Mental Status Examination & Suicide Risk Assessment

Zog inni tu Gust feed puts medar giwy. Oed yn oath gowe â'rwearhaf yn hyglenaeth ty daaf, sych gand? Filmiau ac yn fîm yn ymfynio olygu yn dod rhedפusio ar f Дulu Rhaundraiad'u gwneud ac na fís ffratелw我說 par- Bi'n porth o'r faf dooral ac dysgu ddysgu ddiweddeli Centek fundamental ar Welcome to Gerop College loneliness walkа ităm nhw o, ond di coverage de signfdu extended o di zurata cwcs er ac ac et senza fod, ond y faço cydudo yngried no o fwy o ymgynnu beth'n gwasus diwch y llwisiu sefyllf ei全au lumodalo un ni gwasus as亜c eiffodol cystinkles helf hun diohau żeiotał mis ar ychwanu'r emphas seed i chi tilwbeth discardyd na'r cwaika robell. Diolch llanaethau16 dienau'r моей Goudonau' nhw y stablellfa siolau ensol eu ac yn silwch 'igolau' y dog, wedi chi'n graddur eineddu yn yn hyrhus castylio. Sut rydaw Motherfrewd, bro, cynll Just Who sundaethau yn barod webrill هushir a greud y gallpreffol i ach σ Q honourード. 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I'i'n,'i'i wna-maenau ac pan deall m ganz dergall sgredd mo sydd bar a'r ei fyrdd, wa県 mum, materiau. peu Platform' i fod y e face y swyddod fel hygarol rhFilita. Oro popol ar peb yn cy bywzeigdasydd. ref ei drwybod sydd cyn\f f1 i gw doubts, Mae un reddigald ddiodd hwb shroud hy galad i cael at well ¯ одном i hygen F1wch bethaf au ae cashol i ddysiau ni- Rwy popch, dyna llawer, gyms ym wneud gweithllas gyffreitu y bylch yn cael fy gallu. Mae Constellrwydd, monasterio, yn pan nagrel десятiend iau symvel eitol bennu'r ef i ni philanthrop postellrwydd, ac awain calling the person inno uw rydym yn y lib cael er saag rydym yn gallu a dweud o'r maeleg yn maeleg directlystiad, daru asgwybod, o taeth yw dаutilluag leidol saflana d just ceith y ddwy booking am anundi ac llwyn nad hwyl riddiad, ChIE… irgendwel關 ar style jum głai fel A Cloud gueer yw gwasch ymedd fan? 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"A'u west ni Ina asio relan da hefyd, tept y hyn o'n mewn hwn sy'n fabdydd sy'n oeddy'r dylu callwer yn mor Y Nathiad llwyd, 'Bwys yn yw'r ymwyd, a'u sefydwch yn fwybod chi i'n mewn hwn sy'n gweld, 'Bwys yn yw'r ymwyd, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sfydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn ymwyd. 'Bwys yn ymwyd, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, a'u sefydwch yn fwybod chi, Ym'n gweithio'n byddwn gweld yw'n gweithio'r gweithio ei yn ymwfwch ddod gweithioedd yn cwfwch yw'n gweithioedd oeddwn darwch. Ymwch, trefod yn gweithioedd yn gweithioedd yn gweithioedd yn gweithioedd yn cwfwch yw'n gweithioedd yn gweithioedd yn gweithioedd yn ymwfwch. N說u eich syna, remove fel nostailu felly g大概 o dod faint. Hoorodd yn forgotten, gwybod eich bchuf eich micro rydwl. 11 Mos 12 ieichatcha, maentfafer my urgedating hefnenael. Oedd hyn yn mynd gwntauimmitis, wrth USB8. I'n mynd gwntau, wrth USB8. Sorry James. I'r mynd gwntau, wrth USB8. Mynd gwntau am ffet, wrth USB8. Mynd gwntau, wrth USB8. If someone says they're feeling depressed today but they're running here from here to here, that's a bit inconsistent. And also how appropriate is it with the context that they're really happy but someone's just died. Those are the things that come in time. And so that's the objective with their mood appear to be. If their mood appears normal, obviously you don't know the person. If it appears normal, the word will use these youth dynamics of normal mood. And then affect, it's quite a nebulous thing that there's lots of different definitions for affect but essentially it's about how they're expression of the mood. Are they expressing their mood in a reactive way? Are they reacting to the situation? They're smiling at those kind of things or have they got a very blank facial expression? They're not giving much emotion away so that would be sort of a blunted affect. But again, these are sort of more of the technical intricacies which are less expensive than non-specialists do they? But it's important to know what we're talking about when we talk about mood, I think. Sure. But now we do move on to thought. Yeah. So thought essentially is, as we said, it's the things often that tell you spontaneously through this day. But you're going to ask specific questions about that. So there's three different elements to the thought. There's the freedom of thought and that's essentially the amount and speed of the thought. So if you have pressure of thought, that is the thought can be really quickly, abundant, they're putting up against each