Psychiatric History Taking & MSE Flashcards

Question

Describe each of the following: * Delusional parasitosis * Capgras delusion * Cotard's syndrome * Formication

Answer 1

* **Delusional parasitosis:** *delusion that they are infected by parasites or bugs* * **Capgras delusion:** *delusion that friend or family member has been replaced by identical imposter* * **Cotard's syndrome:** *delusion that their body or part of their body is dead or dying* * **Formication:** *type of parasthesia in which it feels like insects are crawling on skin*

Answer 2

Thought form refers to the processing and organisation of thoughts/in what manner the thought is brought about/the way in which a person puts together ideas and associations

Answer 3

* Loosening of association * Tangential thinking * Derailment of thought (Knight's move thinking) * Word salad * Circumstantiality * Neologisms * Perseveration * Flight of ideas

Answer 4

Loosening of association= loss of the normal structure of thinking. Mainly occurs in schizophrenia. Three types: * **Derailment of thought:** *sequence of unrelated or remotely related ideas* * **Tangential thinking:** *diverts from original train of thought but never returns to it* * **Word salad:** *speech that is just a senseless repetition of sounds & phrases*

Answer 5

* **Circumstantiality:** think slowly and add many unnecessary details and digressions before returning to original point *(often seen in obsessional personalities & learning disability)* * **Neologisms**: words and phrases devised by pt or a new meaning to an already known word *(common schizophrenia & autism)* * **Perseveration:** *uncontrollable & inappropriate repetition of a particular response such as a word, phrase or gesture (common in dementia). e.g. ask patient their name once and they answer all other questions with their name* * **Flight of ideas:** *thoughts move quickly from one topic to another so that one train of thought is not completed before the next begins. Change is so rapid that links between one topic and another may be difficult to follow HOWEVER links are present. Links may be through rhyme/clang associations, puns, distraction e.g. objects in room. If no links then it is formal thought disorder. Common in mania.*

Answer 6

* Pressure of thought * Retardation * Thought blocking

Answer 7

* **Pressured thought:** thoughts are rapid, abundant and varied *(occurs in mania)* * **Retardation/poverty of thought:** thoughts are slow, few (poverty of thought) and unvaried *(occurs in depression)* * **Thought blocking**: sudden cessation of flow of thoughts. Mind is suddenly empty of thoughts. Do not confuse with normal experience of forgeting a particular word, being distracted etc... common schizophrenia

Answer 8

* **Thought insertion** *"does it feel like your thoughts are your own?"* * **Thougth withdrawal** *"does it feel like your own thoughts are being taken away from you?"* * **Thought broadcast***"does it feel as though your thoughts are being heard out loud"*

Answer 9

Perception is the process of being aware of what is presented to the body through the sense organs.

Answer 10

* Illusions * Hallucinations * Pseudo-hallucinations * Depersonalisation * Deralisation

Answer 11

* **Illusions:** false mental image produced by misinterpretation of an external stimulus * **Hallucinations:** perception in the absence of an external stimulus * **Pseudo-hallucinations:** perception in absence of an external stimulus but pt knows it's not real e.g. they hear a voice but they know it's inside their head, not an actual person's voice * **Depersonalisation:** feeling of detachment from the normal sense of self/no longer their true self (ask do you ever feel unreal or that part of your body is unreal?) * **Derealisation:** sense that the environment and people around you are unreal (ask do you ever feel like the world around you is unreal?)

Answer 12

* Visual= organic brain disease or substance misuse * Third person auditory hallucinations particularly running commentary= shcizophrenia

Answer 13

Throughout the process of performing a mental state examination, you will develop a vague idea of the patient’s cognitive performance including: * 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 A formal assessment of cognition can be achieved through a variety of different validated clinical tests including: * Mini-mental state exam (MMSE) * Abbreviated mental test score (AMT-10) * Addenbrooke’s cognitive examination III (ACE-III)

Answer 14

Ability of a patient to understand that they have a mental health problem and if they are in agreement with treatment.

Answer 15

* Intact: accept have mental disorder and willing to accept treatment * Partial: accept have mental disorder but decline treatment or deny they have mental disorder but accept treatment * Non-existent: deny any mental disorder and decline treatment

Answer 16

* Risk to self (self-harm, suicide, self-neglect, financial) * Risk to health (worsening mental illness, worsening physical health) * Risk to others (e.g. paranoid delusions, command hallucinations, driving, children)

Answer 17

Example presentation

Answer 18

If they have disorder of thought form or stream CHECK

Answer 19

* **Your history must inlcude all questions necessary to help you complete a MSE** *(i.e. even if very unlikely that hallucinations are present must still ask so you can comment on this in perception)* * **Always be thinking about differential diagnoses and ask questions to rule in or rule out conditions** *(this is your weak point in all histories. If trying to rule out e.g. depression, don't just ask about low mood ask about other symptoms to be sure)* * **When assessing risk categorise into mild, moderate or severe** *(remember we don't ever say no risk so mild is used for very minimal risks, if there is a clearly identifiable risk likely that they are moderate or severe)* * **Low threshold for safeguarding and include referral to safeguarding in management if necessary** * **Structure management as:** * **Risk assessment to allow you to determine w****here/how will you manage?***(e.g. inpatient, outpatient, MHA)* * **Rule out organic causes** *(blood tests, imaging etc...)* * **Biopsychosocial** *(Can you grade the severity of the disorder and does this affect your management? Don't just think about the mental disorder think about any co-morbid physical problems which may or may not be as a consequence of mental disorder)* \*Dr Kinnair said to think about Bella test (Bella is his mum). If it's an answer she could give it's not detailed enough.