Psychiatry Flashcards
What should you cover in a psychiatric history?
HOPC Past psychiatric hx PMhx Drug hx, concordance with meds & side effects of psychiatric medication Social hx Personal hx Premorbid personality Strengths Carer responsibility Forensic hx Family hx
What should you cover in a risk assessment for someone with psychiatric symptoms?
Risk to self Risk to others Risk of self neglect Risk of exploitation Risk to dependents Other risks - absconding
What should you include in a mental state examination? 8 things
Appearance Behaviour Speech Mood and effect Thoughts - form, content, possession Perceptions Cognition Insight
What should you evaluate for the appearance of a person during a MSE?
Distinctive features Clothing Posture/gait Grooming/hygiene Evidence of self-harm
What should you evaluate for the behaviour of a person during a MSE?
Eye contact
Facial expression
Psychomotor activity –motor activity related to mental processes (can be slowed or increased)
Body language / gestures / mannerisms
Level of arousal –calm / agitated /aggression
Rapport / engagement
How should you evaluate the speech of a person during a MSE?
Rate of speech– pressured / slowed
Quantity of speech– minimal(e.g.only in response to questions) /excessive speech/complete absence of speech. Spontaneous?
Tone of speech –monotonous / tremulous
Volume of speech –loud / quiet
Fluency and rhythm of speech–articulate / clear / slurred
How should you evaluate the mood and affect of a person during a MSE?
Mood – their description
Affect – your observation
Quality of affect:
Sad/agitated/hostile
Euphoric/animated
Range of affect:
Restricted
Normal
Expansive
Intensity of affect:
Normal
Blunted
Flat
Fluctuations in affect:
Labile –easily changed between states
How should you evaluate a persons thoughts during a MSE?
FORM
Speed –accelerated / racing / retarded
Flow/ coherence:
Linear – in a logical order
Incoherent – makes no logical sense
Circumstantial – lots of irrelevant/unnecessary details (not to the point)
Tangential – the patient goes off on tangents relating loosely to the initial thought (flight of ideas)
Perseveration –repetition of a particular response despite the absence/removal of the stimulus
CONTENT Abnormal beliefs/ delusions Obsessions –patient is aware they are their own irrational Suicidal thoughts Homicidal/violent thoughts
POSSESSION
Thought insertion –belief that thoughts can be put into the patient’s mind
Thought withdrawal –belief that thoughts can be removed from patient’s mind
Thought broadcasting –belief that others can hear the patient’s thoughts
How should you evaluate a persons perceptions during a MSE?
Hallucinations –a sensory perception without any external stimulation of the relevant sensethat the patient believes IS real(e.g. hears voices but no sound present)
Illusions –illusions are misinterpreted perception such as mistaking a shadow for a person
How can you test someones cognition during a MSE?
Basic testing:
Orientation(time/place/person)
Attention and concentration
Short-term memory
How can you test if someone has insight during a MSE?
Can they recognise what they’re experiencing is abnormal?
What do they think is the cause of their experiences?
Do they want help with their problem?
What is acute stress reaction?
An acute stress reactions that occurs in the first 4 weeks after a person has been exposed to a traumatic events (PTSD is diagnosed after 4 weeks)
features of acute stress reaction
intrusive thoughts e.g. flashbacks, nightmares
dissociation e.g. ‘being in a daze’, time slowing
negative mood
avoidance
arousal e.g. hypervigilance, sleep disturbance
Mx of acute stress reaction
trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
benzodiazepines
sometimes used for acute symptoms e.g. agitation, sleep disturbance
(should only be used with caution due to addictive potential and concerns that they may be detrimental to adaptation)
What is an illusion?
A false perception of a real external stimulus.
What is a hallucination?
A percept that is experienced in the absence of an external stimulus to the corresponding sense organ.
What are the different types of auditory hallucinations?
Second person hallucinations : voices address the patient directly (depression)
Third person hallucinations : voices talk to one another, referring to the patient as ‘he’ or ‘she’ (schizophrenia)
Gedankenlautwerden : voices speak the patients thoughts as they are thinking them
Echo de la pensee : voices repeat the patients thoughts after they have thought them
What is an over valued idea?
An unreasonable and sustained intense preoccupation maintained with less than delusional intensity. The belief is demonstrably false and not normally held by others of the same subculture. There is marked associated emotional investment.
Schizophrenia
What is a delusion?
A false belief based on incorrect inference about external reality that is firmly sustained despite what constitutes inconvertible and obvious proof or evidence to the contrary. The persons belief is not normally accepted by other members of the same subculture.
What is passivity?
The belief than an external agency is controlling aspects of the self that are normally entirely under ones own control. Includes thought alienation, made feelings, made impulses, made actions and somatic passivity.
Name some types of delusions
Delusion of control Persecutory delusion delusion of poverty Delusion of reference Delusion of self accusation Erotic delusions Delusion of infidelity Delusion of grandeur Delusion of doubles Nihilistic delusion
What is de Clerambault’s syndrome?
Delusional belief that another person is deeply in love with one (usually occurs in women, with the object often being a man of much higher social status). The supposed lover is usually inaccessible.
What is delusional jealousy/Othello syndrome?
Delusional belief that ones spouse or lover is being unfaithful. Jealousy is used on unsound evidence and reasoning.
More common in men.
What is a delusional perception?
A new and delusional significance is attached to a familiar real perception without logical explanation.
Is a 1st rank symptom of schizophrenia