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General Approach to Assessment of Psychiatric Patients
Joe Marie Jardiolin, MD, FPCEM, FACEM Liverpool and Fairfield Hospital March 2016
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SACCIT six essential processes in MH after triage
Safety Assessment Confirmation of Provisional Diagnosis Consultation Immediate Treatment Transfer of Care Mental Health for Emergency Departments: A Reference Guide. NSW Health 2015
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SAFETY Ensuring that the patient’s risk of harm to self and others are well managed during the duration of their ED stay
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Assessment Clear and reliable History MENTAL STATE EXAMINATION
Vital Signs Physical Examination RISK ASSESSMENT ( risk of harm to self/others, risk of absconding, risk of missed organic illness
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Confirmation of Provisional Diagnosis
obtaining the vital information to assist in reaching a provisional or working diagnosis 2 essential elements: Obtaining corroborative History ( Collateral History) Investigations to include or exclude organic cause
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Consultation ED Consultant initially
Accessing early the Mental Health Service /PECC C/L Psychiatry Drug and Alcohol ICAMHS ( infant child adolescent MHS) Rural services
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Immediate Treatment Providing the right intervention
Organic treatment – medication, sedation, treat underlying cause (?infection, delirium) Psychological – de-escalation, therapeutic engagement, counseling Social – mobilizing support from family, community care, social worker/emergency accommodation
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Transfer of Care Ensuring safe and easy transfer of care to: Inpatient teams ( Medical or Psych) Community (GP, psychiatrist, ComMHET)
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MENTAL STATE EXAMINATION
A - Appearance B - Behaviour C - Cooperation Mood and Affect Speech Thought Form Thought Content Perception Cognition Insight Judgment
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MSE APPEARANCE BEHAVIOUR Posture Body appearance and general condition
grooming BEHAVIOUR Mannerisms, tics Agitation, restlessness, aggressive passive
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MSE COOPERATION Friendly or extreme friendliness
Cooperative or uncooperative Suspicious, hostile Evasive Seductive perplexed
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MSE MOOD AFFECT Patient description of how they fell ?Depressed
?Excited / elated AFFECT Clinician’s observation of patient appropriateness of patient’s emotion Patient says he’s sad but is smiling
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MSE SPEECH Rate – fast, slow Volume – loud, soft
Quantity – pressured, non verbal, talkative Quality – accent, rhythm
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MSE THOUGHT FORM THOUGHT CONTENT Poverty of content, racing thoughts
Flight of ideas, incoherence. tangential THOUGHT CONTENT Delusions Pre-occupations Obsession / compulsion
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MSE PERCEPTION Hallucinations ( especially auditory) Delusions
Paranoid thoughts Heightened perception
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MSE COGNITION Level of Consciousness Memory Orientation
Attention and Concentration Mini Mental State exam
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MSE INSIGHT Patients awareness of their illness ( poor, partial or good) JUDGEMENT Patient ability to assess situation and act appropriately
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THANKS ?QUESTIONS
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Reference Mental Health for Emergency Departments: A Reference Guide. NSW Ministry of Health 2015 Mental Health Act 2007
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