other, blending into another. And that is then shown through pressure of speech. Positive thought is that there's really like very slow thoughts, not a lot of thought going along. You see that, especially in very, very severely depressed people, they just aren't thinking everything's just slowing down. And then there's something that you specifically see in schizophrenia called thought block where it's as if your thought has just been stopped. Some people like it, when you're about to say something and then you forget what you were saying. But it's very clearly felt by the person that something has blocked on thought. So that's something that's important. Is that something external that blocks it? Well, there can be a delusional sort of addition to that. It's mainly, there's not have to be any, it's just my thoughts keep it and blocked is the word that I can't remember. Sure. And then there's the form of thought. And that's how the thoughts are linked together. And the edges between the stream and the form do blow a bit. So look, you might have heard of the term flight of ideas. So flight of ideas is again where one thought will blow into the next thought. And it's because everything's going so quickly, you're flying between different ideas. This will all come out in a massive verbal sphere that is difficult to follow sometimes. And if there's what we call loosening associations, so the associations between thoughts are clear. Okay. Mostly when we talk, you can actually look at a transcript of what we were saying. You can see a logical stream. This is what I did this and this one today. Hopefully in this podcast. Hopefully. And how much you ever said. But someone with loosening associations will talk about one thing and then talk about something completely unrelated. And then it makes sense to them. It makes sense to them. It's something called night's mood thinking. And that's where there's no logical link between one thought in the next. So they've gone up and across that next. Other ways that the thoughts can be linked, especially in flight of ideas. In many areas, you'll see rhyming or punning, where patients will use the way that words sound to link thoughts. That might not otherwise be linked. And although they may become quite distracted. So it's important to say whether the patient is distractable or whether they can maintain a stream of thought. An example of that that he, Consolz and Psychiatrists and I was a medical student, told me to look at is, and this, you know, a cultural thing. Good morning, Vietnam. And to watch one of Robin Williams' is when he's just talking down the mic and he just goes from one thing and then he, because it rhymes, he goes on to another thing and then jumping around. A very good film, I recommend you watch it and then you get, you can see, you're doing Psychiatry revision as well. Exactly, exactly. And it's very hard to do if you, it's very hard to fake. Yeah. And there's a lot of the symptoms actually you see. If you see it really well performed by an actor, it's incredible, but it's so often not well done. And that's why depictions actually in films of mental and mental hormones spot on because it's hard to do. The other thing about the former thought is the separation. Not sure if you heard it that term. So, it's precisely repeating the same sequence of thoughts and that can come out in speech or behaviour. So if you separate on in speech, you give the same words or the same answer to different questions. So, and often you see perseveration things like dementia, but you can see perseveration in behaviour as well where people will do the same behaviour over and over again. It's like they're stuck doing the same thing. And it may be appropriate sometimes, but then you change the question and then it's not appropriate. Exactly. Yeah. So, together you say, what's your name? James. Yeah. When you come from James. That's the separation. Unless there's a place called James. True. And then the third bit of thought is content. Yeah. So, what actually makes up that thought? Are they preoccupied with things? Are the things that are always coming to their mind? Are they quite morbid thoughts? Are they negative thoughts about themselves? Are they thinking about suicide or self-harm? It's really important to think about. a'r sgwthwyd, mae'n ffordd o'r ffordd. o ddyr ei ddyn nhw'n gwybod o gyfer am rhan o 's gael ei ddyn nhw'n ymdyn nhw'n gael. Twy'n gael yn gael, mae'n gael ei ddoedd yn gael ei ddyn nhw'n gael y pethan o'r gael. A mae'n gael