Psychiatry - MSE Flashcards
Name the core aspects of the psychiatric history.
- presenting complaint, history of presenting complaint
- past medical & psychiatric history (including previous hospital admission due to mental health)
- drug history, allergies
- family history of psych illness
- social history
- forensic history (‘have you ever been in trouble with the police?’)
- personal history
- premorbid personality (‘what were you like before all this started?’)
Describe the important components of the social history in psychiatric history taking.
- accommodation, who they stay with, if they have dependents
- finances/benefits/debts
- employment status
- support network, negative influences
- self-care; are they able to function independently, do they receive support?
- are symptoms affecting any of the above?
- smoking, alcohol, recreational drug use, gambling
Describe the important components of the personal history in psychiatric history taking.
- pregnancy and birth, early milestones
- preschool, who did they live with, how was family life
- school: friendships, bullying, academic achievement, age of leaving education, qualifications
- ask generally about trauma (e.g. ‘were there any events in your childhood that had a big impact on you?’)
- adulthood: employment history, relationships, sexuality, children
Name the main presenting complaints of depression.
SIG-E-CAPS
- sleep (difficulties, early waking)
- interest (anhedonia in previously pleasurable activities)
- guilt (worthlessness, devaluation)
- energy (lack of, fatigue)
- concentration (reduced, distractibility)
- appetite (changed)
- perception of self and future (negative)
- suicidality (preoccupation with death)
Name the main features of mania.
DIGFAST
- distractibility
- impulsivity
- grandiosity
- flight of ideas
- activity
- sleep
- talkative
Name the components of the mental state examination (MSE).
ASEPTIC is often used, but ASTHMATICS is useful in including more information
1. Appearance and behaviour
2. Speech
3. Thoughts and perceptions
4. Affect and emotion
5. Insight
6. Cognition
7. Suicidality and risk assessment
Describe the important aspects of (1) appearance and behaviour.
GEAR (P)
- general appearance: appropriate clothing, skin, weight, hygiene (e.g. shaving)
- expression: smiling, weeping, eye contact, body language
- attitude: cooperative, hostile, apathetic, overfamiliar
- rapport: is the patient engaged in establishing a rapport?
- psychomotor: agitation, retardation, abnormal movements
Describe some abnormal involuntary movements that may be observed through the MSE.
- tremor
- tics
- lip smacking
- mannerisms
- akathisia (inability to stay still)
- dyskinesia (involuntary, writhing, fluid and dance-like or jerking movements of limbs or face)
Describe important aspects of (2) speech in the MSE.
Rate, quality and form, volume and tone
- rate: pressure, retarded, poverty, mutism
- quality and form: minimal or excessive
- volume and tone: soft, loud, monotonous
Describe the core aspects of (3) thought in the MSE.
Stream/flow, Form, Content
- pressure, poverty of speech, thought blocking
- form may indicate mania or schizophrenia (see later cards)
- content: delusions, obsessions, compulsions, possession
Describe the ordered disorders of form of speech.
- circumstantial speech: organised speech with excessive detail and irrelevancies, delay getting to the point
- tangential speech: organised speech skirts around the topic and never reaches the point of the conversation
- knight’s move: connections between sentences, or parts of sentences, are without a coherent train of thought
- flight of ideas: accelerated flow of speech, with a logical connection between ideas and rapid speech of movement
Describe the disordered disorders of form of speech.
- clang association: linking words together based on coincident sound rather than meaning (‘he rained the train brain grain the crane’)
- word salad: recognisable words arranged completely meaninglessly in incoherent sentences (‘running lately people purple purpose’)
- paragrammatism: disorder of grammatical construction (‘dog for taken I have a walk’)
Describe the ‘single word’ disorders of form of thought.
- neologism: a new word with an idiosyncratic personal meaning to the patient
- logoclonia: repetition of the last syllable of every word
- palilalia: repetition of patient’s own word when no longer appropriate
- echolalia: repetition of the examiner’s words and speech
What is a delusion?
A fixed, firm belief based on inadequate ground, not amenable to rational argument or evidence to the contrary, and not in sync with regional, cultural or religious norms
Describe the main types of delusion associated with schizophrenia.
- persecutory: someone/thing means to do them harm, (someone is following/watching them).
- delusions of control: their thoughts, feelings, and/or actions are being controlled by an outside agent (e.g. thought insertion, withdrawal, or broadcasting)
- delusions of reference: ordinary objects/events have a special significance specifically for them
Describe the main delusion held in mania/hypomania.
Delusions of grandeur
- they have extraordinary special gifts or qualities
- e.g. they can save us all from climate change
Describe the delusions associated with depressive psychosis.
- nihilistic: they, or other important things, no longer exist. may extend to Cotard’s syndrome, where they believe their organs are rotting away or they are dying
- delusions of guilt: belief a terrible wrong, sin, or crime has been committed (e.g. death of a partner)
Describe Schneider’s first-rank thought possession symptoms.
- thought insertion: thoughts inserted into the patient’s mind
- thought withdrawal: thoughts can be removed from the patient’s mind
- thought broadcasting: others can hear the patient’s thoughts
In which body sense are the most common hallucinations seen in schizophrenia?
Auditory
Describe the different types of auditory hallucination.
- audible thoughts (Gedankenlautwerden): hears their own thoughts spoken as they are thinking them
- thought echo: hears their own thoughts spoken immediately after thinking them
- second person auditory: voice addresses the patient directly (‘you are evil, everybody hates you’)
- third person auditory: voices discuss the patient, referring to them as she/he; may be in the form of a running commentary
In which sense are hallucinations experienced in withdrawal states most commonly observed?
Tactile (touch), e.g. formication (sensation of little insects crawling on/just under the skin)
Describe the difference between mood and affect.
- mood is the subjective emotion experienced by the patient over a longer period of time
- affect is the emotion observed in the patient during history taking, i.e. may be a ‘snapshot’ of mood
Describe the ranges of affect that may be observed in the MSE.
- reactive (normal)
- fixed
- restricted
- labile
- blunted
- incongruous (affect is not in keeping with content of thoughts)
Describe the differences between insight and judgement.
- insight is the patient’s awareness of, and ability to understand, the origins and meaning of their current feelings, behaviour and symptoms
- judgement is the ability to make considered decisions, or come to a sensible conclusion when presented with information (‘what would you do if you could smell smoke in your house?’)
