By Salina Chan, R3 2013. Components of an accurate psychiatric diagnosis 1.History – HPI and...
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Transcript of By Salina Chan, R3 2013. Components of an accurate psychiatric diagnosis 1.History – HPI and...
![Page 1: By Salina Chan, R3 2013. Components of an accurate psychiatric diagnosis 1.History – HPI and especially past psychiatric history 2.Collateral 3.Psychiatric.](https://reader035.fdocuments.in/reader035/viewer/2022070413/5697bfbb1a28abf838ca0d6b/html5/thumbnails/1.jpg)
By Salina Chan, R32013
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Psychiatric Diagnosis
Components of an accurate psychiatric diagnosis
1. History – HPI and especially past psychiatric history
2. Collateral
3. Psychiatric interview
4. Mental Status Exam
5. Biological workup
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What is the Mental Status Exam (MSE)?
The MSE is a set of standardized observations and questions designed to evaluate 5 basic elements:1. Sensorium2. Perception3. Thinking4. Feeling5. Behaviour
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What is the Mental Status Exam (MSE)?
Integral part of any clinical interview, not just in the psychiatric context
Records only observed behaviour, cognitive abilities and inner experience during the interview
Partly integrated into the history
To help provide info re: diagnosis, help formulate txn plan, and follow a patient’s clinical course
Essential to a complete psych assessment
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Helpful Determinants of
Diagnosis1. Reasons for referral
2. Previous personality/level of functioning
3. Thought disorder on the MSE
4. Previous psych d/o
5. Testing for organic conditions
6. Personality testing
7. Insight & judgment on MSE
8. Appearance & behaviour on MSE
9. Affect & mood on MSE
10. Physical Exam
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MSE Menomic
A = Appearance
S = Speech
E = Emotion
P = Perception
T = Thought form and thought content
I = Insight and judgment
C = Cognition
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50% of the MSE is FREE
Free Parameters
Level of Consciousness
Appearance
Behavior
Cooperation
Reliability
Affect
Thought form
Parameters to ask about
Orientation
Cognitive functions
Suicidal/homicidal thoughts
Knowledge base
Perception
Mood
Thought content
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A
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Appearance General appearance
Behaviour
Motor disturbances
Internal state
Cooperation, reliability, accessibility
For your exam: describe from outside then go inward
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Appearance Gender & Cultural background
Actual and apparent age
Attire
Grooming and hygiene
Body habitus
Physical abnormalities & assistive devices
Jewelry & cosmetics
Other notable Features
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Appearance 77 yo white Caucasian M who looked his
stated age, thin and tall, with neatly groomed beard, dressed casually and, walked with a cane and an antalgic gait
34 yo Asian female who looked younger than her stated age, average body size, dressed provocatively, wearing colourful makeup applied in excess, with a number of rings adorned on her fingers, with tattoo along the right side of her neck
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Behaviour General Observations
Activity level Habits &
mannerisms Psychomotor
agitation, restlessness or retardation
Specific Movement Abnormalties Akathisia Automatisms Catatonia Choreoathetoid
mvmts Compulsions Dystonia & EPS Tardive Dyskinesia Tremors Negative Symptoms
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Behaviour Pt sat comfortably in the room with his
arms folded across his chest and absent-mindedly figeted with the zipper of his jacket.
