Psychiatric Hx and MSE Flashcards
What is the ultimate aim of the psychiatric hx and MSE?
To diagnose, treat, and prevent mental disorders/illness
What attitude should you have when taking a psychiatric hx?
A respectful, non-judgemental, and open-minded approach, without colluding with the pt
How should we ask questions?
Ask open questions! Challenge beliefs and find pt reasoning for beliefs
What is the structure of a psychiatric hx?
Hx of presenting complaint Past psychiatric history PMH Socio-demographic details Medicines and allergies FHx Social hx Personal Hx Pre-morbid personality Risk assessment
What details should be found out in a personal history?
Pregnancy and birth Developmental milestones School Family relationships Jobs - what, when, how long, why did they leave Forensic history
What kind of things should we ask in a risk assessment?
Do you ever think of harming yourself? Or others? Do you ever think about killing yourself?
What is the aim of the mental state examination?
To get a snapshot of the pts mental state at the time of assessment
What is that great pneumonic for what to assess in an MSE?
About’a see my therapist, please call if ready
What does it all stand for?
A- Appearance and behaviour S- Speech M- Mood T- Thoughts P- Perception C- Cognition I- Insight R- Risk
What observations should be made for appearance and behaviour?
Describe the patient - demographics, clothing, personal hygeine, eye contact, rapport, attention, movements, responding to unseen stimuli, body language
What observations should be made for speech?
Rate, rhythm, volume, tone, fluency
What observations should be made for mood?
Objective mood, subjective mood, and affect
What observations should be made for thoughts?
Content, form, flow, and possession
What observations should be made for perception?
If they are experiencing hallucinations, pseudohallucinations or illusions
What observations should be made for cognition?
Orientation to time place and person, MMSE, short term memory, attention, concentration
What observations should be made for insight?
Whether they have insight into their disease? Is it complete or partial or not at all? What do they think of their treatment?
What observations should be made for risk?
How is their judgement? Are they a danger to themselves or others?
What observations can be made about the rate of speech?
If it is pressured, normal, or slowed down.
Is there a delay before speech starts?
What observations can be made about the tone of speech?
Is it varied or monotonous?
What observations can be made about the volume of speech?
Is it quiet, normal, or loud?
What observations can be made about the pts ability to speek?
Dysarthria?
Dysphagia?
What are some examples of formal though disorder apparent from speech?
- Loosening of associations
- Flight of ideas
- Circumstantiality
- Tangential
- Neologisms
Or “No evidence of formal thought disorder”
What is loosening of associations?
Loss of normal structure of thinking
Pt changes topic of conversation with no obvious link.
In extremes = Word salad
What is flight of ideas?
Thoughts and speech move quickly from one topic to another, so original point is not followed to completion.
Is there a link with flight of ideas?
Yes, the patient usually sees one eg a distraction in the environment, or from word use eg a pun or rhyme
What is circumstantiality thought disorder?
Pt is overly inclusive of details, getting to the answer after a painstakingly slow story
What is tangential thought disorder?
Pt goes off on a tangent and never returns to original topic. Laspes in organisation of thoughts.
What is neologisms in thought disorder?
Pt creates/makes up words that have their own particular meaning
What is the subjective mood of the patient?
How they say they feel/how they describe their mood
Can quote the patients own words
If a patient struggles, how can you help them to express their mood?
By asking them to rate it on a scale of 0 to 10 with other examples on the scale
What is the objective mood of the patient?
How we perceive their mood to be
What words describe a patients mood (objectively)?
Depressed Anxious Manic Irritable Euthmic/Normal
What is the difference between mood and affect?
Mood is like the climate, affect is like the weather.
E.g. A pt can be depressed in mood, but labile in affect as they respond appropriately to happy or exciting, and sad stimuli etc
What do we use to assess the patients affect?
Facial expressions, demeanor, and body language of the pt
What can we assess wrt the pts thought form?
The speed (accelerated,racing,retarded etc)
What can we assess wrt the pts thought flow?
Is it linear? Or incoherent?
Circumstantial/tangential (thought disorder)
Is there persevertion (repetition of a particular response despite removal of stimulus)?
What can we assess wrt the pts thought content?
Are there:
- Abnormal beliefs/delusions
- Obsessions
- Overvalued ideas
- Suicidal thoughts
- Homicidal/violent thoughts
What can we assess wrt the pts thought possession?
If the patient believes there is thought insertion or withdrawal, or if they are experiencing thought broadcasting
What is thought broadcasting?
Belief that others can hear the patient’s thoughts
What is a hallucination?
A sensory perception without any external stimulation of the relevant sense that the pt believes is real.
Perceived from outside the body
What is a pseudo-hallucination?
The same as a hallucination but the patient is aware that it isn’t real
What is an illusion?
Misinterpreted perception such as mistaking a shadow for a person (whereas a hallucination is a false perception)
Describe a blunted affect
Decrease in variation of emotional expression
Describe a flat affect
Virtually a complete abscence of affective expression
Describe an inappropriate/incongruous affect
Emotions expressed are not congruent with content of pts thoughts
Describe a labile affect
Rapid and sometimes extreme changes in emotional state
Describe a reactive affect
Normal! Appropriately responsive/reactive
What kinds of delusions can patients have?
- Persecutory
- Reference (innocuous events believed to have big personal significance)
- Grandiose
- Nihilistic
- Control
What is a second person auditory hallucination example?
“You are sick, you smell, you are worthless”
What is a third person auditory hallucination example?
“She is sick, we know where she lives, she should kill herself”
What is a running commentary auditory hallucination example?
“He is looking at the door now, now he is going to leave”
What is depersonalisation, and which MSE category does it fit into?
The sense that a person is outisde of themselves
Perception
What is derealisation, and which MSE category does it fit into?
A vague sense of unreality in one’s perception of the external world
Perception
