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Medications > MSE > Flashcards

MSE Flashcards

1
Q

what to include in Appearance

A

General appearance
Any distinctive features
Clothing -appropriate to the weather
Any physical signs eg self-harm
personal hygiene

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2
Q

What is included in Behaviour

A

Posture closed, slouched or open
Engagement and rapport
Eye contact
Facial expression- expressive, relaxed, anxious, suspicious, tearful
Body language
Psychomotor activity eg restlessness, fidgeting, distracted
Abnormal movements eg tremors, tics, rocking

Level of arousal- alertness, vigilance, attentive, hyperarousal

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3
Q

What does speech include

A

rate of speech
quantity of speech
tone of speech
volume of speech
fluency and rhythm

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4
Q

what does rate of speech include

A

pressured - tendency to speak rapidly motivated by urgency perhaps due to flight of ideas

Slow speech- may occur due to psychomotor retardation associated with depression

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5
Q

what is the quantity of speech

A

normal

poverty of speech- associated with depression

excessive speech- associated with mania

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6
Q

what is the tone of speech

A

monotonous speech
tremulous speech
dull
whispered

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7
Q

what is the volume of speech

A

loud or quiet

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8
Q

what is fluency and rhythm of speech

A

Stammering
Stuttering
Slurred
Hesitant
Articulate
Stilted- excessive use of uncommon words, repetitious phrases or unusual grammatical structures

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9
Q

What does emotions include

A

Mood and Affect

Mood- patients subjective internal state

Affect- observed emotion

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10
Q

examples of mood states

A

low mood, anxious, angry, enraged, euphoric, guilty, apathetic, euthymic

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11
Q

how to assess Affect

A

Observe the apparent emotion by looking at patients facial expressions and overall demeanour

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12
Q

examples of affect

A

sadness, anger, hostility, euphoria,

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13
Q

what is range and mobility of affect

A

fixed affect- patients affect remains the same regardless of topic

restricted affect- affect changes slightly

labile affect- exaggerated changes which may or may not relate to triggers

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14
Q

what is the intensity of affect

A

heightened- associated with mania

blunted or flat- associated with schizophrenia or depression

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15
Q

what to include in congruency

A

note if patients affect is congruent with the content of their thoughts

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16
Q

what is included in perceptions

A

hallucinations

pseudo hallucinations

illusions

depersonalisation- patient feels they are no longer their true self and are someone different or strange

derealisation- sense that the world around them is not a true reality

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17
Q

give me example of a question to assess hallucinations

A

do you ever see, hear, smell, feel or taste things that others don’t experience?

have you ever seen, heard, smelt, felt or tasted things that you later realised weren’t actually real or there

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18
Q

how to assess for depersonalisation

A

do you ever feel disconnected from yourself or do you feel that your’e not real

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19
Q

questions to ask someone about derealiasation

A

have you ever felt like the world around you seems unreal or distant or like a drream

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20
Q

what is included in thoughts

A

delusions
obsessions
compulsions - repetitive behaviour that someone is compelled to perform

suicidal thoughts

violent thoughts

overvalued ideas- abnormal beleif that is neither delusional nor obsessional but preoccupying to the extent of dominating someones life

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21
Q

how to assess someones thoughts

A

what has been on your mind

are you worried about anything

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22
Q

hallucinations - what else to assess

A

assess the number of voices they might hear

whether it is second or third person

2nd person = command voices
3rd person = talking about them

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23
Q

what are the different types of possession of though

A

thought insertion
thought withdrawal
thought broadcasting

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24
Q

what is thought insertion and give an example of a question to ask

A

a belief that thoughts can be inserted into the patients head

do you think people can put ideas into your head without your control?

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25
Q

what is thought withdrawal and give an example of a question to ask

A

a belief that thoughts can be removed from the patients mind

do you think or has there been a time where people have remove thoughts out of your head?

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26
Q

what is thought broadcasting and give an example of a question to ask

A

a belief that others can hear the patients thoughts

do you believe that others can hear your thoughts

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27
Q

Thoughts- what is word salad

A

speech or thinking that is essentially incomprehensible to others because words or phrases are joined together without logical or meaningful connection

28
Q

what are flight of ideas

A

abrupt changes from topic to topic

29
Q

what are loose associations

A

moving rapidly from one topic to another with no apparent connection between topics

30
Q

what are circumstantial thoughts

A

thoughts which include lots of irrelevant and unnecessary details but eventually comes back to the point

31
Q

what are tangential thoughts

A

digressions from the main conversation introducing thoughts that seem unrelated and irrelevant

32
Q

what is perseveration

A

repetition of a particular response eg word, phrase or gesture despite removal of stimulus

