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Mental Health In Out Of Hospital > OCSE PREP > Flashcards

OCSE PREP Flashcards

1
Q

What are the components of the MSE

A
  1. Appearance
  2. Behaviour
  3. Speech
  4. Mood
  5. Affect
  6. Thought Form
  7. Thought Content
  8. Perception
  9. Cognition
  10. Insight
  11. Judgement
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2
Q

What are the 10 components of the Psychiatric Patient Assessment?

A
  1. History of Presenting Illness
  2. Principal/ Presenting System
  3. Precipitating Events
  4. Risk of Harm
  5. Past History and Treatment History
  6. Family History
  7. Social and Personal History
  8. Pre-morbid Personality
  9. MSE
  10. Provisional Diagnosis
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3
Q

How do you recognise depression?

A

More than two weeks of:

  • Feeling down, sad, miserable most of the time
  • Have lost interest and pleasure in usually enjoyable activities
  • Experiencing several signs and symptoms from at least of these categories; Behaviour, Feelings, Thoughts, Physical
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4
Q

What are the Behavioural signs and symptoms of depression?

A
  • Not going out anymore
  • Not getting things done at work/school
  • Withdrawing from friends and family
  • Inability to concentrate
  • Not doing usual enjoyable activities
  • Reliance on alcohol or sedatives
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5
Q

What are the feelings associated with depression?

A
  • Overwhelmed
  • Guilty
  • Irritable
  • Frustrated
  • Lacking in confidence
  • Unhappy
  • Indecisive
  • Disappointed
  • Miserable
  • Sad
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6
Q

What are the Thoughts associated with Depression?

A
  • I’m a failure
  • It’s all my fault
  • Nothing good ever happens to me
  • I’m worthless
  • Life is not worth living
  • People would be better off without me
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7
Q

What are the physical signs and symptoms of depression?

A
  • Tired all the time
  • Sick and Rundown
  • Headache and muscle pain
  • Churning gut
  • Sleep Problems
  • Loss or change of appetite
  • Significant weight loss or gain
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8
Q

What are the signs and symptoms of Mania in Bipolar Disorder?

A
  • elevated mood
  • irritability
  • increased energy/activity
  • flight of ideas
  • rapid speech
  • enhanced libido
  • impaired judgement: increased risk taking
  • increased creativity
  • increased sociability
  • impaired concerntration
  • psychotic symptoms
  • hypomania is when symptoms are less severe
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9
Q

What do you record in the Appearance section of the MSE?

A

Non-judgemental observations of the patients appearance
How does the person look?
Consider age, gender, race/ethnicity, grooming, posture, hygiene, apparent level of health

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10
Q

What should you record in the Behaviour section of the MSE?

A

Describe persons behaviour

  • general behaviour, facial expressions, eye contact, body movements, gestures
  • How are they reacting? co-operative, hostile, withdrawn, inappropriate, afraid, suspicious
  • level of arousal- calm, agitated, anxious or aggressive?
  • psychomotor activity or movement - Hyper/hypo active?
  • unusual features- tremors, slowed, repetitive or involuntary movements
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11
Q

What should you record under the speech section of the MSE?

A

describe how is the patient is speaking

  • rate, volume, tone, quality, quantity
  • how do they express themselves- disorganised, senseless, unrelated, loosely connected, unrelated or incomplete replies, absence or slowing of thoughts, thought flow interupted
  • easy of conversation
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12
Q

What should you record under the Mood aspect of the MSE?

A

How patient describes their emotional state
Use patients words
down, depressed, sad, anxious, irritable, angry, happy, fearful, ok
Stability of emotions
CONSIDER RISK to self and others

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13
Q

What should you record for the Affect section of the MSE?

A

Affect is your observations of the patients mood at the time of conducting the MSE
depressed, anxious, angry, inappropriate, elevated
- range of emotions -restricted, blunted, flat, expansive
-Appropriateness and stability of emotions

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14
Q

What should be recorded in the thought content and flow components of the MSE?

A

WHAT the person is thinking about
-evaluate thought form, content, process
-amount, rate of production, continuity of ideas,
disturbance of language, delusions, pre-occupations, THOUGHTS OF HARM TO SELF OR OTHERS
- obsessed, anxious, over-valued ideas, vagueness, nonsense words, irrelevant, changes of topic, pressured or halted speech

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15
Q

What should be recorded under the Perception component of the MSE?

