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PACES management > Psych history and MSE > Flashcards

Psych history and MSE Flashcards

1
Q

MSE aspects

A

ASEPTIC

  • appearance
  • speech
  • emotion (mood, affect)
  • perception
  • thought
  • insight
  • cognition
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2
Q

appearance

A
  • 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
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3
Q

emotion - mood (what patient tells you) and affect (what you observe)

A
  • how has your mood been lately? (low mood, anxious, angry, euphoric)
  • affect (facial expressions, apparent emotion, fixed/restricted/labile affect, intensity of affect)
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4
Q

speech

A
  • rate
  • quantity (minimal or excessive)
  • tone (monotonous, tremulous)
  • volume
  • fluency and rhythm
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5
Q

what is perception?

A

involves organisation, identification and interpretation of sensory information to understand world around us

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6
Q

what are abnormalities in perception?

A
  • 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)
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7
Q

questions used to screen for perceptual abnormalities?

A
  • 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?
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8
Q

broad thought categories

A
  • thought form
  • thought content
  • thought possession
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9
Q

what is thought form? what to comment on?

A

processing and organisation of thoughts

  • speed of thoughts
  • flow and coherence of thoughts (loose associations, tangents, flight of ideas, thought blocking, neologisms)
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10
Q

what are the abnormalities of thought content?

A
  • 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
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11
Q

what questions can you ask to screen for thought process abnormalities?

A
  • 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?
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12
Q

what are abnormalities of thought possession?

A
  • 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
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13
Q

what is insight?

A

ability of pt to understand that they have a mental health problem and what they are experiencing is abnormal

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14
Q

give examples of questions to assess insight

A
  • 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?
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15
Q

what is cognition?

A

mental action or process of acquiring knowledge and understanding through thought, experience and the senses

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16
Q

how do you get a vague idea of the patient’s cognitive performance?

A
  • 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
17
Q

in what ways can cognition be assessed more formally?

A
  • MMSE
  • AMTS
  • Addenbrooke’s cognitive examination III (ACE-III)
18
Q

Psych history: PC

A

OPEN QUESTION

  • what led up to you coming to hospital?
  • what has brought you in?
19
Q

Psych history: HPC

A
  • explore first question
  • start?
  • triggers?
  • change?
  • how affected you?
  • associated symptoms
  • rule out DDx
20
Q

Depression screen

A 
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)
21
Q

Anxiety screen (only if appropriate)

A
  • heart palpitations
  • sweating
  • pins and needles
22
Q

Schizophrenia screening

A

first rank symptoms

  1. 3rd person auditory
  2. running commentary
  3. delusions of thought
  4. delusions of control
  5. delusional perception
23
Q

dementia screen (if appropriate)

A
  • 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
24
Q

RISK assess

A
  • harm to self?
  • harm to others?
  • afraid others will harm them?
  • have you ever been involved with police or social services?
25
Q

PMH

A
  • anything happened like this before?
  • any other mental health diagnoses?
  • any physical health diagnoses?
26
Q

DH and allergies

A
  • taking any medications at the moment?
27
Q

FH

A

anyone in the family suffer from mental health conditions?

28
Q

SH

A
  • who is at home with you?
  • do you feel safe and supported at home?
  • alcohol (CAGE)
  • drugs
  • smoking
  • job/ impact on work
  • forensic history, finances
  • ICE

PACES management (7 decks)

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