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Mental state exam SCP2 and NSB Flashcards

1
Q

What are the key structures for psychiatric assessments

A

psychiatric history and mental state examination

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2
Q

Key differences between psychiatric hx and medical hx?

A

Time - psych is much longer
no definitive tests
multiple meetings before diagnosis

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3
Q

What sort of relationship is formed between HCP and patient in psychiatric interviewing?

A

Therapeutic relationship, based on strong comms and interpersonal skills.

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4
Q

What key communication/interpersonal attributes are needed for effective interview

A

-Open, friendly, non-judgemental
-respect autonomy
-sensitive (verbal and non-verbal cues)
-Expressing confidence/calmness

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5
Q

Preparing for interview - SSS?

A

Space (privacy)
Setting (seats, layout, tissues)
Safety (alarm, seat near door)

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6
Q

How to start the interview?

A

Introductions
Establish mode of address etc.
ID (think paranoia)
Explain purpose and duration

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7
Q

What are the components of the psychiatric interview? (flexible)
P
H
P
P
M
F
P
S
P
D
F

A

Presenting problem
History of presenting problem
Past psychiatric history
Past medical history
Medication
Family history
Personal history
Social circumstances
Premorbid personality
Drug and alcohol history
Forensic history

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8
Q

Hx of presenting problem

A

What are they here?
What happened
How did they arrive
What are they expecting

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9
Q

What needs screening?

A

Psychosis
Depression
Anxiety
Mania
Suicide risk (don’t be falsely reassured)

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10
Q

Hx presenting problem

A

Nature
Time of onset
Precipitating factors
Development over time
Ameliorating/excacerbating/perpetuating factors
What have they already tried/who have they seen?

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11
Q

Past psychiatric hx

A

Dates and symptoms
Treatments and effectiveness
Admissions and duration (mental health section?) Hx of self-harm or suicide?

Is it new or a recurrence of previous issue and does pt agree?

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12
Q

What legal framework for detention can pt be held under? how long

A

up to 28 days under Section 2 of the Mental Health Act (for diagnosis)

up to 6 months under Section 3 of the Mental Health Act, with further renewals

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13
Q

Past medical hx

A

Operations and admissions to hospital

Chronic Disease

Head Injury

Current or recent illness

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14
Q

Medications

A

Allergies and sensitivities

Current regular medications (Adherence &Duration)

Current ‘as required’ PRN medications (e.g. st johns)
How often used?

Over-the-counter medications

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15
Q

Family Hx

A

-Who makes up the family (parents, siblings)
-Relationships with all family members
-Social circumstances during development
-Are they alive – if deceased, reaction to death?

-Family Medical History
-Family Psychiatric History
Especially: Depression Anxiety Psychosis Suicide Dementia

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16
Q

Personal hx

A

Early life/development
Education
Occupation
Adult relationships

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17
Q

Early life and development:

A

Pregnancy, birth and early development
Serious illnesses, developmental delays, bereavements, separations
Describe childhood environment (Deprivation, neglect?)

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18
Q

Educational history:

A

Schools.
Academic achievements.
Friendships?
Problems? (Bullying, problematic conduct?)

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19
Q

Occupation history:

A

Jobs types
Duration, reasons for change
Job satisfaction
Relationships with colleagues

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20
Q

Adult relationship history:

A

Psychosexual history, including sexual orientation and any difficulties
Partner(s)
Any children

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21
Q

Social circumstances

A

Current description of:
Accommodation
Work
Finances
Social support and contact
Spiritual or religious beliefs
Driving
Daily activities

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22
Q

What does Premorbid personality mean?

A

“How would your friends and family describe you before this happened”

Temperament
Abilities to form relationships + friendships
Attitudes
Character
Interests
Spiritual beliefs

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23
Q

What can you ask regarding drug an alcohol hx?

A

Alcohol and tobacco

Illicit or misused substances
What?
When?
Why?
Amount?
How?
Pattern of use?
Dependence?

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24
Q

What is included in a forensic hx?

A

Arrests
Charges
Convictions
Imprisonments – Duration and index offence.

Violence, weapons?
Probation
Current or pending issues with the Criminal Justice System?

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25
Q

How long are a risk assessment and a MSE valid for?

A

They are just snap shots of the “here and now” and liable to change -
Also tracking to see how the pt is improving or deteriorating

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26
Q

Risk assessment could cover:

A

Risks to Self/others (Suicide/violence/abuse/exploitation)
Substances
Fire
Falls

27
Q

What is MSE?

A

Mental state examination is a framework and structure for our natural observations

28
Q

what topics should be covered within MSE?

A

Appearance and behaviour
Speech
Mood and Affect
Thoughts – Form + Content
Perception
Cognition
Insight

29
Q

How do you assess appearance and behaviour?