A
  • Perceptual disturbances- Hallucinations
  • When present, degree of fear or distress associated
  • Any command hallucinations?
  • Derealisation, depersonalisation, illusions (does the person accept they have perceptual disturbances?)
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16
Q

What should be recorded in the cognition component of the MSE?

A
  • Is patient alert and orientated to time and place?

- LOC, attention, memory, orientation, concentration, abstract thinking

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17
Q

What should be recorded under the Insight component of the MSE?

A

persons capacity to recognise problems and symptoms
ability to understand treatment options and ability to comply with these
ability to identify potentially pathological events- (hallucinations, suicidal impulses)

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18
Q

What should you record in the judgement section of the MSE?

A

patients capacity to make sound, reasoned, responsible decisions
problem solving ability
evaluate by exploring recent decision making or posing practical dilemma

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19
Q

What are the four components of the Suicide Risk Assessment and what is involved in each section?

A
  1. Engagement: maximise engagement with patient (build rapport) and assess patient engagement
  2. Detection: identify risk- most people seek help before suicide attempt
  3. Preliminary Suicide Risk Assessment: assess severity of patient problems. Assess risk to self and others. Use basic screening questions. May lead to detailed Suicide Risk Assessment
  4. Management: Consider safety. Do you need to transport? Is medical intervention required?
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20
Q

What are seven possible basic suicide screening questions?

A
  1. Have things been so bad lately you’ve felt like you’d rather not be here anymore?
  2. Have you ever thought about harming yourself?
  3. Are you thinking that you don’t want to live anymore?
  4. Are you thinking of killing yourself?
  5. Have you ever harmed yourself?
  6. Have you made plans to kill yourself?
  7. Do you have access to means by which you could kill yourself?
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21
Q

Define Bipolar. What the two types of Bipolar?

A

Bipolar refers to cycling between elevated and depressed mood.

Bipolar I: have experienced at least one manic episode, though often more, and episodes of depression

Bipolar II: experienced episodes of hypomania and depression.

22
Q

What is meant by the term story-catchers?

A

the art of being able to capture the true essence of somebody. someone who is intrigued by human experience and aware of the power of story. inquisitive, curious, ability to be present while another experiences emotion and have insight.

23
Q

What are the four types of restraints?

A
  1. Manual: bodily force
  2. Chemical: medication primarily to control patients behaviour
  3. Mechanical: devices to restrict movement. belts, harnesses, manacles, sheets, straps, mittens etc
  4. Seclusion: deliberately confinement of a patient in a room they can not freely exit
24
Q

What is dementia?

A

A syndrome of acquired, chronic cognitive impairment occurring in clear consiousness, sufficient to interfere with social and occupational functioning and characterised by impairment in at least two cognitive domains

25
Q

What are the symptoms of dementia?

A

Main symptom cognitive impairment.

others include:

  • irritability
  • depressed mood
  • wandering
  • apathy
  • hallucinations
  • delusions
  • anxiety
  • personality changes
  • excessive motor behaviour
  • pacing
  • aggression
  • sexual inhibition
  • restlessness
  • psychosis
26
Q

What is delirium?

A

An acute decline in cognition and attention. the patients presentation is not representative of baseline cognition, with rapid change. develops over hrs-days and changes through out the day

27
Q

Why does Mental Illness often go undiagnosed in elderly patients?

A

symptoms often misunderstood as a normal part of ageing. Symptoms often present non-specific, atypical. Often masked by other conditions or caused by underlying conditions. many co-morbidities. older people are less likely to seek help and can fear more about losing independence.

28
Q

What are some of the risk factors for depression?

A
  • Biological: genetics, chemical balance in brain effecting the likes of sleep, concentration, memory, appetite. depression makes people more vulnerable to physical disorders and vice versa.
  • Psychological: prolonged stress, many negative life events. dissatisfaction at school or work. mental or physical abuse as a child
  • Social: traumatic situations, early separation, lack of social support, harassment/ bullying
29
Q

What is substance abuse? What is the criteria?

A

Substance abuse is the continued use of a substance, despite negative consequences.

