OTY 2003 Seminar 1-Clinical Assessment PDF

Se m in a r: Me n ta l Sta te Exa m in a tio n Assoc Prof Tan Bhing Leet Director of Programmes Health and Social Sciences Cluster Part of the clinical assessment that describes the examiner’s observations and impressions of the patient at the time of the interview. Patient’s psychiatric/social/fami...

Se m in a r: Me n ta l Sta te Exa m in a tio n Assoc Prof Tan Bhing Leet Director of Programmes Health and Social Sciences Cluster Part of the clinical assessment that describes the examiner’s observations and impressions of the patient at the time of the interview. Patient’s psychiatric/social/family history may remain stable, but MSE can change. Even when patient is mute, incoherent, or refuses to answer questions, the therapist can obtain a wealth of information through careful observation. Presentation Title 3 Build rapport through: Presentation Title Open posture and eye contact. Putting patients at ease. Reinforcers. Expressing empathy. Balancing roles of an empathic listener and getting patients to answer questions. 4 Seminar Activity: Go through each component of the MSE. Practise assessing the various components. Explanations given in videos may not be accurate, hence to follow the seminar instructor’s guidance. Presentation Title 5 Appearance General physical appearance (height, size, complexion, any significant physical features). Attire: what is the person wearing? Are the clothing generally matching and appropriate for the occasion? Grooming: neat and tidy, dishevelled, unkempt, filthy. Is the person old or young for his/ her age? Posture: upright or slouching, any unnatural posture. Presentation Title 6 Behaviour Overall overt behaviour and psychomotor activity. Refers to the quantitative and qualitative aspects of the person’s motor behaviour. Examples of behaviour terms: Withdrawn Excited Agitated Odd mannerism. Psychomotor agitation/ retardation: (5.17- 5.53) MSE Training Motor Movement: https:// www.youtube.com/ watch?v=4eSB4Blwr5o. Presentation Title 7 Tics/ twitches and/ or stereotypies: repetitive or ritualistic movements, such as bodyrocking, hand flapping: (1 0.0 2 -1 0.1 6 ) MSE Training Motor Movement: https:// www.youtube.com/ watch?v=4 eSB4 Bl wr5o. Gestures/ gesticulating Echopraxia: imitation of another person’s action. Hyperactivity Rigid gait Agility. Presentation Title Restlessness/ fidgety: (7.46- 8.14) MSE Training Motor Movement: https:// www.youtube.com/ watch?v=4eSB4 Blwr5o. Talking/ laughing to self. Responsive and appropriate. Disinhibited/ over- familiar. Combativeness Inhibited. Tearful. Distracted/ dazed. Perplexed 8 Also consider attitude towards interviewer/ therapist: Cooperative, friendly, attentive, interested, frank, seductive, defensive, contemptuous, apathetic, hostile, playful, ingratiating (intended to gain approval), evasive, or guarded. The level of rapport established can also be recorded. Presentation Title 9 Appearance and Behaviour (MSE Examples) (0.0 9 - 0.3 5 ): https:// www.youtube.com/ watch?v=1 HbgPhq3 MzA Appearance and Behaviour (Psychiatric Interviews for Teaching: Mania) (1.3 0 - 2.2 5 ): https:// www.youtube.com/ watch?v=zA- fqvC0 2 oM Behaviour/ Motor Movement (MSE Training Motor Movement) (1 5.1 3 1 5 :3 5 ): https:// www.youtube.com/ watch?v=4 eSB4 Blwr5 o Presentation Title 10 Speech reflects the thought process. For forms of thought disorder, record under ‘thought process’ and give verbatim examples. Describe quantity, rate of production, and latency of response (how long it takes to respond):  E.g. talkative, garrulous (excessively talkative), voluble (rapid fluent speech), and taciturn (saying very little), unspontaneous, increased latency of response, normally responsive. Other ways to describe speech: slow, rapid, pressured, hesitant, emotional, dramatic, monotonous, loud, whispered, slurred, staccato, or mumbled. Presentation Title 11 Echolalia: Repeating what the other person