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Mental Health > Psychiatric Hx and MSE > Flashcards

Psychiatric Hx and MSE Flashcards

1
Q

What is the ultimate aim of the psychiatric hx and MSE?

A

To diagnose, treat, and prevent mental disorders/illness

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2
Q

What attitude should you have when taking a psychiatric hx?

A

A respectful, non-judgemental, and open-minded approach, without colluding with the pt

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3
Q

How should we ask questions?

A

Ask open questions! Challenge beliefs and find pt reasoning for beliefs

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4
Q

What is the structure of a psychiatric hx?

A 
Hx of presenting complaint
Past psychiatric history
PMH
Socio-demographic details
Medicines and allergies
FHx
Social hx
Personal Hx
Pre-morbid personality
Risk assessment
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5
Q

What details should be found out in a personal history?

A 
Pregnancy and birth
Developmental milestones
School
Family relationships
Jobs - what, when, how long, why did they leave
Forensic history
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6
Q

What kind of things should we ask in a risk assessment?

A

Do you ever think of harming yourself? Or others? Do you ever think about killing yourself?

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7
Q

What is the aim of the mental state examination?

A

To get a snapshot of the pts mental state at the time of assessment

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8
Q

What is that great pneumonic for what to assess in an MSE?

A

About’a see my therapist, please call if ready

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9
Q

What does it all stand for?

A 
A- Appearance and behaviour
S- Speech
M- Mood
T- Thoughts
P- Perception
C- Cognition
I- Insight
R- Risk
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10
Q

What observations should be made for appearance and behaviour?

A

Describe the patient - demographics, clothing, personal hygeine, eye contact, rapport, attention, movements, responding to unseen stimuli, body language

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11
Q

What observations should be made for speech?

A

Rate, rhythm, volume, tone, fluency

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12
Q

What observations should be made for mood?

A

Objective mood, subjective mood, and affect

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13
Q

What observations should be made for thoughts?

A

Content, form, flow, and possession

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14
Q

What observations should be made for perception?

A

If they are experiencing hallucinations, pseudohallucinations or illusions

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15
Q

What observations should be made for cognition?

A

Orientation to time place and person, MMSE, short term memory, attention, concentration

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16
Q

What observations should be made for insight?

A

Whether they have insight into their disease? Is it complete or partial or not at all? What do they think of their treatment?

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17
Q

What observations should be made for risk?

A

How is their judgement? Are they a danger to themselves or others?

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18
Q

What observations can be made about the rate of speech?

A

If it is pressured, normal, or slowed down.

Is there a delay before speech starts?

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19
Q

What observations can be made about the tone of speech?

A

Is it varied or monotonous?

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20
Q

What observations can be made about the volume of speech?

A

Is it quiet, normal, or loud?

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21
Q

What observations can be made about the pts ability to speek?

A

Dysarthria?

Dysphagia?

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22
Q

What are some examples of formal though disorder apparent from speech?

A
  • Loosening of associations
  • Flight of ideas
  • Circumstantiality
  • Tangential
  • Neologisms

Or “No evidence of formal thought disorder”

23
Q

What is loosening of associations?

A

Loss of normal structure of thinking

Pt changes topic of conversation with no obvious link.

In extremes = Word salad

24
Q

What is flight of ideas?

A

Thoughts and speech move quickly from one topic to another, so original point is not followed to completion.

25
Q

Is there a link with flight of ideas?

A

Yes, the patient usually sees one eg a distraction in the environment, or from word use eg a pun or rhyme

26
Q

What is circumstantiality thought disorder?

A

Pt is overly inclusive of details, getting to the answer after a painstakingly slow story

27
Q

What is tangential thought disorder?

A

Pt goes off on a tangent and never returns to original topic. Laspes in organisation of thoughts.

28
Q

What is neologisms in thought disorder?

A

Pt creates/makes up words that have their own particular meaning

29
Q

What is the subjective mood of the patient?

A

How they say they feel/how they describe their mood

Can quote the patients own words

30
Q

If a patient struggles, how can you help them to express their mood?

A

By asking them to rate it on a scale of 0 to 10 with other examples on the scale

31
Q

What is the objective mood of the patient?

A

How we perceive their mood to be

32
Q

What words describe a patients mood (objectively)?

A 
Depressed
Anxious
Manic
Irritable
Euthmic/Normal
33
Q

What is the difference between mood and affect?

A

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

34
Q

What do we use to assess the patients affect?

A

Facial expressions, demeanor, and body language of the pt

35
Q

What can we assess wrt the pts thought form?

A

The speed (accelerated,racing,retarded etc)

36
Q

What can we assess wrt the pts thought flow?

A

Is it linear? Or incoherent?
Circumstantial/tangential (thought disorder)
Is there persevertion (repetition of a particular response despite removal of stimulus)?

37
Q

What can we assess wrt the pts thought content?

A

Are there:

  • Abnormal beliefs/delusions
  • Obsessions
  • Overvalued ideas
  • Suicidal thoughts
  • Homicidal/violent thoughts
38
Q

What can we assess wrt the pts thought possession?

A

If the patient believes there is thought insertion or withdrawal, or if they are experiencing thought broadcasting

39
Q

What is thought broadcasting?

A

Belief that others can hear the patient’s thoughts

40
Q

What is a hallucination?

A

A sensory perception without any external stimulation of the relevant sense that the pt believes is real.

Perceived from outside the body

41
Q

What is a pseudo-hallucination?

A

The same as a hallucination but the patient is aware that it isn’t real

42
Q

What is an illusion?

A

Misinterpreted perception such as mistaking a shadow for a person (whereas a hallucination is a false perception)

43
Q

Describe a blunted affect

A

Decrease in variation of emotional expression

44
Q

Describe a flat affect

A

Virtually a complete abscence of affective expression

45
Q

Describe an inappropriate/incongruous affect

A

Emotions expressed are not congruent with content of pts thoughts

46
Q

Describe a labile affect

A

Rapid and sometimes extreme changes in emotional state

47
Q

Describe a reactive affect

A

Normal! Appropriately responsive/reactive

48
Q

What kinds of delusions can patients have?

A
  • Persecutory
  • Reference (innocuous events believed to have big personal significance)
  • Grandiose
  • Nihilistic
  • Control
49
Q

What is a second person auditory hallucination example?

A

“You are sick, you smell, you are worthless”

50
Q

What is a third person auditory hallucination example?

A

“She is sick, we know where she lives, she should kill herself”

51
Q

What is a running commentary auditory hallucination example?

A

“He is looking at the door now, now he is going to leave”

52
Q

What is depersonalisation, and which MSE category does it fit into?

A

The sense that a person is outisde of themselves

Perception

53
Q

What is derealisation, and which MSE category does it fit into?

A

A vague sense of unreality in one’s perception of the external world

Perception

Mental Health (17 decks)

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