33
Q

what are neologisms

A

words that a patient has made up

34
Q

what is mutism

A

refusal to speak

35
Q

what is preoccupation

A

sustained processing of uncertainty/ worry

36
Q

what is rumination

A

sustained processing of negative information

repetitive and passive thinking that dominates attention

37
Q

what are the types of delusions

A

grandiose delusions
persecutory
referential

38
Q

what are grandiose delusions

A

exaggerated self-importance or abilities
eg having special powers or they are saving the world

39
Q

what are ideas of reference or referential delusions

A

belief that specific events relate to them eg news or events are directed at themselves

40
Q

what are persecutory delusions

A

belief of being harmed or harassed

41
Q

what is included in cognition

A

oriented to time, place and person

attention span and concentration
short term of memory

42
Q

what is insight

A

ability of a patient to understand they have a mental health problem and what they’re experiencing is abnormal

43
Q

examples of questions to ask to assess insight

A

what do you think the cause of the problem is

would you need help with the problems that you are encountering

what would you like the outcome to be following this assessment

do you know why you are taking this medication

44
Q

what is judgement

A

ability to make considered decisions to come to a sensible conclusion when presented with information

45
Q

give me an example of a question to ask about someones judgement

A

what would you do if you ran out of medication

if you smelt smoke in a room with other people what would you do

46
Q

how to assess for memory

A

give them 3 words and ask them to repeat

47
Q

how to assess for cognition using another validated tool

A

spell a word backwards

48
Q

what to include in Risk

A

risk to self- self-harm, substance misuse, self-neglect

risk to others- harm to others

risk from others- safeguarding, bullying, etc

49
Q

how to assess for risk to self and give an example of question

A

“Sometimes, when people are going through difficult things, they might have thoughts of wanting to harm themselves – is this something you’ve experienced?”

“People can sometimes hurt themselves to manage overwhelming emotions or feelings of numbness– is this something you’ve ever done?

50
Q

how to assess for suicidal ideation

A

’ when people are so low in mood or struggling with emotions they don’t want to be here have you felt like this

some people believe that life is not worth living have you ever felt this

have you had thoughts of ending your life

51
Q

how to assess for suicidal thoughts plans and intent

A

do you intent to act on these thoughts and have you made a plan

52
Q

how to assess for immediate risk

A

do you feel safe right now

do you have access to means that could cause harm eg medication

53
Q

how to explore protective factors

A

with these thoughts what have you done to cope

what has stopped you from acting on these thoughts

54
Q

what do you do after conducting the mse

A

summarise the findings with the patient

thank the person for their time and being open

explain what will happen next

i am going to discuss this with the team about how best we can support you

ask if they have any questions

55
Q

what to do before seeing the patient and after

A

hand hygiene

56
Q

For the patient assessment what is included in observation and behaviour

A

facial expressions - flat or expressive

psychomotor activity (agitation- restlessness, fidgeting)
retardation - slowed movements

repetitive movements

disorganised activity or purposefulness

specific behaviours- tics, tremors or unusual gestures - any involuntary movements

or say no abnormal movements or postures
or no abnormal psychomotor activity

57
Q

what to do as an introduction

A

hand hygiene

introduce self- full name and role

confirm patients identity- name and date of birth

explain the purpose of the conversation

explain confidentiality

gain consent - are we okay to move on with the assessment

58
Q

confidentiality - what to say

A

everything you say to me is confidential between me and the team however if you say something that is concerning in a way that is harmful to you or others then i will have to share it with the team on a needs to know basis

59
Q

what is marked on the working hypothesis of the problem

A

ask how the patient is feeling

explore the onset and chronology- have they had previous treatments and episodes

explore the triggers

note impact on ADLs and activities

do they have any other medical conditions or medical history

60
Q

how to assess for precipitating factors-

A

have you noticed any particular situations that seems to worsen your symptoms

can you think for what was happening before you started feeling this way

when you are feeling this way what tends to go through your mind

61
Q
A
62
Q

how to assess for medical history

A

do you have any current medical conditions that you are being treated for

have you been diagnosed with any medical conditions

63
Q

what is included in situation

A

gain consent from the examiner to do handover

i was asked to see patient
state the purpose

provide a clear statement of the patients problem

64
Q

what is included in background

A

background of the patient eg past treatment
risks
diagnosis
allergies
medications

65
Q

what is included in the assessment of SBAR

A

Thoughts eg delusions
Perception - eg hallucinations
risk to self or others

66
Q

what is included in recommendation

A

recommend doing physical health checks eg ECG or full blood count

review medications - check dosage

consider therapies eg individual or groups

ADLs support

recommend mini mental state examination to assess cognitive function

67
Q
A

Medications (5 decks)

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