Week 4.1.1: The Clinical Assessment Flashcards
A snapshot of the patient’s current mental state, including their appearance, behavior, mood, thoughts, perceptions, cognition, and insight.
Purpose: Assesses how the patient is doing at the moment of the examination.
Mental State Examination (MSE)
The patient’s personal story, including their difficulties, life context, and how they arrived at the current situation.
Purpose: Provides background information and helps understand the patient’s journey.
Patient’s History
Aggressive or unfriendly behavior.
Hostility
Irrational and persistent feeling of being persecuted.
Paranoia
Perceptions in the absence of external stimuli (e.g., hearing voices).
Hallucinations
False beliefs held despite evidence to the contrary.
Delusions
Information obtained from third-party sources such as clinical notes, family members, general practitioners, or other clinicians.
Confidentiality: Must consider whether access to this information is permissible with or without the patient’s consent.
Purpose: Provides additional context and verifies the patient’s history and current state.
Collateral Information
Physical examination and investigations like blood tests.
Purpose: Ensures there are no physical health issues contributing to the patient’s mental state.
Physical Investigation
How can we identify the patient’s condition based on the gathered information?
Can be diagnosis-based (specific mental health condition) or formulation-based (holistic understanding of the patient’s situation).
The principle of keeping patient information private and only sharing it with consent or when legally required.
Confidentiality
A detailed understanding of the patient’s issues, considering psychological, social, and biological factors.
Formulation
When a patient leaves a hospital or care facility without permission, potentially putting themselves at risk.
Abscond
The main issue or symptom that brought the patient to seek help.
Purpose: Identifies the primary reason for the current visit.
Presenting Complaint
Detailed account of the current issues, including why the patient is seeking help now.
History of Presenting Complaints
Record of previous mental health issues and treatments.
Purpose: Provides context and helps understand patterns and severity of past episodes.
Questions to Ask:
Number of episodes of mental ill health.
Duration of each episode.
Triggers and helpful interventions.
Types of treatment received (e.g., GP, community mental health team, hospital).
Past Psychiatric History
What are factors to consider in the history of presenting complaints of a patient?
Predisposing Factors
Precipitating Factors
Perpetuating Factors
Risks
Conditions or situations that make the patient more susceptible to mental health issues.
Predisposing Factors
Elements that maintain or worsen the mental health condition.
Perpetuating Factors
Events or triggers that lead to the onset of the current issues.
Precipitating Factors
Any immediate risks to self or others.
Risks
Record of previous physical health issues and treatments.
Purpose: Identifies any physical health conditions that might impact mental health.
Past Medical History
Information about mental and physical health issues in the patient’s family.
Purpose: Identifies genetic or familial patterns that might affect the patient’s health.
Family History
Information about the patient’s social, occupational, and personal life.
Purpose: Provides context about the patient’s environment and support systems.
Psychosocial History
The study of mental disorders and abnormal behaviors.
Psychopathology
What are the categories of Mental State Examinations (MSEs)?
- Appearance and Behavior
- Speech
- Mood
- Thoughts
- Perceptions
- Cognition
- Insight
- Risk
Definition: Observations about the patient’s physical appearance and behavior.
Examples: Grooming, clothing, eye contact, motor activity.
Appearance and Behavior
Definition: Characteristics of the patient’s speech.
Examples: Rate, volume, tone, fluency.
Speech
Definition: The content and process of the patient’s thoughts.
Examples: Delusions, coherence, speed of thoughts.
Thoughts
Definition: Sensory experiences and interpretations.
Examples: Hallucinations, illusions.
Perceptions
Definition: The patient’s sustained emotional state.
Examples: Depressed, anxious, euphoric.
Mood
Definition: The patient’s cognitive functions.
Examples: Orientation, memory, attention, executive function.
Cognition
Definition: The patient’s awareness and understanding of their condition.
Examples: Recognition of illness, understanding of treatment.
Insight
Definition: Assessment of potential risks to the patient or others.
Examples: Suicidal ideation, self-harm, aggression.
Risk
What is covered in a patient’s psychiatric history?
- Presenting Complaint
- History of Presenting Complaints
- Past Psychiatric History
- Past Medical History
- Medications
- Family History
- Psychosocial History
Definition: List of current and past medications.
Purpose: Understands the impact of medications on the patient’s mental and physical health.
Medications
What are the differences between the history and the mental state of the patient?
Length and Nature:
History: Static and detailed, covering the patient’s life story.
Mental State: Dynamic and brief, focusing on the current state.
Language Used:
History: Descriptive and narrative (e.g., “I’m being followed by MI5 and the FBI”).
Mental State: Clinical and diagnostic (e.g., “paranoid delusion”).
The subjective experience of mental health symptoms.
Phenomenology
Helps in accurately defining psychopathology (e.g., delusions).
Systematic Assessment
The presence of more than one disorder in the same person.
Co-morbidity
Beliefs that unrelated events or actions are directly related to oneself.
Ideas of Reference
