History and MSE✅ Flashcards
(28 cards)
Psych History
- Structure
Psych History
- Structure
- HPC
- risk
- Past psych
- PMH
- DHx
- FHx
- Personal Hx
- Childhood, education, occupation
- Sexual development, relationships
- Substances
- Forensic - social history
- Pre-morbid personality
- MSE
Psych Hx PC
- NOTEPAD
Psych Hx PC
- nature
- onset
- triggers
- exacerbating/relieving factors
- progression
- associated symptoms
- disability
Psych Hx
- past psychiatric history
- existing psychiatric diagnosis
1. when?, details? relapse? - previous treatments
1. effectiveness? - past contact with mental health services
1. primary care, community health team, crisis team/home treatment?
2. community psychiatric nurse or care coordinator?
3. previous admissions
1. number of admissions
2. dates
3. informal or under section
4. PICU?
Psych Hx
- Personal History
Psych Hx
- Personal History
- Infancy and early childhood
- Adolescence and education
- Occupational record
- Sexual development/relationships
- Forensic Hx
Psych Hx
- social Hx
- living circumstances
- where they live?
- do they live with anyone else?
- any children at home?
- homeless? - risk for mental health problems
- activities of daily living
- how are they coping?
- can they look after themselves?
- do they have any worries?
diet, personal hygiene, housework, financial concerns
- smoking
- alcohol
- recreational drugs
Personality history
- distinguishing question
Personality history
- Helpful question
- How do you deal with stress
Mental health history
- risk assessment
Risk to self:
1. Current suicidal thoughts
2. current self harm thoughts
2. Past suicidal thoughts/ attempts
4. Plans of suicide/self harm
Risk to others:
1. “ever felt like hurting other people”
2. anyone in particular
Risk from other:
1. Is the patient vulnerable/ at risk from anyone?
Mental state exam
- Sections
Mental state exam
- Sections
- Appearance and behaviour
- Speech
- Mood and affect
- thought
- perceptions
- cognition
- Insight and judgement
- Risk
MSE
- Appearance and behaviour
MSE
- Appearance and behaviour
- Clothing/kemptness
- Eye contact
- Appropriate
- Sustained, intense
- Reduced, avoidant - Rapport
- Psychomotor
- Agitation/retardation - Distraction
MSE
- Speech
- rate - pressured/slow
- quantity of speech - poverty of speech, excessive speech
- tone of speech - monotonous/tremulous
- volume of speech - quiet/loud
- fluency and rhythm of speech - stammering, stuttering, slurred, stilted (thought block)
What is the difference between mood and affect?
affect → immediately expressed and observed emotion
mood → patients predominant subjective internal state at any one time as described by them
affect is what you observe and mood is what the patient tells you
Examples of mood
- low mood
- anxious
- angry
- enraged
- euphoric
- guilty
- apathetic -> lack of interest or emotion
- anhedonia -> inability to experience pleasure
- avolition -> lack of motivation
- euthymia -> normal and neutral mood, not low or elevated
Affect
- examples
- sadness
- anger
- hostility
- euphoria
Affect
- range and mobility
- fixed - same throughout the interview
- restricted affect - doesn’t demonstrate the normal range of emotional expressions expected
- labile - exaggerated changes in emotions, may or may not relate to emotional triggers. no control over their emotions
intensity of affect
- heightened
- blunted or flat
congruency of affect
patients affect appears in keeping with the content of their thoughts
Thought form
- 2 types
- examples
- speed of though (fast/slow)
- flow and coherence
1. loose association
2. circumstantial thoughts
3. tangential thought
4. flight of ideas
5. thought blocking
6. perseveration
7. neologism
8. word salad
thought content
- delusions
- obsessions
- compulsions
- overvalued ideas
- suicidal thoughtd
- homocidal/violent thoughts
Thought possession
- 3 types
- thought insertion - belief that thoughts can be inserted into the patients mind
- thought withdrawal - belief that thoughts can be removed from the patients mind
- thought broadcasting - belief that others can hear the patients thoughts
Perception
- 5 types
- Hallucinations - sensory perception without external stimulation
- Illusions
- eg. dog bark sounds like speech - Pseudo-hallucinations
- Patient knows they aren’t real - Depersonalisation - feel they’re not their true self
- derealisation - sense the world around them is not true reality
MSE
- Cognitive function
MSE
- Cognitive function
- Oriented to time, place, person
- Further testing
- MMSE
- ACE etc.
MSE - Insight
- Two questions
MSE - Insight
- Two questions
- Belief in illness
- Acceptance of treatment
Hallucination
- Modalities
Hallucination
- Modalities
- Auditory
- Visual
- Olfactory
- Tactile
- Gustatory
Delusion
- Types
Delusion
- Types
- Persecutory
- Nihilistic - believe they’re dead
- Guilt - believe they’ve done something
- Grandiose
- Reference
- external world relates to them