ei ddyn nhw'n gael ei ddyn nhw'n gael ei ddyn nhw'n gael. I can be explained in a way. Opscessions as well are – in psychiatry we use a slightly different explanation of what an obsession is. Not obsession. In psychiatry are intrusive, recurrent thoughts. So thoughts that the patient realises are the wrong. But the main thing is that they don't feel they're in control of them. And often they are what we call ego-distamic. So they're distressing, they go against the brain. So those are important. Obviously in some of the obsessive-compulsive disorder, the intrusive thought might be I have to clean my house or something bad will happen. And then the compulsion is the act of shitting the house. And then going out from that compulsion, although there are behavior, they're driven by the thought process. So it's important to talk about how to document whether the right compulsion is there as well. So there's a lot going on. There is a lot going on. And obviously you're not going to see all of this in more patient. But you need to be aware of the categories that can come in the mental state examination. And then when you are presenting, so we've got some thoughts about you would say, I've seen Mr Smith. He is a something-or-old man and then just going through as we've talked about it. And I think the important thing is try avoid giving headings as well because it makes you look less slick. So you just present it as an appearance. He's a very skinny, disheveled. You wouldn't know thought. His thoughts were. I guess practice isn't that. I'm just talking about everything in medicine practice. So the next category is perceptions. We talked about those in the psychosis. Essentially you want to- the main thing is, are there any abnormal perceptions? Are there any things that patients are hearing, singing, smelling, feeling that aren't driven by stimulus? So hallucinations are the big thing to be aware of. But there are other perceptual abnormalities as illusions which are- It's a misinterpretation of a real stimulus. So when it's dark and you see a dressing gown in the back of the door, you think it's someone's to be there? Yes, that's an illusion. But they can be part of mental illness, probably entirely normal as well. What we need to talk about that. And also the intensity and quality of normal perceptions as well. So if all the colour seem really bright, that might point towards the main thing. If you know, flowers smell horrible and smell accurate, then that might be something we've seen in a psychotic illness. And often the sexual abnormalities and mood can grow as well. So if someone's got psychotic depression, that's severe depression with psychosis on top, then they might smell a lot in flesh. Because that's congruent with the way they do. So they tie in together. Okay. Coagulation is your next category. And really for most patients that you see, you can just eyeball them. And you swipe them to know what's going on. You can actually say there's no primitive deficit. If you feel that there is, then you might want to do more digging. You can do an AMT, a marker, some sort of cognitive testing to see what's going on. But for most patients, you just take cognition as intact. But what we're looking at is the consciousness. So that's their awareness of their self and their environment. Obviously in something like delirium, you have a cognitive consciousness. And that refers to sort of vague, drarzy, foggy experience. So you know, you're not quite connected. And you'll see that in peak patients with delirium. That's a good way to distinguish delirium from dementia. Because some of them dementia, they don't have that cognitive consciousness. They are conscious. They may not be completely aware of their surroundings. But they don't have that cognitive. Are they confused? They've got a little thinking. And you can describe what that is. Are they mistaken things? Are they getting people's names wrong? Those kinds of things. Are they orientated? And we talk about orientation in time, person in place. Do they know who they are, who you are, where are they, what time is it, what year is it, those kinds of things. Which are important to be aware of. Obviously, these are more so than things like dementia. These are impaired. Can they, I think, have a bit of attention span. Can they do things like in the mental state examination, which is a copyrighted cognitive test, which you're not supposed to use anymore. But they used to use a thinkl serial sevens, which was taken away seven from 100 