Mental state examination and psychiatric assessment Flashcards
(79 cards)
1
Q
A&B - looking for? (9)
A
Age / ethinicity Clothes and accessories Self care and hygiene Evidence of self harm Eye contact Posture Facial expression Psychomotor - retardation / agitation Ability to establish a rapport
2
Q
3 aspects to affect
A
Quality
Range
Intensity
3
Q
Speech 3 parts
A
Rate, Volume and tone
4
Q
Thought form 2 parts
A
Speed and flow / coherence
5
Q
Circumstantial thought form =
A
get to the point but takes a while
6
Q
Tangential =
A
flight of ideas with little connection
7
Q
Thought content, what things to look out for? (5)
A
Delusions / abnormal beliefs Obsessions Over valued ideas Suicidal thoughts Homicidal / violent thoughts
8
Q
Two aspects to abnormal perceptions
A
subjective and objective
9
Q
types of hallucinations (4)
A
Auditory
Visual
Tactile
Olfactory / gustatory
10
Q
Risk assessment section
A
Harm to self
Harm to others
Vulnerability
11
Q
Quantify the risk in 3 ways
A
How iminent?
How likely?
Severity
12
Q
What to screen for in a psychiatric history?
A
- low mood
- elevated mood and increased energy
- dellusions and hallucinations
- anxiety
- obsessions / compulsions
13
Q
3 important points for PMH?
A
Head injury / surgery
Neuroconditions
Endocrine abnormalities
14
Q
How long does generalised anxiety have to last for a formal diagnosis?
A
For at least 6m around a range of events / activities
15
Q
Physical causes to exclude in anxiety
A
Hypertension
Angina
Asthma
Excessive caffeine
16
Q
How long should benzodiazepines be used in generalised anxiety?
A
2-4 weeks
17
Q
First line medication in generalised anxiety?
A
SSRIs
18
Q
3 core symptoms of depression
A
Low mood
Loss of interest / pleasure
Fatiguability
19
Q
5 biological symptoms of depression
A
Early morning waking Depression worse in the morning Marked loss of appetite Psychomotor retardation / agitation loss of libido
20
Q
5 cognitive symptoms of depression
A
Reduced concentration / memory Poor self esteem Guilt Hopelessness Suicidal thoughts / self harm
21
Q
Minimum duration of depression for a diagnosis?
A
2 weeks
22
Q
How many core symptoms needed for a diagnosis of depression?
A
2
23
Q
ICD - 10 scoring for depressive disorder
A
Mild - 4
Moderate - 5-6
Severe - 7+
24
Q
7 non core symptoms of depression
A
Disturbed sleep Poor concentration / decisiveness Low self confidence Poor / increased appetite Suicidal thoughts / acts Agitation or slowing of movement Guilt or self blame
25
diagnosis of a major depressive disorder requires what from a DSM-5
5< over a two week period with at least one of
1) depressed mood
2) diminished interest or pleasure
26
Definition of schizoaffective disorder?
Mood symptoms + schizophrenic symptoms in the same episode
27
Neurological conditions involving depression (2)
MS and Parkinsons
28
3 endocrine conditions that can manifest like depression
HypoT
Cushings
Addisons
29
Infections causing secondary depression (2)
HIV and hepatitis
30
First line for mild depression
CBT
31
First line for moderate to severe depression
CBT and SSRIs
32
5 aspects to psychotic psychopathology
```
Perception
Abnormal beliefs
Thought disorder
-ve symptoms
Psychomotor functions
```
33
A delusion is false because of...
False reasoning
34
Neologisms =
New words created by the patient
35
8 negative symptoms of schizophrenia
```
Apathy
Absent / blunted
Decrease in speech
Social withdrawl
Impaired attention
Anhedonia
Sexual problems
Lethargy
```
36
Key differentials in psychosis (7)
```
Schizophrenia/ Schizoaffective
Secondary to mood disorder
Secondary to medical conditions
Secondary to psychoactive substance use
Delirium / dementia
Personality disorder
Neurodevelopmental disorder
```
37
Medical conditions associated with psychosis
```
Cerebral neoplasm
Infarcts
Trauma
Infection
Endocrine
SLE
HyperT
HyperCa2+
```
38
What needs to be ruled out in psychosis?
