Symposium 1 - Hx taking and MSE Flashcards by caitlin stewart

What are the two main components of psychiatric history taking?

Collection of clinical data

Intuitive understanding of patient (empathy, descriptive psychopathology)

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List important factors for the setting of a psychiatric exam.

Privacy
Avoid interruptions 
Easy exit 
Informal setting 
Avoid barriers
Respect personal space

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When would a past psychiatric history be taken in a history?

Before past medical and after HPC

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Along with psychiatric history, what else is added to a normal history?

Personal history

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What is included in a personal history?

Developmental milestones
Schooling/education 
Occupational history 
Relationships 
Pre-morbid personality

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What is a formal and informal patient?

Informal - there on own behalf i.e voluntary

Formal - not on own behalf i.e involuntary

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How can you ask about psychotic symptoms?

“Have you seen or heard anything that other people are not aware of?”

“Have you heard anyone talking when there was nobody there?”

“What do you this is causing them?”

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What do you want to know about past psychiatric history?

Past episodes/diagnoses/contact s
Previous Rx
Inter-episode functioning 
Previous hospital admissions
Attempted suicide/repeated DSH
Previous detentions

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What is important of a family history in a psychiatric exam?

Age, employment, circumstances, health problems, quality of relationship

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What do you want to know about with regards to social history?

Employment 
Current financial situation 
Stressors
Alcohol/drugs/smoking 
Relationships
Children

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What will you ask about in relation to drugs/alcohol?

Regular/intermittent, amount, pattern, dependence, withdrawal symptoms, impact on work/relationships/money/police

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What do you want to know with regards to forensic history?

Contact with police
Offences
Recidivism
Violent and sexual crimes

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What is pre-morbid personality?

Emphasis on consistent patterns of behaviour, interaction, mood.

“How would your best friend describe you?”

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What are the 10 points to consider in a mental state examination?

Appearance
Behaviour
Beliefs
Cognitive function
Insight
Mood
Percepts
Speech
Suicide
Thoughts

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What do you consider with regards to appearance?

Height/build
Clothing
Personal hygiene
Make-up/jewellery

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What do you consider with regards to behaviour?

Greeting
Non-verbal cues
gesturing 
Abnormal movements 
Cooperative
Rapport

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What do you consider with regards to mood?

Eye contact
Affect
Mood rating
Psychomotor unction - retarded agitation

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What do you consider with regards to speech?

Spontaneity
Volume
Rate
Rhythm 
Tone
Dysarthia
Dysphasia

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What do you consider with regards to abnormal thoughts ?

Phobias
Obsessions
Flight of ideas
Formal thought disorders

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What is formal thought disorder and what is it associated with abnormal thoughts?

Schizophrenia

Broadcast, echo, insertion, block, withdrawal

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What is delusional belief/intensity?

Unshakeable/fixed/can’t be persuaded from it

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What is formal thought disorder and what is it associated with abnormal percepts?

Illusions
Hallucinations
Auditory/visual/somatic/olfactory/gustatory domains

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What is formal thought disorder and what is it associated with suicide/homicide?

Suicidal thoughts
Ideation
Intent
Plans

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How do you assess cognitive function?

Orientation (time, place person)
Attention/concentration
Short term memory

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If concerns about cognitive function, what detailed assessments are available?

MSQ, MMSE, MOCA, FAS, Clock drawing, executive function tests

What 3 questions would you ask a patient with regards to insight?

1. Are symptoms due to illness? 2. Is this mental illness? 3. Do they agree with treatment/Mx plan?

Patient J is an informal (voluntary) emergency admission from GP with sever depression, suicidal ideation and alcohol misuse. List 3 areas to be explored in HPC.

Mood problem; depression Suicidal thinking Alcohol

What psychiatric symptoms are associated with hypothyroid and hyperthyroid?

Hyper = manic symptoms Hypo = psuedodepression

What is psychopathology?