A

Describe the patient so that someone else could recognise them.
Think
Appearance, behaviour, movement

30
Q

Behaviours that could be covered

A

Eye contact or gaze avoidance
Manner towards interviewer (Intimidating, over-familiar)
Rapport/Guarded
Facial expression
Excessive movements (Restless/distressed/agitated)
Decreased movements (psychomotor retardation/stupor)

31
Q

define tremor

A

involuntary rhythmic shaking movement in one or more parts of your body.

32
Q

what’s akathisia

A

internal restlessness

33
Q

what is tardive dyskinesia

A

involuntary repetitive movements often peri-oral

34
Q

what’s dystonia

A

muscular spasm of face or body movement/posture

35
Q

what are tics

A

sudden, repetitive, non-rhythmic movement or vocalization

36
Q

what is chorea

A

repetitive movements of whole limbs, sinusoidal

37
Q

What mannerisms could a patient display

A

repetitive, voluntary, purposeful movements

38
Q

What aspects of speech should be considered?

A

Rate

Volume

Pressure of Speech (Seen in mania-Fast, constant, hard to interrupt)

39
Q

What is “euthymic”?

A

normal mood

40
Q

what is mood vs affect?

A

Mood like “climate” - the general situation
Affect is like weather - storms blowing in and out

41
Q

Give some examples of Affect

A

Brief emotional state
Reactive/unreactive
Labile
Flattened
Perplexed
Irritable
Incongruous

42
Q

What is “dysthymic”?

A

also known as persistent depressive disorder (PDD)
as opposed to elated (ectstatic happiness)

43
Q

How could you ask about mood? (depressed v elevated)

A

Have you been feeling low and tearful?
Do you still enjoy the things you used to?
1-10 can be useful
Do you feel hopeful for the future?
How are your spirits?
Have you felt very cheerful or confident?
Do you have more energy and less need for sleep?
Are your thoughts racing?
Have you done anything you wouldn’t usually do?

44
Q

What biological considerations should be considered as possible links to altered mood?

A

Appetite
Weight Loss
Sleep
Libido
Concentration

45
Q

What biological considerations should be considered as possible links to altered mood?

A

Appetite
Weight Loss
Sleep
Libido
Concentration

46
Q

Thoughts:
What are stream/form/content?

A

Stream: How thoughts are flowing – a deluge or a trickle?

Form: The way that thoughts are expressed

Content: What the patient is thinking (saying)

47
Q

what is a delusion

A

“Deeply held, unshakable beliefs, out of keeping with social, cultural, religious and educational norms”

Linked with psychosis

48
Q

what is a delusion

A

“Deeply held, unshakable beliefs, out of keeping with social, cultural, religious and educational norms”

Linked with psychosis E.g. in schizophrenia, mania, depression, delirium, dementia

49
Q

What could you ask about delusions?

A

Do you feel under threat?
How do you know this to be true?
Could there be an alternative explanation?

Do you have experiences that you find hard to explain?
Do you feel that others are out to harm you?

Do you feel under control by anything?
Do you have any special powers?
Does anything have a special meaning for you?

50
Q

what is an overvalued idea?

A

type of delusion

Solitary abnormal belief preoccupies the person
Dominates experience and behaviour

50
Q

what is an overvalued idea?

A

type of delusion

Solitary abnormal belief preoccupies the person
Dominates experience and behaviour

51
Q

what is an Obsessional thought?

A

type of delusion

Repetitive thought, recognised as a product of their own mind
Recurs despite resistance, often distressing

52
Q

what is suicidal ideation?

A

Passive suicidal thoughts (ideation)
may also have Intent & Plans

53
Q

What is an illusion?

A

A “sensory deception” in response to a stimulus

A combination of the perception of an external object and a mental image to produce a false perception

Associated with anxiety, delirium, intoxication with drugs

54
Q

How is a hallucination different to an illusion?

A

A perception in the absence of a stimulus (illusion requires a stimulus that is mis-precieved)

55
Q

When do hallucinations happen?

A

Schizophrenia and psychotic disorders
Severe depression or mania

Organic brain conditions
Dementias, delirium, epilepsy, encephalitis

56
Q

5 types of illusions are…

A

Sensory Modality
Auditory
Visual
Olfactory
Gustatory
Tactile

57
Q

how could you ask about hallucinations in an open way?

A

Have you had any unusual experiences?
Things other people cannot see or hear?

58
Q

What are 4 aspects of cognition?

A

Attention
Concentration
Orientation
Short and long term memory

59
Q

what are three aspects of cognition- orientation

A

Time
Place
Person

60
Q

how could you determine if someone is cognitively impaired?

A

Brief cognitive test if appropriate

61
Q

What does “insight” mean when a patient is being assessed?

A

Whether they are self-aware about being unwell and needing treatment or do not accept..
can be partial

62
Q

What are the 5 P’s?

A

Presenting problem
pre-disposing factors
protective factors
perpetuating factors
precipitating factors

NSB (10 decks)

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