History and MSE

Question 1

Order of history

Answer 1

PC

HPC

Past psychiatric history

Past medical history

Medication history

Personal history

• birth and early development
• family background and early childhood
• education
• occupation
• psychosexual/relationships

Substance use

• alcohol
• soking
• other substances

Forensic history

Premorbid personality

Social history

Collateral history

Question 2

Order of MSE

Answer 2

Appearance and behaviour

Speech

Mood

Thought

Perception

Cognition

Insight

Question 3

Movement vocab (MSE)

Answer 3

Akathisia

Parkinsonism (shuffling gait, pill rolling hand tremor, slowed movements, rigidity)

Mannerisms, stereotypies, tics, compulsions

Catatonia

Question 4

Speech definitions vocab (MSE)

Answer 4

Rate, tone, volume, flow, rhythm

Pressure of speech, poverty of thought, thought block

Circumstantial, flight of ideas (understandable still), derailment

clanging, punning, neologisms

dysarthria, dysphasia

Question 5

Mood (2 types)

Answer 5

Subjective

Objective = low, elated, irritable anxious, LABILE, FLATTENED/BLUNTED

Affect is incongruent if the perosn’s report doesn’t match their presentation

normal = ‘reactive and euthymic’

Question 6

Thought: types of delusions

Answer 6

primary delusions are rare

secondary delusions = follow another symptoms (e.g. altered mood, hallucination)

systematised delusions = delusions grow and build on each other, into an elaborate delusional system

partial delusions

overvalued ideas

Question 7

obsessions vs compulsions: Under appearance and behavior

Answer 7

obsessions = recurrent, unwanted intrusive thoguths, images, or impulses which enter the person’s mind despire attempts to resist them

• not a delusions as deep down the thought is known to be irrational

compulsions = repeated, stereotyped, superficially purposeful rituals that the person feels compelled to perform. Can be actions or thoughts

do thoughts keep coming into your head, even though you try to block them out?

some people have tiruals they need to do in a specific way. Do you do anything like that?

Question 8

Perception: illusions and hallucinations

Answer 8

illusion = mispereception of a real, external stimulus

hallucinations = perception in the absence of an external stimulus

Question 9

types of hallucinations

Answer 9

Auditory

• first person, second person, third person (schizophrenia)
• schizophrenia = discuss/argue about the person give a running commentary of their actions, or say their thoughts aloud (thought echo)
• most common in psychosis

Visual

• associated with organic conditions (e.g. delirium and dementia)

Touch

• tactile
• deep

Olfactory

Gustatory

Hypnopompic/hypnagogic hallucinations or following bereavment (temporary hallucinations)

Question 10

perception: depersonalisation and derealisation

Answer 10

depersonalisation = the person feels unreal, detached, numb or emotionally distant

derealisation = the world feels undreal e.g. like a film set

Question 11

Cognition

Answer 11

thinking and remembering

• TIME AND PLACE AND PERSON
• orientation, attention, concentration, language, memory
• MACE, MMSE

Question 12

Insight

Answer 12

awareness that others are concerned by their sx and behaviour

agreement that there is a problem

recognition of mental health problems

awareness that symptoms require treatment

Question 13

Factors influencing risk

Answer 13

Question 14

Biopsychosocial and PPP for depression

Answer 14

Question 15

Management of depression BPS + immediate, medium and long term

Answer 15

Question 16

BPAD BPS and PPP (aetiology)

Answer 16

Question 17

BPAD BPS and Immediate, Medium and Long Term (management)

Answer 17

Question 18

Structure of formulation

Answer 18

background information: name, age, occupation, ethnicity, marital statu s

summary of current episode

relevant history

examination

• salient features of MSE
• important physical findings, e.g. hemiparesis, jaundice