The MSE and Psych History Taking Flashcards
What is the basic structure of a psych patient assessment?
- HPC (onset, severity, duration, aggravating/relieving factors, associated symptoms)
- Past psych Hx
- Sociodemographic details
- Past med Hx
- Medication Hx
- Family Hx
- Personal Hx
- What was their premorbid personality like
- MSE
What are some vital questions to ask a patient presenting with low mood?
- How long have they felt like this
- When did they last feel normal
- Is there anything in particular worrying them
- Do you feel blame
- Are you worried about what others think
- How do you see the future
- Are you able to enjoy things as usual
- Have you ever felt the opposite of this but still not normal (mania)
- Have you ever felt like this before
What is the single most important question to ask a patient with low mood, and how would you go about it?
RISK ASSESSMENT!
- Do you feel your life is worth living
- Has it every gotten so bad that you have thought about harming yourself/ending your life
- What stops you from going through with it
If during a history someone reports visual hallucinations, what would you start to think of?
Organic disease, more likely to be LBD than anything psychiatric.
Psych disease predominantly causes auditory hallucinations.
What sort of delusions would you expect in someone with psychotic depression
- Hallucinate voices telling them to kill themselves
- Delusion that they’ve committed a crime
- Delusion that they’re dying or already dead
Essentially the delusions and hallucinations tend to fit in with depressive thinking
What questions can you ask someone with delusions to try and establish that these are in fact delusions?
- HOW DO YOU KNOW this is happening
- How long have you known about this
- Could there be any other explanations?
- Sometimes the mind can play tricks on us, could this be that
How might you assess risk in a patient experiencing delusions?
That sounds very frightening, have you ever taken steps to protect yourself from…
How might you assess risk in a person experiencing hallucinations?
- Do the voices ever tell you dangerous things?
- Do the voices ever tell you to harm yourself?
- Do you feel you’re able to resist them?
What are the components of the MSE?
- ABS (appearance, behaviour, speech)
- Mood (overall mental status)
- Affect (mental state in that moment)
- Thought (content, possession, flow and speed, DELUSIONS)
- Perception (HALLUCINATIONS, Illusions, Depersonalisation, etc)
- Cognition (orientation and attention span, check using MSE or date/time/location)
- Insight and Judgement (do you know where you are/what’s wrong, what would you do if a building was on fire)
What is the distinction between para-suicide and deliberate self-harm?
DSH = an act of self harm where the action was not intended to kill but to cause harm
Para-Suicide = an act where the intention was fully to end one’s life, but for whatever reason this failed.
Which groups of people are at greatest risk of suicide?
- Suicide occurs at all ages, all demographic groups
- Men in their early 40s, women in their early 50s
- Psych inpatients (and people released from a psych inpatient facility in the past 14 days- why they get seen after 7)
What are some risk factors for suicide?
- Mental illness (depression, Sz huge link, personality disorder)
- Chronic physical illness (neurological is the biggest one)
- Unemployment
- Substance abuse
- Lack of social support
- Being unmarried (if male)
What are the essential components to a psych risk assessment?
- Psych exam/MSE
- Followed by a specific suicide enquiry
- Risk factors (dynamic vs static, modifiable vs fixed)
- Ask about protective factors
What are the key questions to ask someone post suicide attempt?
- Background (medical Hx, psych Hx)
- Triggers
- Preparation (was it spontaneous or did they plan it out for weeks, were there any final acts)
- Circumstances (were they alone, did they take any precautions against discovery, what did they do)
- How did they feel after the act (did they seek help, do they regret failure)
- Broader history (look for depression, psychosis, chronic health conditions that might push someone to suicide)
- How are they feeling now (regret, plans, intentions to try again)
When do you admit someone post-suicide attempt?
Only if there is serious concern they might attempt again.
