depression
Disturbed sleep Poor concentration / decisiveness Low self confidence Poor / increased appetite Suicidal thoughts / acts Agitation or slowing of movement Guilt or self blame
diagnosis of a major depressive disorder requires what from a DSM-5
5< over a two week period with at least one of
1) depressed mood
2) diminished interest or pleasure
Definition of schizoaffective disorder?
Mood symptoms + schizophrenic symptoms in the same episode
Neurological conditions involving depression (2)
MS and Parkinsons
3 endocrine conditions that can manifest like depression
HypoT
Cushings
Addisons
Infections causing secondary depression (2)
HIV and hepatitis
First line for mild depression
CBT
First line for moderate to severe depression
CBT and SSRIs
5 aspects to psychotic psychopathology
Perception Abnormal beliefs Thought disorder -ve symptoms Psychomotor functions
A delusion is false because of…
False reasoning
Neologisms =
New words created by the patient
8 negative symptoms of schizophrenia
Apathy Absent / blunted Decrease in speech Social withdrawl Impaired attention Anhedonia Sexual problems Lethargy
Key differentials in psychosis (7)
Schizophrenia/ Schizoaffective Secondary to mood disorder Secondary to medical conditions Secondary to psychoactive substance use Delirium / dementia Personality disorder Neurodevelopmental disorder
Medical conditions associated with psychosis
Cerebral neoplasm Infarcts Trauma Infection Endocrine SLE HyperT HyperCa2+
What needs to be ruled out in psychosis?
Substance abuse
Neuroleptic malignant syndrome characterised by?
Altered mental state Increased muscle tone / frank rigidity Alterations in autonomic NS Hyperthermia Hyperactivity
How to reverse the effects of neuroleptic malignant syndrome?
Use dopamine agonists
Levels of the pyramid of differentials for psychiatry
1) organic disorders
2) psychotic disorders
3) mood disorders
4) anxiety disorders
5) personality disorders
4 L’s of harmful substance abuse
Love
Livelihood
Liver
Law
3 elements of substance dependence
Physiological
Behavioural
Psychological
6 signs of dependence syndrome
Strong compulsion to take Lack of control Physiological withdrawl Signs of tolerance Neglect of other interests Persistance with substance use
Units =
ABV x Vol
Mean time taken for delirium after alcohol withdrawl?
48hrs
3 characteristics of wernicke’s encephalopathy
Delirium, opthalmopelgia and ataxia
How to treat wernicke’s encephalopathy
Parenteral thiamine
CAGE questionnaire
Ever thought about cutting down?
Have people ever annoyed you by criticising your drinking?
Have you ever felt guilty about your drinking?
Ever needed an eye opener?
3 key parts to the history in suspected personality disorder
Source of distress
Co-morbid mental illness
Specific impairment
3 types of drugs used in personality disorder
SSRIs
Mood stabalisers
Benzodiazepines
Preferred psychological therapy
Direct behavioural therapy
4 types of schizophrenia?
Paranoid
Hebephrenic
Catatonic
Residual
6 sections to MMSE
Orientation Registration Attention Recall Language Copying
Reversibe causes of confusion (5)
VitB12 / folate deficiency TSH Calcium Cushings Addisons
Where should someone with suspected dementia be sent?
Memory clinic
Above what score of the MMSE can cholinesterase inhibitors be used?
10
3 cholinesterase inhibitors used in dementia
Donepezil
Rivastigmine
Galantamine
When are NMDA receptor antagonists recommended?
1) moderate to severe dementia
2) ACh inhibitors not tolerated
example of an NMDA receptor antagonist used in dementia?
Memantine
Anxiolytic recommended in dementia?
What should be avoided?
Trazdone
Benzodiazepine
Complete contraindication for those with Lewy body dementia and why?
Antipsychotics
- 50% have catastrophic results
- precipitates potentially irreversible Parkinsonism
- impaired consciousness, severe autonomic symptoms
- 2-3x increase in mortality
Average survival from diagnosis in dementia
4 yrs
3 types of dementia and their examples
1) Cortical
- Alzheimers
- Frontotemporal dementia
2) Subcortical dementia
- Parkinsons
- Lewybody
- Huntingtons
- HIV related
3) Mixed
- vascular
- infection induced
Early onset dementia defined as
Before 65
Molecules involved in alzheimers
Tau protein and Beta amyloid
4 risk factors for alzheimers
genetic
vascular
head injury
low educational attainment
pathology of vascular dementia
death of neurones due to blood flow disruption
Symptoms of lewy body dementia a combo of …..
Alzheimers and Parkinsons disease
secondary prevention of risk factors in vascular dementia (2)
stop smoking
aspirin / clopidogrel
Section 2 of the MHA =
admission for assessment - 28 days
Section 3 of MHA =
admission for treatment - 6m
to put a section 2/3 in place you need 2 doctors one of which needs to be…
section 12 approved
Section 4 =
emergency admission for assessment - 72hrs
no time to wait for a section 2
Section 17 =
community treatment order
Section 17 =
community treatment order
pt liable to a section 3 order
supervised treatment in the community
must obey the conditions set on them - or can be recalled into hospital.
Presenting back risk
Risk to self, others and risk of neglect
short term
medium term
long term
Long term risk assessment
Biological - drugs / alcohol / medication
Social - their social situation
Psychological - their state of mind and how you can support them
how long does lithium take for patients to feel the full benefit?
6-12m