Symptoms and signs you are finding

What is descriptive psychopathology?

Describes and categorises the abnormal experience as described by the patient

What is phenomenology?

Observation and understanding of psychological event or phenomenon so the observer knows as much as possible how patient feels.

What is SCAN used in a present sate examination?

Schedules for Clinical Assessment in Neuropsychiatry

What should you think about if visual symptoms?

Organic causes

What should risk assessments include in a mental state examination?

Suicide/homicide

When should you do a mental state examination?

During history taking

What does responding to unseen stimuli suggest?

Hallucinations

What is catatonia?

Abnormality of movement and behaviour arising from a disturbed mental state. It may involve repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism. ``` Forced grasping Waxy flaccidity Opposition Increased resistance Negativism including eversion ```

What treatment is given for catatonia?

Benzodiazepines

What is monosyllabic responses and whispers almost diagnostic of?

depression

What is mood?

Subjective patient's account

What is affect?

How emotion conveys normally e.g anxiety, anger, euphoria

Loose thoughts is linked to what?

Manic

What 4 sections can be associated with thinking?

1. Speed and tempo of thoughts 2. Types of thoughts demonstrated 3. Linkage and thought form 4. Possession of thoughts

What thinking speed would you see in severe depression?

Psychomotor retardation p decreased sleep

What are potential causes of slowing thought with limited content termed "poverty" of thought?

Schizophrenia | Dementia

List different types of thoughts displayed at MSE?

``` Preoccupations Phobias Obsessions Delusions Overvalued ideas ```

What is the difference between primary and secondary delusions?

Primary delusions arise from disorders e.g being pursued by CIA Secondary delusions = Comes out of something e.g someone speaking to you in the car and you begin to decide they have inserted a chip in your ear.

What is a delusion?

"Unshakeable idea or belief which is out of keeping with person's social and cultural background; it is held with extraordinary conviction."

Give examples of delusions.

Grandiose Paranoid Hypochondriacal Self referential

A patient presents with delusional perception. What is this and what is it a sign of?

Real perception then sudden delusional belief Sign of schizophrenia

What is Nihilistic delusion?

Guilt, rotting, being dead - everything is terrible

Give an example of a persecutory delusion screening questioning?

Is anyone deliberately trying to harm you?

How do you differentiate partial or full delusions?

Ask "even when you seem to be most convinced, do you really feel in the back of your mind that it may not be true?"

How is a formal thought disorder described specifically?

``` Thought blocking Fusion Loosening associations Tangential thinking Derailment of thought or knights move thinking ```

What abnormal possession of thoughts is associated with schizophrenia?

Thought blocking, thought insertion and withdrawal, thought broadcasting

List three classes of perceptual disturbance?

Hallucinations Pseudohallucinations Illusions

What is the difference between illusion and hallucinations?

Illusion = perception in presence of stimulus misperceived Hallucinations = perception in absence of stimulus, not willed or controlled

What senses can hallucinations occur in?

Auditory or visual Tactile Olfactory and gustatory

What is the difference between hypnopompic and hypnagogic?

Hypnopompic on awakening Hypnagogic before falling asleep

How can you test short term memory?

name 3 objects or name and address

How can you test long term history?

Personal history

List objective tests.

``` MSQ MOCA MMSE FAS Clock drawing Executive function tests ```

Would you give someone a dementia diagnosed if you think they are depressed?

NO Treat depression first

What three questions can indicate place on the spectrum of insight?

1. Do you think you are ill? 2. If you are ill is it a mental illness? 3. If you are ill and it is a mental illness do you agree broadly with the current treatment plan?

What does 'formulating the case' mean?

Allows consideration of the diagnosis in the context of the individual's particular personal and medical history Organic, social and psychological factors are assessed as either predisposing, precipitating or perpetuating factors

Symposium 1 - Hx taking and MSE Flashcards

(65 cards)