Psych history and MSE Flashcards
MSE aspects
ASEPTIC
- appearance
- speech
- emotion (mood, affect)
- perception
- thought
- insight
- cognition
appearance
- sex
- ethnicity
- body habitus
- unkempt? well dressed?
- posture
- psychomotor activity
- abnormal movements
- eye contact
- body language
- engagement and rapport
- facial expression
- stigmata of IVDU or self harm
emotion - mood (what patient tells you) and affect (what you observe)
- how has your mood been lately? (low mood, anxious, angry, euphoric)
- affect (facial expressions, apparent emotion, fixed/restricted/labile affect, intensity of affect)
speech
- rate
- quantity (minimal or excessive)
- tone (monotonous, tremulous)
- volume
- fluency and rhythm
what is perception?
involves organisation, identification and interpretation of sensory information to understand world around us
what are abnormalities in perception?
- hallucinations (sensory perception without external stimulation that patient believes is real)
- pseudo-hallucinations (hallucination but patient is aware is not real)
- illusions (misinterpretation of external stimulus)
- depersonalisation (pt feels that they are no longer their “true” self)
- derealisation (sense that world around them is not a true reality)
questions used to screen for perceptual abnormalities?
- do you ever see, hear, smell, feel or taste things that are not really there?
- did you think this was real at the time?
- do you ever feel like you’ve changes or that you don’t recognise the person you currently are?
- do you ever feel like the world around you isn’t real?
broad thought categories
- thought form
- thought content
- thought possession
what is thought form? what to comment on?
processing and organisation of thoughts
- speed of thoughts
- flow and coherence of thoughts (loose associations, tangents, flight of ideas, thought blocking, neologisms)
what are the abnormalities of thought content?
- delusions (firm, fixed belief based on inadequate ground, not amenable to rational argument, not in sync with cultural norms)
- obsessions (thoughts/impulses that occur repeatedly, feel out of person’s control)
- compulsions (repetitive behaviours pt feels compelled to perform)
- overvalued ideas (abnormal belief that is not delusional or obsessional but is so preoccupying)
- suicidal thoughts
- homicidal/violent thoughts
what questions can you ask to screen for thought process abnormalities?
- what’s been on your mind recently?
- are you worried about anything?
- do you have any beliefs that aren’t shared by others you know?
what are abnormalities of thought possession?
- thought insertion: belief that thoughts can be inserted into pt mind
- thought withdrawal: belief that thoughts can be removed from pt mind
- thought broadcasting: belief that others can hear pt thoughts
what is insight?
ability of pt to understand that they have a mental health problem and what they are experiencing is abnormal
give examples of questions to assess insight
- what do you think the cause of the problem is?
- do you think you have a problem at the moment?
- do you feel you need help with your problem?
what is cognition?
mental action or process of acquiring knowledge and understanding through thought, experience and the senses
how do you get a vague idea of the patient’s cognitive performance?
- whether they are orientated in time, place and person
- what their attention span and concentration levels are like
- what their short term memory is like
in what ways can cognition be assessed more formally?
- MMSE
- AMTS
- Addenbrooke’s cognitive examination III (ACE-III)
Psych history: PC
OPEN QUESTION
- what led up to you coming to hospital?
- what has brought you in?
Psych history: HPC
- explore first question
- start?
- triggers?
- change?
- how affected you?
- associated symptoms
- rule out DDx
Depression screen
CORE symptoms (MIE): - mood is low: are you not enjoying things you used to enjoy? - low interest (anergia): how is your libido? do you still do normal activites? - energy is low (anhedonia) Additional: - biological: wt loss, period disturbance, low libido, early morning awakening - cognitive: reduce memory and concentration, guilt, loss self esteem, bleak future, self harm, hopelessness, lack of social interaction - ask manic symptoms for BPAD e.g. high libido, grandiose delusions (if yes = ask finances)
Anxiety screen (only if appropriate)
- heart palpitations
- sweating
- pins and needles
Schizophrenia screening
first rank symptoms
- 3rd person auditory
- running commentary
- delusions of thought
- delusions of control
- delusional perception
dementia screen (if appropriate)
- Alzheimer’s: apraxia, aphasia, agnosia, amnesia, vascular
- Lewy body: EPS symptoms (slow movement, stiff limbs, shaking, confusion, Parkinsonian, vivid hallucination)
- Frontotemporal: personality change, inappropriate behaviour
- Vascular: quick onset after stroke, ischaemic event
RISK assess
- harm to self?
- harm to others?
- afraid others will harm them?
- have you ever been involved with police or social services?
