Psychiatry Flashcards
In an MSE what is assessed for in appearance?
age physique/build dress/evidence of self neglect effort with appearance tattoos signs of physical ill health posture physical expression physical features of alcoholism or drug abuse
In an MSE what is assessed for in behaviour?
what is the pt doing and is it appropriate
psychomotor agitation/retardation
eye contact
attitude/rapport
In an MSE what is assessed for in speech?
form of speech pressure or poverty of speech spontaneous speech latency rate volume tone articulation sudden silences accent vocabulary abnormalities of articulation
In an MSE what is assessed for in mood?
objective and subjective description of mood
neutral, euthymic, dysphoric, euphoric, anxious, angry, apathetic, irritable
rating of mood on a scale
In an MSE what is assessed for in affect?
congruent/incongruent
intensity - normal, blunted, exaggerated, flat, heightened
extent to which affect changes
In an MSE what is assessed for in suicidality?
suicidal ideation
thoughts of life not worth living
thoughts of wanting to self-harm, methods, plans
In an MSE what is assessed for in thought?
form tempo flight of ideas poverty of thought formal thought disorder thought blocking loosening of associations knights move thinking tangential thinking circumstantiality neologisms
What is knights move thinking?
Jumping from topic to topic with no connections between them
What is a formal thought disorder?
a disturbance in organisation, control and processing of thoughts
What is tangential thinking?
Wandering from the topic and never providing the information asked for
What is Circumstantiality?
Inability to answer a question without providing an excessive amount of detail.
In an MSE what is assessed for in thought content?
preoccupations
overvalued idea
delusional ideation
delusions
In an MSE what is assessed for in perception?
derealisation/depersonalisation
illusions
hallucinations
What should be assessed for in auditory hallucinations?
Interna; vs external space open to conscious manipulation 2nd or 3rd person number of voices gender content running commentary thoughts spoken commanding voices compelled to act on them
In an MSE what is assessed for in cognition?
attention and concentration orientation memory calculation language visuospatial functioning executive functioning
In an MSE what is assessed for in insight?
Awareness of symptoms
Attribution of symptoms to a mental disorder
Appraisal and analysis of consequences of such symptoms
Acceptance of treatment
In depression what can the MSE show about a persons’ appearance and behaviour?
reduced facial expression brow classically 'furrowed' reduced eye contact limited gesturing rapport often difficult to establish
In depression what can the MSE show about a persons’ speech?
reduced rate, volume and innotation
lowered pitch
increased speech latencies
limited content
In depression what can the MSE show about a persons’ mood?
low, miserable, unhappy, sad
can be described as flat
often empty
In depression what can the MSE show about a persons’ affect?
depressed
reduced range
limited reactivity
In depression what can the MSE show about a persons’ thought?
form typically normal
flow - slow, pondering, can almost be absent
content - negative, self-accusatory, failure, guilt, low self-esteem, pessimism
delusions can occur
paranoia - increased sensitivity to the criticisms of others
In depression what can the MSE show about a persons’ perception?
hallucinations - almost always auditory, 2nd person and derogatory, typically reflecting negative and depressive themes
In depression what can the MSE show about a persons’ cognition?
slow - poor memory
‘psuedo-dementia’
typical deficits in working memory, attention and planning
In depression what can the MSE show about a persons’ insight?
typically preserved
attribution however can often be affected
How is depression diagnosed?
last at least 2 weeks no hypomanic or manic symptoms 2 of - depressed mood - loss of pleasure or interest - decreased energy
What are the additional symptoms (non core) in depression?
loss of confidence unreasonable feelings of guilt any suicidal thoughts/behaviour diminished ability to think/concentrate any agitation or retardation sleep disturbance change in appetite
What is mild depression?
2/3 main symptoms + additional symptoms to make 4
What is moderate depression?
2/3 main symptoms + additional symptoms to make 6
What is severe depression?
3/3 main symptoms + additional symptoms to make 8
What is somatic syndrome?
4 of the following:
- loss of interest or pleasure
- lack of emotional reactions
- early waking
- psychomotor retardation/agitation
- loss of appetite
- weight loss
- marked loss of libido
What is atypical depression?
Mood is reactive 2 or more of: - weight gain or increased appetite - hypersomnia - leaden paralysis - longstanding personal rejection
What is psychotic depression?
Occasional paranois, typically mood-congruent or hypochondrial
Cotard’s syndrome with nihilistic delusions
What is a hypomanic episode?
Mood elevated or irritable more than normal for individual for at least 4 days and 3 of the following must be present:
- increased activity/restlessness
- increased talkativeness
- difficulty concentration/distractability
- decreased need for sleep
- increased sexual energy
- mild spending sprees or other types of reckless or irresponsible behaviour
What is a manic episode?
Mood predominantly elevated, expansive or irritable
Mood sustained for at least 1 week
At least 3 of following:
- increased activity or physical restlessness
- increased talkativeness
- flight of ideas
- loss of normal social inhibitions
- decreased need for sleep
- distractability or constant changes in activity or plans
- foolhardy or reckless behaviour
- marked sexual energy
What is mania with psychotic symptoms?
Mania with delusions or hallucinations are present - grandiose, self-referential, erotic or persecutory.
What is the lifetime prevalence of BPD?
1-4%