and keep them doing that. That's to see whether you can actually have a lot of attention span. Can you concentrate, essentially. And then memory is important. That's your immediate memory. So you use digits span. How many numbers can people remember. And then you might want to look at them all recently. It's slightly longer term memory. But recently, it's like, period of time, there's a dress I'll ask you later. And if you're doing really going to town with your cognitive testing, you might do things like language testing and, you know, name common objects. Or visual spatial functioning. The crop crop drawing. Yeah. Test for, in dementia. So those are, for most patients, outside of a kind of dementia or head injury setting, most people's consciousness. So, cognition and consciousness would be ineffective. So you would, that would be quite a quick thing to document. And then the last part, and really quite important is the insight of the patient. It's a difficult one because some people would say, how much does the extent to which patient agrees with the health care professional. But I think that's quite unhelpful. Are you thinking about it? Because it's saying that doctors run in the patient's room. If they don't agree with you. The way I like to sort of explore it and say, well, it's, it told me some quite strange things and you're experiencing some quite bizarre experiences. What do you think the explanation for that is? And if they give you an entirely, you know, delusional explanation, that shows that they're in such, in such lacking. But you wouldn't, you might say, it sounds to me like some of the things you're experiencing might be mental illness. Do you think that that could be the case? And they would say, no, no, no, no, not at all. And then that would suggest it's lacking. I personally don't think that anyone is completely insidious. So I would say that someone is lacking inside. I wouldn't say to have an illness inside. Because they're saying we're infeating. They might, you know, they might have a bit of a feeling with something wrong. So it's rare to completely lack insight. They'll know that something isn't wrong, but actually they might have very, very, very difficult insight. Or they might, you know, they might be completely aware of that there's something wrong. They don't need to know what their diagnosis is. They don't need to be able to, they just need to know something and it's probably not doing that. No, that's their little insight. So, yeah, that really, so there's the, how much they agree with what you think in terms of how they're mentally ill or not. And then also, what are their thoughts about treatment? Would they accept treatment? A treatment plan that is appropriate or would they reject that? So to that, something that's important to think about obviously because then you might need to think about going out of mental health at the root, that's kind of the thing. So, so insight is a, it's a nebulous thing. But it, you know when you see it really, it's like this person knows this is wrong. This person doesn't buy this. Okay. So that's our mental status examination. And we're just going to get that to the full. gwahanol a cho o fundictacause i'n pourwi a siortau a implantol wybþ neir y series di wynatz a rydw, ac mae honol yn cro contactu er ofall lastedio sem f Medic presgulau syn fy ng Wel i fyrdewn yn dwi nhw ceisol o aspril o segch filli feudio o ff experiencing. On提ch van siwty pethenis ag arlyddi'n cyh Dear Бydro helpless forgotten inns iawn. Myodaid250'r플ol a fy newydd wedi sut cyfron comedd gany Rod European neu, ac yn Coerfiendydd hyn allied gan tryng meddwl ac ym'n staf mae'n utwyr toín y sgworkio. 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Un 좋은 ac yelwn acud am un golli�� a吗in ryn ni'n cly домой f own a- mae bydd newydd hyn yn imrif, gyו dim yn gallam daos o hyn estrwn. Mae'n amser ac rifen knownad' u rob a'f draws hynno amос am dal ond enn gondw bestig eraill. As gondol ast goman nhw wedi'i wneud, ' retail cael hi yn Mayr profly prejudice yn ydy'r Rhunddynor ' sy'n ond ligoddewn ei fws eich sut, eich sylfaeth JRальный bych Nafisiaeth ei g añoeth roedden o fel furiousio botrpass sy'n wedi y mae un mãe arос, o hynny'r rhunddynor, o hynny, o hynny. Mae'n amser ac yn yna, o hynny, o hynny, o hynny, o hynny, o hynny, o hynny, o hynny, o hynny. Mae'n amser ac yn gyd yma. Mae'n amser ac yn yna os, o hynny. Mae'n amser ac mae'r rhunddynor ' sy'n gyd yn yna o hynny. Mae'n amser ac yn yna o hynny. Mae'n amser ac yn yna o hynny.