Criteria for substance abuse:

  1. maladaptive pattern of use leading to clinically significant impairment or distress. manifested by one more of the following occurring within 12-months
    - Recurrent use resulting in failure to fulfil major role obligations at work/school/home.
    - recurrent use in situations where it is physically hazardous
    - recurrent substance related legal problems
    - continued use despite having persistent social or interpersonal problems caused or exacerbated by the effects of the substance
  2. the symptoms have never met the criteria for substance dependance for this class of the substance
30
Q

What is substance dependance? What is the criteria?

A

Substance dependance is when someone relies on a substance to function normally.

Maladaptive pattern of use leading to clinically significant impairment or distress manifested by three or more of the following occuring within 12 months

  1. Tolerance, as defined by either of the following
    - A need for markedly increased amounts of substance to achieve intoxication/desired effect
    - Markedly diminished effect with continued use of the same amount of the substance.
  2. Withdrawal, as manifested by either of the following:
    - The characteristic withdrawal symptoms for the substance
    - The same or closely related substance is taken to avoid or relieve withdrawal symptoms
  3. Substance is often taken in larger amounts over a longer period of time than was intended
  4. Persistent desire or unsuccessful efforts to cut down or control substance use
  5. A great deal of time is spent in activities necessary to obtain the substance, use or recover from its effects
  6. important social, occupational or recreational activities are given up or reduced because of substance use
  7. Substance use is continued despite knowledge of having persistent or recurrent physical or psychological problems that are caused or exacerbated by the substance.
31
Q

What is bioethics? What are the four principals and a basic explanation of them?

A

Ethics are a set of principals that describe appropriate behaviour. They are designed to guide conversations about treatment.
the four principals are:
1. Autonomy- a patients right to decide on treatment
2. Non-maleficence: above all, do no harm
3. Beneficence: do what is in the patients best interests
4. Justice: everyone has the right to equal treatment

32
Q

What is anxiety?

A

Anxiety is the ongoing feeling of anxiousness most of the time, without any reason or cause. worries are intense, persistent and interfere with normal life. worries relate to several aspects of daily life. symptoms are present for six months or more, on more days than not

33
Q

What are the symptoms of anxiety?

A
  • Restlessness
  • Excessive worrying
  • Difficulty concentrating/ making decisions
  • unexplained headaches and stomach aches
  • agitation
  • trembling
  • increased respiration rate
  • impending sense of danger/ panic
  • increased heart rate
  • sweating
  • avoiding situations which cause anxiety, impacting on study/work/social life
34
Q

What are some treatment options for anxiety?

A

Psychological and medications for moderate- severe anxiety

lifestyle changes can assist to reduce stress levels in mild cases

35
Q

How does Indigenous mental health vary?

A

Indigenous Australians have a whole-of-life view of health. this includes mind, body, emotions, spirit, culture, and environment. If any of these are out of balance, the entire community is out of balance, not just the individual.

36
Q

what are some of the major issues in indigenous mental health?

A

some of the major impacts of indigenous mental health are that there culture has recently experienced a breakdown of traditional structures, communities, beliefs and this has lead to some feeling as though they have lost direction.

the stolen generation has had an impact as well, as many of the children of the stolen generation had no role models growing up and now they have childern, struggle to understand the role of a parent, family and community.

indigenous australians are more likely to come from disadvantaged backgrounds, with lower educational attainments, overcrowded housing, higher unemployment, higher poverty, poor access to services. they also may have stress ad anxiety around how stereotypical aboriginals should live.

37
Q

What is self-harm? What are some of the reasons people self-harm?

A

Self-harm is deliberately inflicting pain or injury to ones self. Some reasons people may self-harm include:

  • to release tension, frustration and anger
  • in order to substitute emotional pain for physical pain.
  • to reconnect or “feel something” when disconnected
  • dissociation to avoid adverse emotion

the urge to self-harm maybe caused by:

  • having trouble managing anger and frustration
  • in acute psychosis, compelled by hallucinations and delusions
  • having problems managing the symptoms of trauma such as intense emotion, self-blame and self-loathing
38
Q

What are some risk factors for suicide?

A
  • previous attempts
  • substance abuse
  • family history
  • poor job satisfaction and low job security
  • being a victim or witness of abuse
  • social isolation
  • mental health disorder, especially depression. bipolar and schizophrenia also at risk
39
Q

What are some of the high risk populations for suicide?

A
  • males
  • over 45 years of age
  • living in rural and remote areas
  • indigenous
  • youth
  • anyone bereaved by suicide
  • previous self-harm or attempted suicide
  • older people
  • LGBTI
40
Q

What is Schizophrenia?