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Cooperation & Reliability
Eye Contact
Attitude/Demeanor
Attentiveness to the I/V
LOC
Affect
Secondary Gain
Malingering
Factitious d/o
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S
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Speech Primary language d/o
E.g. aphasia, dystarhria, anomia, apraxia
Quality of speech Accent, dialect,
amount (), articulation, modulation
Quantity of speech
Prosody Pitch/intonation/
musicality Spontaneity/latency Rhythm/cadence Stress/inflection
Volume
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E
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Mood & Affect
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Affect & Mood Mood
The person’s internal feeling state, subjective “emotional background”
Affect Visible, external, or objective manifestation of
emotional state “emotional foreground”
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Affect & MoodAffect
Type/Quality
Range/Variability
Degree/Intensity
Stability/Mobility
Appropriateness
Congruence
Mood
TypeQuality
Reactivty
Intensity
Stability/Duration
Pattern
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P
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Perception Hallucinations
Illusions
Disturbances of self & environment Depersonalization Derealization
Disturbances of experiences Deja vu Jamais vu
Disturbances of Quality of size Micropsia Macropsia Dysmegalopsia
Disturbances in intensity of perception Hyperacusis Visual
hyperaesthesia
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T
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Thought Form/Process
Describes the way in which ideas are produced and organized
An assessment of how patients are communicating Degree of connection b/t ideas Flow of thought
Assessed via speech, writing and behaviour
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Thought FormLogical and goal-oriented?
Tangential or Circumstantial?
Flight of Ideas?
Loosening of Associations?
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Designed to show thoughts of persecution
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Thought Content What the patient talks about
Delusions = fixed, false belief Lots of different ones!
Overvalued Idea = preoccupy patient’s thinking and alter behaviour Less firmly held – pt can admit not true Content less absurd & Not systematized
Obsessions = Thoughts/impulses/images that are recurrent, unwanted, not controllable, recognized as irrationa
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Thought Content Phobias = marked, persistent fears that are
excessive, with anxiety
Thoughts of suicide and homicide. Be direct and specific when asking Suicide assessment lecture
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I
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Insight & Judgment
Insight
Awareness of having illness
Understanding of factors contributing to illness
Appreciation that various signs and symptoms part of disease
Awareness of illness impacts on other ppl and society
Acknowledgment of need for txn
Judgment
1. Appraising the situation
2. Surveying the alternatives
3. Weighing the alternatives
4. Deliberating about selection
5. Making a commitment to a choice
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C
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Sensirium & Cognitive
LOC and attentiveness
Orientation x 3
Attention
Concentration
Memory
Knowledge
Intelligence
Capacity for abstract thinking
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Examples Catatonia:
http://www.youtube.com/watch?v=_s1lzxHRO4U&list=PLB917B13752F820BE&index=24
Pressured Speech: http://www.youtube.com/watch?v=F_YPZt7CuNY&list=PLB917B13752F820BE&index=16
Thought Block http://www.youtube.com/watch?v=0u9d96b-Tyc&list=PLB917B13752F820BE&in
dex=6
Delusion http://www.youtube.com/watch?
v=Gc2Nox6PMnc&list=PLB917B13752F820BE&index=7&ytsession=v_3GrpGVjj4SZQikefVmIwQM3XDixgmygOKTnNMFPF8U3b9mP0Rhpm8KNWmuRRAIEmGzO3q7MnFfwhhwSzSaCdwdRAh8Q6SOLbrnLYz55bdDdSrGVc_jA7k1q4MZ2MR2Z7YN4hYQII4EeeMYhFa99GHdynP62Qai9rNUAVjYpEXKIq83rtLJEFIjtc58SYPmJ0D9kHZEun5FZalQsGSw5woaoPvtU8FmcZnny-S3jfw_R_oVmcfHXY3Mmo7l0hTnPdBhubWfENumayfjnzJbX3LLF2OMVMUnfgbBSfsAy_PraWyJMcW-8t-fN_PVGCrHWdB8scm4ETqkDr1KgCg4gaP7czlWq_zh4tEX-IoFuIPYt06Szua9SxEC8-of_f0I97iQ9IOcU4Crv7tM5S7eNLSy4Xw2gBqn299ZtKhgv5DwWnay2eANL3fNxr5L3aaZS_VGX-3NyFA6PHZ-itMqjQLhgEYfMc4iwYRixaPjUrQRJoCtObxUCPxjv-s1oUtn2NsNzF0xx9n4BfSYEsKmpFrBA_UEdjZKt8-aZ6G-hXMdSwP0B-XqxBBL0Jq_GNcPaiJgX7focwLskatuUhXRNNkn-giq5JzJvsm2uZscogg