midterm 1 study Flashcards
general observations overview of MSE
9
general observations
speech
mood
affect
perception
thinking
cognition
insight/judgment
ideas of harming self or others
further into mood
normal, euphoric (intense happiness)
or dysphoric mood (depressed)
further into perceptions
hallucinations (false sensory perceptions)
auditory, visual disturbances
illusions (misrepresentation of real perceptual sensory stimuli)
3 types of control delusions
- thought insertion
- The belief that thoughts are being inserted into one’s mind by someone else - thought broadcasting
- The belief that one’s thoughts are obvious to others or are being broadcast to the world - ideas of references
- The belief that other people, objects, and events are related to or have a special significance for one’s self.
paranoid delusions and bizarre delusions
Paranoid delusions
An irrational distrust of others and/or the belief that others are harassing, threatening,
Bizarre delusions
An absurd or implausible belief. Ex - the electricity is making me gain weight
somatic delusions and delusions of grandeur
Somatic delusions
A false belief involving the body or bodily functions.
Delusions of grandeur
An exaggerated belief of one’s importance or power (reference to sovereignty or super powers)
religious delusions and erotomania
Religious delusions
The belief that one is an agent of or specially favoured by a greater being.
Erotomania
The belief that someone (often a public figure) unknown to the individual is in love with them or in a relationship with them.
Ideas of Harming Self or Others
Suicidal or homicidal thoughts:
Presence of a plan
Lethality of means
Means to carry out the plan
Opportunity to carry out the plan
disturbances in thought processes
organized,
circumstantiality (mild/moderate)
tangentially (severe)
word salad (extreme)
loosening of associations, circumstantiality, tangentiality, thought blocking
loosening of associations - lack of logical relationship between thoughts and ideas
circumstantiality - takes a long time to make a point because they obsess over unnecessary detail
tangentiality - same as circumstantiality but they don’t come to a central point
thought blocking - pausing or interruption in ones train of thoughts and after they can’t recall what they said
Neologisms, flight of ideas, word salad, preservation
neologisms - creation of new words
flight of ideas - rapid, continuous verbalizations without shifting from a topic to another
word salad- an inherent mixture of words/phrases
preservation - persisting response to stimuli even after a new stimulus has been presented
clang associations, echolalia, verbigeration, pressured speech
clang associations - use of words/phrases hat have similar sounds but don’t associate with meaning (rhymes/puns)
echolalia- the persistent echoing or repetition of words/phrases said by others
verbigeration - meaningless repetition of incoherent words or sentences
pressured speech - speech increased in rate and volume and is difficult to interrupt (mania)
insight vs judgment
insight
- Understanding the reality of a set of circumstances. (Reflects the person’s awareness of his or her own thoughts and feelings and an ability to compare with the thoughts and feelings of others)
judgment
- Ability to reach a logical decision about a situation and to choose a course of action after examining and analyzing various possibilities. (Reflects problems-solving abilities and capacity to learn from experience)
purpose of the mental health act
Protect the health of persons with mentally illness
Protect the rights of persons with mentally illness
Protect the rights of the community
Mental Health Act: Form 1
The law gives every physician in Ontario the right to sign an Application for Psychiatric Assessment (Form 1)
A Form 1 authorizes the admission and involuntary admission of a person for up to 72 hours at a psychiatric facility for the purpose of assessment
Filled out and signed by a physician who has examined the person
Expires 7 days after being signed
Form 42: provided to the patient once the Form 1 is signed. Without the Form 42, the Form 1 is invalid
mental health act form 42
Notice to Patient (Signed by a physician)
Given promptly when a person is detained at a psychiatric facility for the purpose of an assessment under a Form 1
No right to appeal
mental health act form 2
Same as form 1 except it can be filled out by anyone and needs to be signed by a justice of the peace
Expires 7 days after being signed
Authorizes the police to bring a patient to the hospital to be examined by a physician
A physician X at the hospital conducts an initial assessment if a psychiatric assessment is necessary
If yes, Form 1 is signed – because the Form 2 doesn’t authorize the involuntary admission / only the transportation to the hospital
Once the Form 1 is signed, the patient is admitted for 72h
form 3
Certificate of Involuntary Admission
Filled out by attending physician - different than the physician who completed the Form 1
Must be completed 72 hours from start of detention period under a Form 1
A Form 3 is valid for 2 weeks from and including the date it is signed
If the Form 3 expires, the person is considered to be a ‘voluntary patient’
form 4
Certificate of Renewal
Initiated by the attending physician before the expiry date of the previous Form 3 or 4.
1st Form 4 is valid for 30 days
2nd Form 4 is valid for 60 days
3rd Form 4 is valid for 90 days
Mental Health Act: Form 30
Notice to Patient
The physician who initiates a Form 3 or Form 4 must also inform the rights adviser (form 30) who will visit the patient, explain the situation, and inform the person of the right to appeal and will assist with the application process and help obtain legal services.
form 5
Change from Involuntary to Informal or Voluntary Status
Initiated by attending physician
Whenever deemed appropriate to end a Form 3 or Form 4
No expiration or renewal
form 9
Order for Return from escaped person (form 3 or 4 must have a 9 bc 1/2 have a return policy)
Initiated by the officer in charge of a psychiatric facility.
Whenever the absence of a person who is subject to involuntary admission becomes known to the officer in charge.
Expires one month after absence becomes known
involuntary admissions
3 situations
Three situations:
Psychiatric Assessment: Judge believes a person having committed a criminal act suffers from a psychiatric disorder.
Inpatient Assessment (Section 22 – MHA)
Outpatient Assessment (Section 21 – MHA)
Fitness Assessment* (Criminal Code): Judge believes a person may be unfit to stand trial
5 day assessment (nature of proceedings, consequences, communication with counsel)
Criminal Responsibility Assessment* (Criminal Code): Judge believes a person may not be criminally responsible (NCR) on account of mental disorder for criminal acts committed
30 to 60 day assessments