said. Associated with autism spectrum disorder. (MSE Training Speech)(8.3 1 - 8.5 0 ): https:// www.youtube.com/ watch?v=mT4 mikXkynA Laconic: terse, brief response,suggesting lack of interest (MSE Training Speech) (5.1 0 - 5.4 4 ): https:// www.youtube.com/ watch?v=mT4 mikXkynA Presentation Title 12 Speech: (3.10- 4.00) (Psychiatric Interviews for Teaching: Mania): https:// www.youtube.com/ watch?v=zA- fqvC02oM Speech (MSE Examples)(0.44- 1.19): https:// www.youtube.com/ watch?v=1HbgPhq3MzA Presentation Title 13 Mood Pervasive and sustained emotion that colours the person’s perception of the world. Source: Dr Thomas Field: https:// www.youtube.co m/ watch?v=o_ziBs7 jV BU Presentation Title 14 Mood Other terms: despairing, irritable, anxious, angry, expansive (inflated selfimportance, grandiose), empty, guilty, awed, futile, self- contemptuous, frightened. Mood may be labile (uncontrollable crying/ laughing), fluctuating, or alternating rapidly. Presentation Title 15 Affect The person’s present emotional responsiveness, inferred from his/ her facial expression. May or may not be congruent with mood (congruent or congruent). Depth of emotion: may be within normal range, constricted, blunted or flat. Appropriateness of Affect: consider the appropriateness of the person’s emotional responses in the context of the subject of discussion. Presentation Title 16 Affect (MSE Training, Affect and Mood) (9.0 5 -1 2.5 5 ): https:// www.youtube.com/ watch?v=o_ziBs7 jVBU Mood and Affect (MSE Training, Affect and Mood) (2 4 :1 5 - 2 5 :5 5 ): https:// www.youtube.com/ watch?v=o_ziBs7 jVBU Mood and Affect (MSE Examples) (1.2 8 - 2.0 7 ); (2.1 7- 2.3 8 ): https:// www.youtube.com/ watch?v=1 HbgPhq3 MzA Presentation Title 17 Thought process The way in which a person puts together ideas and associations. May be logical and coherent or completely illogical and even incomprehensible. Presentation Title 18 Forms of Thought Disorder (Disorder inThought Process) Circumstantiality: digresses to give unnecessary and often irrelevant details before arriving at the main point. Tangentiality: digresses to irrelevant topics and fails to arrive at the main point. Loosening of associations or derailment: speech that is disconnected and fragmented (Loose Associations) https:// www.youtube.com/ watch?v=edVcPSdP7Ow (watch from 0:00 to 1:45). Flight of ideas: thoughts are expressed in an associative manner but are rapidly shifting (Psychiatric Interviews for Teaching: Mania): https:// www.youtube.com/ watch?v=zA- fqvC02oM (watch from 0:00 to 1:20). Presentation Title 19 Forms of Thought Disorder Clang associations: groupings of words that rhyme or are similar- sounding. Usually associated with bipolar disorder or schizophrenia (eg: “here she comes with a cat catch and a rat match, dial trial a while child”). Word salad: senseless repetition of sounds, words or phrases. Marked by severe loosening of associations. Can occur in severe expressive aphasia or in schizophrenia. Neologisms: a word/ phrase coined by the patient himself/ herself, usually to describe his/ her psychotic experience. Thought block: thoughts are abruptly stopped. For persons with schizophrenia, he/ she may report that his/ her thoughts are removed from his/ her brain. Presentation Title 20 Thought Process (MSE Training Thought Process) (13.50-16.13): https:// www.youtube.com/ watch?v=12kQCYfdqcM Thought Process (MSE Training Thought Process)(18.30-19.10): https:// www.youtube.com/ watch?v=12kQCYfdqcM Thought Process (MSE Examples) (4.00- 4.44): https:// www.youtube.com/ watch?v=1HbgPhq3MzA Presentation Title 21 Thought Contents Refers to what a person is actually thinking about. Disorder in Content of Thought Preoccupations (Eg: preoccupied with thoughts of being overweight). Obsessions and compulsions (eg: obsessions with cleanliness, accompanied by compulsive rituals on washing). Phobias (eg: phobia of spiders) Suicidal or homicidal ideas. Poverty of content. Presentation