Post on 19-Apr-2018
transcript
Skills in Mental State
Examination Dr Michael Bowden
Dr Karen Veary
NSW Institute of Psychiatry
Introduction
‣ What is the MSE?
‣ What to look for
‣ How to report the MSE
‣ Practice
‣ Feedback and knowledge test
Introductions
‣ What is your name and where are you from?
‣ What is the most important thing you want to
gain from the workshop today?
Knowledge Test
‣ Complete the pre-workshop knowledge test
‣ We just want to see if you learn anything from
the workshop!
What is the MSE?
‣ Examination of psychological symptoms,
function and emotional state
‣ Part of overall mental health assessment and
evaluation of person’s strengths
‣ Used whenever a person contacts MH
services
Purpose of MSE
‣ Clarify nature of person’s problems
‣ Evaluates present mental state
‣ Identifies areas for intervention
‣ Establish record and baseline
‣ Assists with rapport
Components
‣ Appearance
‣ Behaviour
‣ Mood and Affect
‣ Speech
‣ Perception
Components 2
‣ Thought
‣ Judgement
‣ Insight
‣ Cognition
‣ Impulsivity
Small Group Discussion
‣ Discuss the elements of the MSE you have
been assigned
‣ Define your components
‣ What questions can you ask to elicit each?
‣ What words can you use to describe each?
Also consider . . .
‣ Individual and clinician’s
• Attitude
• Expectations and assumptions
• Reactions to individual
‣ Recovery focus
MSE & MMSE
‣ Mini Mental State Examination
• Cognitive assessment
Discussion
‣ How does all this fit into a busy General
Practice?
PANIC
ALTERNATIVE?
‣ D – Danger; immediate risk
‣ R – Reconnoitre;
‣ A – Airways; keep calm
‣ B – Breathe; remember to breath,
calm doc helps calm patient
‣ C – Circulation; communicate with patient and staff
FOCUS
BATHE
‣ B ackground
‣ A ffect
‣ T rouble
‣ H ow handling it
‣ E mpathy
‣MMSE
‣MSE
RISK
Risk Assessment Q’s
‣ life is not worth living?
‣ felt hopeless?
‣ thought about hurting or killing yourself?
‣ how often?
‣ how long?
‣ what’s happening in your life?
‣ thought of a way to hurt or kill yourself?
‣ planned how to do it?
‣ access to weapons or pills?
‣What has stopped you?
‣ who makes you feel safer or that you can rely on?
‣ hope in your future?
‣ past attempts?
‣ how long ago?
‣ plan or impulse?
‣ how did you do it?
‣ is now similar?
Modified Scale for Suicidal Ideation
‣ Ivan W. Miller
‣ William H. Norman
‣ Stephen B. Bishop
‣ Michael G. Dow
‣ Department of Psychiatry and Human Behaviour
‣ Brown University and Butler Hospital
‣ Available from Medicare Locals
ASSESS
‣ Investigations
‣ -FBC, E/LFTs, TSH, 25 OHD
‣ Screening tools
‣ - DASS21
‣ - K10
Mental Health Care Plan
‣ New appointment
‣ MSE
Audio
Circumstantiality Clang associations Echolalia
Flight ideas Loosening association Neologism
Preservation Tangentiality Word salad
Harry
‣ 18 year old high school student
‣ BIB Police to ED for assessment
‣ Running into traffic
‣ Uncooperative and aggressive
Harry 2
‣ Decline in academic and social fn 1/12
‣ Disturbed sleep
‣ Fluctuates between sad and angry
‣ Drugs
Video
‣ Watch the video
‣ How would you ask the questions to assess
his mental state?
‣ How would this fit into your practice as a GP?
Harry: MSE
‣ Complete the MSE for Harry
‣ Concentrate on
• Thought Processes and content
• Insight
• Perception
• Judgement
‣ Harry Video
Discussion
‣ What other factors would you consider if he
was 16 years old?
‣ What strengths does he have?
‣ How would you assess MSE in your General
Practice?
Jess
‣ 57 year old Aboriginal woman
‣ Recent Dx of Diabetes Mellitus Type 2
‣ Feeling confused
‣ Poor sleep
‣ Son died
Jess 2
‣ Withdrawn from family
‣ Not taking care of the house
‣ May be drinking again
Video
‣ Watch the video
‣ Write up the MSE
‣ Compare your MSE to the model provided
‣ Jess Video
Discussion
‣ Would you do anything different to this
interviewer?
‣ Any questions or concerns about the MSE?
Evaluation
‣ Evaluation and post-workshop knowledge test
www.nswiop.nsw.edu.au
‣ Mental Health courses specifically for GPs
‣ Grad Cert, Grad Dip, Masters
‣ Workshops
‣ Single Units of study
‣ Scholarships for NSW residents