Psychiatric history, MSE and cognitive assessment Flashcards
components of the cognitive assessment?
GOAL-CRAM: general orientation-time,place,person attention and concentration language calculation R hemisphere function-visual-spatial orientation abstraction-concepts memory
what is the premorbid personality and why is this important to ask about?
this is the personality of the pt before the onset of mental illness
important to look for change in the personality of the pt
what do you want to know about the history of presenting complaint?
nature
severity-amount of distress and functional impairment?
onset-when did it start, was this sudden? was it spontaneous or related to stressful events?-?precipitators, a delusional perception in schizophrenia-misinterpreting the significance of something perceived normally.
duration?
course-static, worsening, improving,fluctuating?
factors making problem worse or better
what is important to note with regards to past psychiatric history?
have you ever felt like this before? what was done about it? what support was sought? hosp admission? willingness for this? medication? compliance?
nature of illness, problems such as this in the past?
number and severity of episodes
requiring inpt hosp admission?
treatments given an their success?
did the pt think that they were unwell?
any assoc. with risks to self e.g. self-harm, or to others?
components of the MSE?
appearance and behaviour-eye contact, psychomotor agitation/retardation, hygiene, dress, smell, rapport?, abnormal behaviours e.g. fidgety suggesting anxiety?, facial expression, posture, movement
speech-rate, rhythm, content-logic?, tone, formal thought disorder?
mood-objective and subjective
thoughts-stream, form, content-preoccupatons, morbid thoughts including suicidality, delusions and overvalued ideas, obsessional symptoms. thought insertion, broadcast and withdrawal?-*schizophrenia. paranoia- anyone trying to harm you? people referring to you on TV or the radio?
perception-hallucinations, illusions, pseudohallucinations, thought echo-form of auditory hallucination.
cognition-general obs, MMSE, specific lobe exam., orientation, attention and conc, memory, language, visuospatial functioning. simple qns- time, place and person orientation.
insight-do you think that you may be unwell? mental illness?
what must we assess in the MSE when considering a patient’s insight?
do they realise that they are unwell?
do they understand that they have a mental illness?
do they think they need treatment?
are they willing to accept treatment?
do they understand the usefulness of that treatment?
what may suggest self-neglect when observing the pt?
dirty, unkempt appearance
crumpled stained clothing
appearance suggests alcoholism, drug addiction, dementia or schizophrenia. ?depression.
movement disorders that may be noted on general appearance of pt?
tics-irregular repeated movements involving a group of muscles
choreiform movements-brief involuntary movements, coordinated but purposeless
dystonia-muscle spasm, often painful and may lead to contortions.
name given to copious rapid speech difficult to interrupt seen in manic patients?
pressure of speech
abnormalities in the form of thought?
flight of ideas-seen in mania
loosening of associations (knight’s move thinking)-seen in schizophrenia
perseveration-persistent and inappropriate repetition of same sequence of thought, e.g. giving the same answer as given for the 1st question as the answer to a series of questions although these require different answers. Occurs most often in dementia.
how can preoccupations be asked about?
what sort of things do you worry about?
what sort of thoughts occupy your mind?
how to ask about suicidal ideation when considering thoughts in the MSE?
consider feelings of hopelessness-how do you see your future?
do you think that life is worth living?
have you had any thoughts about not wanting to live anymore? ever wished you might not wake up one morning?
any thoughts about ending your life?-what were these, how might you do it?
any plans to end your life?
any attempts to end you life? what stopped you? who was present?
how may the stream of thought be abnormal?
pressure of thought-thoughts rapid, varied, abundant
poverty of thought-slow, few, unvaried
blocking of thought- may be linked to delusion of thought withdrawal seen in schizophrenia
what is a secondary delusion?
most common form
arises from a previous idea or experience e.g. a hallucination-person may hear a voice and believe he is being followed, mood- depressed, may have feelings of worthlessness and believes other people feel the same about him, or another delusion.
what phenomena are not delusional in nature but are closely related to delusions?
delusional mood-inexplicable feeling of apprehensions shortly followed by a delusion that explains it
delusional perception-misinterpretation of the significance of something perceived normally
delusional memory-delusional misinterpretation of memories of actual events
how might persecutory delusions in schizophrenia and severe depressive disorder differ from one another?
depression-pt accepts that supposed actions of persecutor are justified by his behaviour
schizo-pt resents the actions
how can overvalued ideas be distinguished from delusions?
based on how the pt came to believe what they did
an overvalued idea is a preoccupying strongly held belief that affects the pt’s actions but has been derived through normal mental processes.
how are obsessions different from delusions?
patient recognises an obsession to be their own thought, and often tries to resist it
with obsessional thoughts, they know they are irrational and do not wish to carry them out.
what is a compulsion?
a recurrent, persistent stereotyped action that the person feels compelled to carry out but resists, recognises as senseless, and as a product of their own mind.
asking about obsessions?
do any thoughts keep coming repeatedly into your mind, even when you try hard to get rid of them?
when are illusions more likely?
impaired consciousness e.g. in delirium
inattention
emotional arousal, usually fear
sensory impairment
what is consciousness?
awareness of self and the environment
how do levels of consciousness vary between alertness and coma?
clouding of consciousness-state of drowsiness
stupor-person mute, immobile and unresponsive but appears conscious as eyes open and follow objects
confusion
drowsiness
difference between attention and concentration?
attention-ability to focus on matter in hand
concentration-ability to sustain that focus