A

Schizophrenia is a condition where people can experience an altered reality. Can be like a split between reality and a dream-like state.

41
Q

What are some of the symptoms of schizophrenia?

A
  • hallucinations and delusions
  • confused thoughts leading to disjointed speech
  • unusual behaviour, disorganised behaviour
  • lack of motivation for everyday tasks.
  • cognitive impairment in memory, reasoning, problem solving and planning
  • loss of ability to express emotions
  • experiencing less pleasure
42
Q

What are the steps of the suicide risk assessment framework? What do each of these mean?

A
  • Engagement: important to build rapport. Maximise engagement with patient and assess patients engagement with you
  • Detection: Identify risk factors
  • Preliminary Suicide Risk Assessment: determine severity and nature of problems and level of risk. Determines if comprehensive risk assessment is needed
  • Management: safety, transport, referral.
43
Q

What are the components of the Comprehensive Suicide Risk Assessment? What is required in each section?

A
  • Distress and Pain: What are persons levels of distress/pain? What are the main sources of these?
  • Meaning/ Motivation: Do they have an understanding of their predicament? Have recent events caused more distress for them? Has the person felt they have lost their reason for living? Do they believe their situation may change and can they see a way out of it?
  • At risk mental states: hopelessness, despair, agitation, guilt, shame, anger. Has the person felt like this before? Have they previously harmed themselves? What were the details of previous attempts? Any similarities between today and previous attempts? Family/friend history of suicide?
  • Current Suicidal Thoughts: Are suicidal thoughts present? What are these thoughts? When did they begin and how frequent are they? Can the person control them? What has stopped them in the past? Degree of intent? Have they finalised business or finances?
  • Intent and lethality: did they intend to die? Is there plan lethal? Is it carefully planned or impulsive?
  • Documentation and overall risk: must be thorough. Staff at handover must fully understand situation to ensure patient receives appropriate care and a full psychiatric assessment.
44
Q

What is meant by competency and capacity?

A

Capacity is a functional term referring to cognitive ability to understand where competency is more so a legal term requiring someone had capacity.

Capacity is required for informed consent to be valid.

45
Q

How do we assess capacity?

A

if the patient is able to:

  1. Take in, retain and comprehend treatment information
  2. Believe the information they have been given
  3. Weigh up the risks and benefits of the treatment before communicating their decision to consent or refuse to treatment.

It is to be assessed on a scale of importance, with better capacity required to make decision with larger consequences.

46
Q

What is required for valid consent?

A
  1. Consent is voluntary
  2. The patient must be provided with sufficient information
  3. The consent covers the treatment that is to be provided
  4. The patient has capacity to make decisions about the treatment
47
Q

What are the forms of consent and what do they mean?

A

Implied: most common. Patient indicates via act or gesture that they have no objection to treatment/ procedure. Only when treatment is minor and general knowledge of the procedure is commonplace.

Verbal: most common paramedics seek or obtain. conversation about assessment findings and recommended treatment. verbal agreement to what is said

written consent: usually for invasive procedures and when considerable risk involved. not usual for paramedics

48
Q

What is therapeutic communication?

A

Process of interaction with patient focusing on advancing the physical and emotional well-being of a patient. These types of relationships are built only to benefit the patient. Therapeutic communication is based on:

  • Genuineness and authenticity
  • Empathy
  • Self-awareness
  • Mindfulness
  • Putting aside biases
  • being non-judgemental

It involves centring care around the individuals wishes , preferences and goals.

49
Q

What is a Delusion? What are some common types of delusions and what do they involve?

A

A fixed, false, irrational belief.
Common types of delusions include:
- Grandiose delusions: belief that they are king, are really Jesus, they can cure the sick, they are a multi-millionaire or they have the power of telepathy
- Persecutory delusions: believing people are following them or that someone is out to get you or someone you know

50
Q

What is an illusion?

A

A misinterpreted sensory experience created outside of the mind

51
Q

What is a hallucination? What are the types of hallucinations?

A

A hallucination is a false sensory perception, arising without any stimulus.

Types of hallucinations include:

  • Auditory: hearing things
  • Visual: seeing things
  • Tactile: feeling things
  • Gustatory: tasting things
  • Olfactory: smelling things

Mental Health In Out Of Hospital (1 decks)

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