Substance abuse
39
Neuroleptic malignant syndrome characterised by?
```
Altered mental state
Increased muscle tone / frank rigidity
Alterations in autonomic NS
Hyperthermia
Hyperactivity
```
40
How to reverse the effects of neuroleptic malignant syndrome?
Use dopamine agonists
41
Levels of the pyramid of differentials for psychiatry
1) organic disorders
2) psychotic disorders
3) mood disorders
4) anxiety disorders
5) personality disorders
42
4 L's of harmful substance abuse
Love
Livelihood
Liver
Law
43
3 elements of substance dependence
Physiological
Behavioural
Psychological
44
6 signs of dependence syndrome
```
Strong compulsion to take
Lack of control
Physiological withdrawl
Signs of tolerance
Neglect of other interests
Persistance with substance use
```
45
Units =
ABV x Vol
46
Mean time taken for delirium after alcohol withdrawl?
48hrs
47
3 characteristics of wernicke's encephalopathy
Delirium, opthalmopelgia and ataxia
48
How to treat wernicke's encephalopathy
Parenteral thiamine
49
CAGE questionnaire
Ever thought about cutting down?
Have people ever annoyed you by criticising your drinking?
Have you ever felt guilty about your drinking?
Ever needed an eye opener?
50
3 key parts to the history in suspected personality disorder
Source of distress
Co-morbid mental illness
Specific impairment
51
3 types of drugs used in personality disorder
SSRIs
Mood stabalisers
Benzodiazepines
52
Preferred psychological therapy
Direct behavioural therapy
53
4 types of schizophrenia?
Paranoid
Hebephrenic
Catatonic
Residual
54
6 sections to MMSE
```
Orientation
Registration
Attention
Recall
Language
Copying
```
55
Reversibe causes of confusion (5)
```
VitB12 / folate deficiency
TSH
Calcium
Cushings
Addisons
```
56
Where should someone with suspected dementia be sent?
Memory clinic
57
Above what score of the MMSE can cholinesterase inhibitors be used?
10
58
3 cholinesterase inhibitors used in dementia
Donepezil
Rivastigmine
Galantamine
59
When are NMDA receptor antagonists recommended?
1) moderate to severe dementia
| 2) ACh inhibitors not tolerated
60
example of an NMDA receptor antagonist used in dementia?
Memantine
61
Anxiolytic recommended in dementia?
What should be avoided?
Trazdone
Benzodiazepine
62
Complete contraindication for those with Lewy body dementia and why?
Antipsychotics
- 50% have catastrophic results
- precipitates potentially irreversible Parkinsonism
- impaired consciousness, severe autonomic symptoms
- 2-3x increase in mortality
63
Average survival from diagnosis in dementia
4 yrs
64
3 types of dementia and their examples
1) Cortical
- Alzheimers
- Frontotemporal dementia
2) Subcortical dementia
- Parkinsons
- Lewybody
- Huntingtons
- HIV related
3) Mixed
- vascular
- infection induced
65
Early onset dementia defined as
Before 65
66
Molecules involved in alzheimers
Tau protein and Beta amyloid
67
4 risk factors for alzheimers
genetic
vascular
head injury
low educational attainment
68
pathology of vascular dementia
death of neurones due to blood flow disruption
69
Symptoms of lewy body dementia a combo of .....
Alzheimers and Parkinsons disease
70
secondary prevention of risk factors in vascular dementia (2)
stop smoking
| aspirin / clopidogrel
71
Section 2 of the MHA =
admission for assessment - 28 days
72
Section 3 of MHA =
admission for treatment - 6m
73
to put a section 2/3 in place you need 2 doctors one of which needs to be...
section 12 approved
74
Section 4 =
emergency admission for assessment - 72hrs
| no time to wait for a section 2
75
Section 17 =
community treatment order
76
Section 17 =
community treatment order
pt liable to a section 3 order
supervised treatment in the community
must obey the conditions set on them - or can be recalled into hospital.
77
Presenting back risk
Risk to self, others and risk of neglect
short term
medium term
long term
78
Long term risk assessment
Biological - drugs / alcohol / medication
Social - their social situation
Psychological - their state of mind and how you can support them
79
how long does lithium take for patients to feel the full benefit?
6-12m
