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
