By Salina Chan, R3

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2013. Psychiatric Diagnosis. Components of an accurate psychiatric diagnosis. History – HPI and . especially. past psychiatric history. Collateral. Psychiatric interview. Mental Status Exam. Biological workup. ID: 624351 Download Presentation

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By Salina Chan, R3




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Presentations text content in By Salina Chan, R3

Slide1

By Salina Chan, R3

2013

Slide2

Psychiatric Diagnosis

Components of an accurate psychiatric diagnosis

History – HPI and

especially

past psychiatric history

Collateral

Psychiatric interview

Mental Status Exam

Biological workup

Slide3

What is the Mental Status Exam (MSE)?

The MSE is a set of standardized observations and questions designed to evaluate 5 basic elements:

Sensorium

Perception

Thinking

Feeling

Behaviour

Slide4

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

Slide5

Helpful Determinants of Diagnosis

Reasons for referralPrevious personality/level of functioningThought disorder on the MSEPrevious psych d/oTesting for organic conditions

Personality testing

Insight & judgment on MSE

Appearance & behaviour on MSE

Affect & mood on MSE

Physical Exam

Slide6

MSE Menomic

A = Appearance

S = Speech

E = Emotion

P = Perception

T = Thought form and thought content

I = Insight and judgment

C = Cognition

Slide7

50% of the MSE is FREE

Free Parameters

Level of ConsciousnessAppearanceBehaviorCooperationReliabilityAffectThought form

Parameters to ask about

Orientation

Cognitive functions

Suicidal/homicidal thoughts

Knowledge base

Perception

Mood

Thought content

Slide8

A

Slide9

Appearance

General appearance

Behaviour

Motor disturbances

Internal state

Cooperation, reliability, accessibility

For your exam: describe from outside then go inward

Slide10

Slide11

Appearance

Gender & Cultural background

Actual and apparent age

Attire

Grooming and hygiene

Body

habitus

Physical abnormalities & assistive devices

Jewelry & cosmetics

Other notable Features

Slide12

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

Slide13

Slide14

Behaviour

General ObservationsActivity levelHabits & mannerismsPsychomotor agitation, restlessness or retardation

Specific Movement

Abnormalties

Akathisia

Automatisms

Catatonia

Choreoathetoid

mvmts

Compulsions

Dystonia

& EPS

Tardive

Dyskinesia

Tremors

Negative Symptoms

Slide15

Behaviour

Pt sat comfortably in the room with his arms folded across his chest and absent-mindedly

figeted

with the zipper of his jacket.

Slide16

Slide17

Cooperation & Reliability

Eye Contact

Attitude/Demeanor

Attentiveness to the I/V

LOC

Affect

Secondary Gain

Malingering

Factitious

d/o

Slide18

S

Slide19

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Speech

Primary language d/oE.g. aphasia, dystarhria, anomia, apraxiaQuality of speechAccent, dialect, amount (), articulation, modulation Quantity of speech

Prosody

Pitch/intonation/musicality

Spontaneity/latency

Rhythm/cadence

Stress/inflection

Volume

Slide21

E

Slide22

Mood & Affect

Slide23

Affect & Mood

Mood

The person’s internal feeling state, subjective

“emotional background”

Affect

Visible, external, or objective manifestation of emotional state

“emotional foreground”

Slide24

Affect & Mood

Affect

Type/QualityRange/VariabilityDegree/IntensityStability/MobilityAppropriatenessCongruence

Mood

TypeQuality

Reactivty

Intensity

Stability/Duration

Pattern

Slide25

P

Slide26

Slide27

Perception

HallucinationsIllusionsDisturbances of self & environmentDepersonalizationDerealizationDisturbances of experiencesDeja vuJamais vu

Disturbances of Quality of size

Micropsia

Macropsia

Dysmegalopsia

Disturbances in intensity of perception

Hyperacusis

Visual

hyperaesthesia

Slide28

T

Slide29

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

Slide30

Thought Form

Logical and goal-oriented?

Tangential or Circumstantial?

Flight of Ideas?

Loosening of Associations?

Slide31

Designed to show thoughts of persecution

Slide32

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

Slide33

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

Slide34

I

Slide35

Insight & Judgment

Insight

Awareness of having illnessUnderstanding of factors contributing to illnessAppreciation that various signs and symptoms part of diseaseAwareness of illness impacts on other ppl and society Acknowledgment of need for txn

Judgment

Appraising the situation

Surveying the alternatives

Weighing the alternatives

Deliberating about selection

Making a commitment to a choice

Slide36

C

Slide37

Sensirium & Cognitive

LOC and attentiveness

Orientation

x

3

Attention

Concentration

Memory

Knowledge

Intelligence

Capacity for abstract thinking

Slide38

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&index=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-s1oUtn2

NsNzF0xx9n4BfSYEsKmpFrBA_UEdjZKt8-aZ6G-hXMdSwP0B-XqxBBL0Jq_GNcPaiJgX7focwLskatuUhXRNNkn-giq5JzJvsm2uZscogg


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