Physical signs in psychiatric illness and MSE Flashcards
What are the 9 parts to the mental state examination
- Appearance
- Behaviour
- Speech
- Mood (subjective and objective, emotional state over period of time)
- Affect (emotional state at that point- flat, blunted, animated etc)
- Perception (ask about all 5 sensory modalities)
- Thought (content: what theyre thinking, form - disjointed, disorganised, linear, rapid, blocked)
- risk and suicidal ideation
- cognition (time/ place/ memory)
- insight
What should you consider about a pts appearance?
Overall impression
Physical condition
well kept/ cleanliness
suitability of dress
What should you consider about a pts behaviour?
- eye contact, level of rapport, distractability
- appropriateness (aggressive, agitated, over familiar)
- psychomotor retardation/ agitation
- changes in movement
What should you consider about a pts speech
- rate, rhythm, tone
- coherence, relevance, quantity, fluency, flight of ideas
- dysarthria, dysphasia
What are the different affects a pt may display?
- Blunted: decrease in variation of emotional expression
- Flat: virtually complete absence of affective expression
- inappropriate: emotions expressed not congruent with content of thoughts
- labile: rapid and sometimes extreme changes in emotional state
- reactive: normal/ appropriate response
What are the pathological types of perception?
- altered perceptions eg illusions- distored perception of real object
- false perceptions: hallucinations- without external object
- depersonalisation
- pseudohallucination
What should be considered about a pts thoughts?
- form: are they ordered coherently and logically
- content: predominent themes preoccupying the pt and their nature, delusions, overvalued ideas, obsessions, phobiasn
Give 4 possible physical causes for mood changes (depression/ mania)
- MS
- Stroke
- brain tumour
- DM
- hypothyroid
Give 3 physical causes for insomnia
- sleep apnoea
- hyperthyroidism
- GORD
- pain
give 3 physical causes for confusion/ diorientation
- renal failure
- cerebral arteritis
- sepsis
- any cause of delirium
Give 3 physical causes for hallucinations
- migraine
- substance misuse
- encephalitis
- seizures
Give 3 physical causes of personality and behaviour change
- personality: MS, SOL, SLE
- behaviour: lyme, vascular infarct, parkinsons, dementia, subdural haematoma, mass lesion
encephalitis
Give 3 physical causes of psychosis
sensory loss, syphillis, dementia, wilsons disease
give 3 physical causes of irritability
- vit b12 deficiency
- drug withdrawl
- substance misuse
- pain
Give 2 psychiatric causes of parkinsonian facies?
antipsychotic treatment
depression
Give a psychiatric cause of enlarged parotids and of excessive salivation
enlarged parotids: bulimia nervosa
excessive salivation: clozapine treatment
Give a psychiatric cause of gynaecomastia
- antipsychotic treatment
- alcoholic liver disease
Give a psychiatric cause of resting tremor?
- increased sympathetic drive: anxiety, drug/ alcohol misuse
- antipsychotic treatment
- lithium treatment
What risks need to be assessed in the risk assessment?
- suicide
- self harm
- murder/ harm to others
- discrimination and abuse
- dienfranchisement from society
What is the ID
the part of the personality a person is born with, it is unconscious, demanding and works on the pleasure principle
What is the EGO
The rational part of the personality that tries to get the id what it wants and satisfy the person. develops from age 18 months
What is the superego?
develops around 4 yrs, works on morality principle. It is the conscience and given to them by their parents and society indicating what is right and wrong.
Name and describe 4 defence mechanisms
- repression: ego stops disturbing thoughts from becoming conscious
- denial: blocking external events from awareness
- projection: attributing unacceptable thoughts feeling or motives to another person
- displacement: satisfying an impulse with a substitute object
- regression: acting childlike when facing stress
- sublimation: satisfying an impulse but in a socially acceptable way