Title 22 Disorder in Content of Thought Delusions Persecutory: belief that persons or organisations are trying to inflict harm on the patient, damage his reputation etc. Delusions of reference: objects, events or people unconnected with the patient, has personal significance for him. Grandiose delusions: beliefs of exaggerated self importance. Such ideas occur in mania and schizophrenia Delusions of control: patient believes that his actions, impulses or thoughts are controlled by an outside agency. This delusion suggests schizophrenia. Presentation Title 23 Delusions concerning possession of thoughts 1. Thought insertion: the belief that certain thoughts are not patient’s own and are implanted by an outside agency. Usually associated with an explanatory delusion (*not to be confused with obsessional thoughts that are distressing and rejected by patient). 2. Thought withdrawal: belief that thoughts have been taken out of patient’s mind. Accompanies the phenomenon of thought blocking. 3. Thought broadcasting: unspoken thoughts are known to other people through radio, telepathy or some other way. Presentation Title 24 Thought Content: (5.0 0 - 6.0 0 ) MSE Examples: https:// www.youtube.com/ watch?v=1 HbgPhq3 MzA Presentation Title 25 Perceptual disturbance in mental health is usually in the form of hallucinations. The sensory system involved and the content of the hallucinatory experience should be described. The circumstances of the occurrence of any hallucinatory experience are important (eg: patient started experiencing auditory hallucinations after quarrel with family members). Hallucinations may occur in particular times of stress for individuals. Presentation Title 26 Perception (6.52-7.57) MSE Examples: https:// www.youtube.com/ watch?v=1HbgPhq3MzA Presentation Title 27 Sensory systems involved in hallucinations Tactile (eg: hallucinations of ants crawling under skin). Olfactory (eg: smell of chemicals/ toxins). Gustatory (eg: taste of poison). Visual hallucinations: can be shapes, vague visual patterns, objects, people. Auditory hallucinations: noises, music, single words, whole conversation.  Usually second or third person.  Can be commentary or commands. Presentation Title 28 Consciousness Disturbances of consciousness may indicate organic brain impairment. Altered arousal states: Somnolence: sleepiness/ drowsiness Catatonic stupor: the patient keeps the eyes open and there are no spontaneous movements or response to verbal call or stimuli. Lethargy Fugue state: a sudden loss of memory involving loss of autobiographical memories and the sense of personal identity. Presentation Title 29 Orientation and memory Time, place, person Remote, recent past, recent and immediate retention and recall. Other cognitive areas to indicate (may need separate cognitive assessments to determine) Information processing and attention Memory Reading, writing. Visuospatial ability, Impulsivity. Presentation Title 30 What questions will you ask to assess orientation? How will you assess attention? Immediate and delayed recall? Presentation Title 31 Judgement: general observations about the patient’s ability to form reasonable judgements. Insight: patient’s degree of awareness and understanding about being ill. Levels of insight Deny any illness. Some awareness of being sick but not aware of it as a mental health condition. Some awareness of having a mental health condition but unaware of the need to receive help. Awareness of mental health condition and see the need to receive help. Presentation Title 32 Judgement (6.1 0 - 6.4 1 ) MSE Examples: https:// www.youtube.com/ watch?v=1 HbgPhq3 MzA Presentation Title 33 Geddes, J., Andreasen, N. C., & Goodwin, G. (2 0 2 0 ). New Oxford Textbook of Psychiatry. 3 rd Edition. Oxford, Oxford University Press. Sim, K., Sengupta, S., Fung, D. and Chee, K. T. (2 0 1 4 ) Essential Guide to Psychiatry. Singapore, Pearson Education South Asia Pte Ltd. Presentation Title 34 THANK YO U!