Symposium 1 - psych history and MSE

Question 1

The setting

Answer 1

privacy
avoid interruptions
easy exit
informal setting, avoid barriers, respect personal space

Question 2

Safety/risk assessment

Answer 2

inform who you are interviewing and where
during iv - feel uncomfortable then stop
violence is unusual

Question 3

Overview of a psychiatric history

Answer 3

Presenting complaint 
HPC 
past psychiatric history 
PMH
current and recent medication 
social history 
FH 
personal history

Question 4

3 important things to establish at start of history

Answer 4

purpose of interview
likely duration
note taking and confidentiality

Question 5

Important things in your manner

Answer 5

eye contact, non hurried, relaxed, facilitative noises, acknowledge non verbal cues, open questions

Question 6

Objectives of interview

Answer 6

form rapport and gather information 
establish and explore symptoms 
inform and motivate patient 
mental state 
begin formulation 
circumstance of referral

Question 7

Presenting complaint

Answer 7

record each

“can you tell me in your own words why you are here?”

Question 8

HPC

Answer 8

clarify each in turn 
onset, severity, precipitants, course 
associated symptoms, QOL
worse or better?
responded to any treatment?

Question 9

Related symptoms

Answer 9

family noticed any change in you?
specific symptoms - closed
systematic enquiry eg depression, psychosis, anxiety

Question 10

percepts

Answer 10

Seen or heard anything others are not aware of?

cause? is this possible?

Question 11

Beliefs

Answer 11

playing on your mind? change in thoughts eg interference, access

Question 12

Past psychiatric history

Answer 12

past episodes/diagnoses
previous treatments 
inter episode functioning 
previous hospital admissions 
attempted suicide or DSH?
previous detentions under mental health legislations

Question 13

FH

Answer 13

siblings, parents, grandparents etc
major mental health in distant relatives
age, employment, relationship, health

Question 14

What might be useful in the FH?

Answer 14

genogram

Question 15

5 main things to explore in PMH?

Answer 15

head injuries 
endocrine 
developmental abnormality 
liver, oesophageal varices, peptic ulcer
vascular risk factors

Question 16

Current and recent medications

Answer 16

tablets and injections 
discontinued drugs in last 6 months 
how long and dose 
adverse reactions and allergies
adherence

Question 17

Social history

Answer 17

social circumstances and occupation 
finances/stressors
smoking, alcohol, illicit drugs 
relationships 
children

Question 18

Alcohol/illicit drugs

Answer 18

intermittent or regular?
amount, pattern
withdrawl/dependence
impact

Question 19

Screening questionnaires for alcohol

Answer 19

CAGE

Question 20

Personal history

Answer 20

developmental milestones 
occupational 
friends, hobbies, interests 
early life 
education 
relationships 
finance

Question 21

Forensic history

Answer 21

ever been in contact with police? charged?

offences eg violent or sexual?

Question 22

MSE

Answer 22

appearance 
mood 
speech 
thoughts
beliefs 
perception 
insight 
behaviour 
suicide/homicide
cognitive function

Question 23

Appearance

Answer 23

build/height
clothing
personal hygiene
makeup, jewellery, accessories

Question 24

Behaviour

Answer 24

greeting 
non verbal cues 
gesturing 
abnormal movements 
co-operative

Question 25

Mood

Answer 25

eye contact
affect
mood rating
psychomotor function - retarded, agitated

Question 26

speech

Answer 26

spontaneity
volume, rhythm, tone, rate
dysarthria, dysphasia

Question 27

Abnormal thoughts

Answer 27

close relationship with speech
phobias, obsessions
formal thought disorder - insertion, withdrawal, echo
knights move

Question 28

Abnormal beliefs

Answer 28

preoccupations
overvalued beliefs
delusional

Question 29

Abnormal percepts

Answer 29

illusions

hallucinations

Question 30

suicide/homicide

Answer 30

suicidal thoughts, ideation, plan, intent

homicidal risk

Question 31

Cognitive function

Answer 31

orientation
attention and concentration
short and long term memory
MMSE/MOCA

Question 32

Insight

Answer 32

spectrum which varies

Question 33

3 questions for insight

Answer 33

symptoms due to an illness?
mental illness?
management and agree with treatment?

Question 34

psychopathology

Answer 34

abnormal experience, cognition and behaviour

Question 35

descriptive psychopathology

Answer 35

describes and categorises the abnormal experience

Question 36

phenomology

Answer 36

observation and understanding of event - empathy

Question 37

euthymic

Answer 37

neutral

Question 38

mood versus affect

Answer 38

mood - patients subjective report on current mood state

affect - objectively observed by emotions conveyed

Question 39

blunted affect seen in?

Answer 39

schizophrenia

Question 40

thinking - 4 categories

Answer 40

speed and tempo
type
linkage
possession

Question 41

delusion

Answer 41

unshakeable idea or belief which is out of keeping with person’s social and cultural background eg grandiose, paranoid, hypochondriac

Question 42

SCAN - thoughts

Answer 42

persecutory = anyone deliberately trying to harm you?
differential - might not be true?
think clearly? anyone read your mind?

Question 43

Where do pseudohallucinations occur?

Answer 43

internal space

Question 44

Where do hallucinations occur?

Answer 44

external space, no external stimuli

Question 45

Hallucinations senses

Answer 45

all 5 - olfactory, visual, auditory, tactile, gustatory

Question 46

hypnopompic hallucination

Answer 46

end of sleep

Question 47

hypnagogic hallucination

Answer 47

going to sleep

Question 48

Formulation of case

Answer 48

allows consideration of diagnosis in context of history

management and treatment

Question 49

formulation - factors

Answer 49

organic, psychological and social

predisposing, precipitating, perpetuating