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Psychology & Neuroscience of Psychosis > The clinical assessment > Flashcards

The clinical assessment Flashcards

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1
Q

What are the steps of a standard psychiatric assessment?

A
  1. Individual’s history
  2. Mental state
  3. Collateral information
  4. Physical investigations
  5. Diagnosis or formulation
  6. Risk assessment (to self/others, indirect vulnerability)
  7. Create a plan
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2
Q

What are the elements we want to have in the individual’s history?

A
  • History of presenting complaint
  • Past psychiatric history
  • Past medical history
  • Medications
  • Family history
  • Psychosocial history
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3
Q

What constitutes the individual’s history of the presenting complaint?

A
  • Why here and now?
  • Predisposing, precipitating, perpetuating factors
  • Risk to self, others
  • Acute precipitants of substance misuse
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4
Q

What constitutes the individual’s past psychiatric history?

A
  • Number of episodes of ill-health
  • Precipitants
  • Typical duration
  • Relieving/treating factors
  • Location, type of treatment
  • Past risk history (self/others)
  • Past substance misuse
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5
Q

What are the categories to assess in the individual’s mental state?

A
  • Appearance and behaviour
  • Speech
  • Mood
  • Cognition
  • Insight
  • Thoughts
  • Perceptions
  • Risk
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6
Q

What is an important elements to keep in mind about the individual’s mental state?

A

Mental state is dynamic: here and now

  • if you know your patient (their history) well, you might just assess their current mental state
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7
Q

How do the individual’s history and their mental state differ?

A
  • Personal history is static
  • Mental state is dynamic
  • They differ in length and language

e. g. History: “I’m recorded by FBI and MI5”
- > mental state: patient had a paranoid delusion

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8
Q

Why do clinicians use the ‘history’ and ‘mental state’ systems?

A
  • To be systematic
  • Communication with other professionals (more rigorous and structured)
  • Allows us to make a provisional diagnosis and/or formulation
  • Allows us to monitor change
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9
Q

In what do the systems of assessing the patient’s history and mental state make clinicians systematic?

A
  • More rigorous in defining psychopathology
  • Reduces risk of missing areas of assessment (psychotic depression, bipolar past, OCD comorbidity, risk)
  • > always ask even if no signs presented
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10
Q

How do we classify delusions?

A
  • Delusions must be fixed (odd ideas are not enough)

- Delusions should be culturally inappropriate

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11
Q

What are the common delusional types?

A
  • Paranoid:
    feelings of being persecuted, followed or spied on
  • Nihilistic:
    sense of things not being real or dying
  • Grandiose:
    sense of having special powers or abilities
    (positive component)
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12
Q

What is the most common delusional type in psychosis?

A

Paranoid

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13
Q

What is the delusional type most commonly linked with depression?

A

Nihilistic

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14
Q

What is the passivity phenomena observed in psychotic symptomatology?

A
  • Made actions or thoughts

- Feeling of actions and thoughts being controlled by other people

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15
Q

What are ideas of reference in psychotic symptomatology?

A

Taking a personal message from a general medium

e.g. “FBI is sending me a message through the news”

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16
Q

What is the symptom of thought insertion?

A

Sense of thoughts being implanted into one’s brain

17
Q

What is the symptom of thought withdrawal?

A

Sense of thoughts being taken out from one’s brain

18
Q

What is the symptom of thought broadcasting?

A

Feeling that one’s thoughts can be heard by other people

19
Q

What is the symptom of thought echo?

A

Feeling of thoughts echoing around one’s head

20
Q

What characterises a formal thought disorder?

A

Difficulty in conveying thoughts (content) in a logical linear manner

  • the problem is the form, not the content
  • disjointed way of expressing one’s thoughts in the speech or writing
  • > it’s still possible to get a sense of content
21
Q

What are hallucinations?

A

Perception without stimulus
- can occur in any sensory modality

  • taste, smell, sight, hearing, touch
  • classical auditory
22
Q

What is insight?

A

Ability to recognise one’s difficulties or limits

  • it’s not necessarily present or absent
23
Q

What are the areas a clinician can enquire about one’s insight?

A

Do they recognise:

  • presence of mental illness
  • nature of mental illness
  • utility or need for medication
  • utility or need for engaging with services/professionals
  • risk to self and/or others
  • vulnerabilities
24
Q

Why can recovering insight be a major problem for patients?

A

As individuals recover, their improved insight on their illness and the negative impact it had in their lives can lead them to self-harm or feel depressed

25
Q

What characterises the risk assessment?

A
  • Static factors (e.g. risk ratio male-female)
  • Dynamic factors (e.g. drug consumption)
  • Risk to self or others
  • Vulnerabilities
  • Neglect or absconding (escape)
26
Q

Why is detail required in a risk assessment?

A

To reduce ambiguity

27
Q

What are common worries in a clinical assessment, especially amongst junior clinicians?

A
  • Aggressive, agitated individual
  • Someone without insight
  • Who won’t engage
  • Someone with ‘unusual’ symptoms
28
Q

What are key ideas on the attitude to adopt during a clinical assessment?

A
  • Treat people with respect and courtesy
  • Don’t push areas people don’t wish to talk about
  • Get senior support if you feel unsafe, uncomfortable or unprepared
  • Try to empathise with your patient

Psychology & Neuroscience of Psychosis (16 decks)

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