Mental Health Nursing: MSE, Psychiatric Disorders and Communication

[MSE] What is the purpose of an MSE?

To describe the patient's current mental state systematically; it supports assessment, documentation and handover, but is not a diagnosis.

[MSE] List the core MSE domains.

Appearance/behaviour; speech; mood/affect; thought form; thought content; perception; cognition; insight/judgement.

[MSE] Mood versus affect?

Mood is the patient's reported internal emotional state; affect is the observed emotional expression.

[MSE] Thought form versus thought content?

Thought form is how ideas are organised; thought content is what the person believes or thinks about.

[MSE] Examples of abnormal thought form?

Tangentiality, circumstantiality, loosening of associations, derailment and disorganised speech.

[MSE] Examples of abnormal thought content?

Persecutory or grandiose delusions, obsessions, suicidal thoughts.

[MSE] What belongs under perception?

Hallucinations, illusions and other perceptual disturbances.

[MSE] What belongs under cognition?

Level of consciousness, orientation, attention and memory.

[MSE] What is insight?

The person's awareness or understanding of their experiences, symptoms or illness.

[MSE] Why distinguish observation from inference?

Interacting with unseen objects suggests possible hallucinations, but does not confirm hallucinations without assessment.

[MSE] What does a persecutory delusion involve?

A fixed belief that someone is threatening, pursuing or intending harm to the person.

[MSE] What is an IMIST-AMBO handover used for?

A structured clinical handover; practise with the Week 10 case and observations.

[Conditions] Positive symptoms of schizophrenia?

Delusions, hallucinations and abnormal/disorganised behaviour.

[Conditions] Negative symptoms of schizophrenia?

Reduced emotional expression, speech, motivation or social functioning.

[Conditions] Cognitive/disorganised symptoms of schizophrenia?

Disorganised thought and difficulty with memory or concentration.

[Conditions] DSM-5 active-phase symptom rule for schizophrenia in the tutorial?

At least 2 active symptoms, with at least 1 being delusions, hallucinations or disorganised speech.

[Conditions] Brief psychotic disorder duration?

Less than 1 month

[Conditions] Schizophreniform disorder duration?

Less than 6 months, according to the tutorial recap.

[Conditions] What distinguishes schizoaffective disorder?

s distinguished by a combination of psychotic symptoms (hallucinations or delusions) and significant mood episodes (depression or mania).

[Conditions] MDD symptom threshold?

At least 5 symptoms over the same 2-week period, including depressed mood or loss of interest/pleasure.

[Conditions] Common MDD symptoms?

Low mood, anhedonia, sleep/appetite change, fatigue, impaired concentration, guilt, psychomotor changes and suicidal thoughts.

[Conditions] Is depression simply low serotonin?

No. Other factors include multiple biological, psychological and social influences; not merely a chemical imbalance.

[Conditions] What is a manic episode?

Persistently elevated, expansive or irritable mood with increased energy/activity for at least 1 week, plus associated symptoms.

[Conditions] What is hypomania?

A similar but less severe episode lasting at least 4 consecutive days without marked functional impairment or hospitalisation.

[Conditions] What does psychosis during an elevated mood episode imply?

The episode is manic rather than hypomanic, per the tutorial.

[Conditions] Typical manic symptoms?

Grandiosity, reduced need for sleep, pressured speech, racing thoughts, distractibility, increased activity and risky behaviour.

[Conditions] Bipolar I versus bipolar II: what must be revised?

Bipolar I requires at least one manic episode, which may involve significant impairment, hospitalisation or psychosis; depressive episodes and hypomania may also occur but are not required for diagnosis. Bipolar II involves at least one hypomanic episode and one major depressive episode, with no history of mania.

[Conditions] GAD core feature?

Excessive, difficult-to-control worry with symptoms such as restlessness, fatigue, poor concentration, irritability, muscle tension and sleep disturbance.

[Conditions] Common panic attack symptoms?

Palpitations, sweating, tremor, dyspnoea, chest discomfort, dizziness, tingling and fear of dying or losing control.

[Conditions] Obsessions versus compulsions?

Obsessions are intrusive unwanted thoughts/urges/images; compulsions are repetitive acts or mental rituals to reduce distress.

[Conditions] What is an important feature of OCD-related impairment?

Obsessions or compulsions may be time-consuming (over 1 hour/day) and cause distress or functional impairment.

[Conditions] Which personality disorder is particularly highlighted?

Borderline personality disorder; revise features, trauma-informed care and suicide risk.

[Conditions] Which neurodevelopmental conditions are prioritised?

ADHD and autism spectrum disorder (ASD).

[Conditions] Which neurocognitive comparison is prioritised? Delirium vs Dementia:

Delirium vs Dementia: Delirium is an acute, fluctuating disturbance in attention and awareness, whereas dementia is generally a gradual, progressive decline in cognitive function.

[Conditions] What is dual diagnosis?

Co-occurring mental health and substance use disorders; both influence assessment and care.

[Conditions] Trauma case: symptoms lasting months after an assault?

Consider PTSD

[Conditions] Trauma case: symptoms 2 weeks after fatal crash?

Consider acute stress disorder; assess full criteria and alternative medical explanations.

[Conditions] Trauma case: anxiety after divorce and job loss?

Consider adjustment disorder; assess symptoms, duration and differential diagnoses.

[Communication] What is diagnostic overshadowing?

Attributing physical symptoms to mental illness and overlooking medical disease or injury.

[Communication] What is implicit bias?

Automatic attitudes or associations that can affect decisions even when they conflict with conscious values.

[Communication] What is anchoring bias?

Fixating on an early impression and insufficiently updating it with new information.

[Communication] What is confirmation bias?

Seeking or interpreting information that supports an existing belief.

[Communication] What is negativity bias?

Giving disproportionate weight to negative information or experiences.

[Communication] What is fundamental attribution error?

Overemphasising personal characteristics and underestimating situational influences on behaviour.

[Communication] How can stigma affect access to care?

Patients may avoid disclosure, delay help-seeking, decline treatment or experience discrimination.

[Communication] Four therapeutic communication strategies for psychosis?

Calm voice; short clear statements; active listening; offer appropriate choices without arguing about delusions.

[Communication] How should paramedics respond to a delusion?

Acknowledge distress without affirming or confrontationally challenging the belief.

[Communication] Should paramedics ask directly about suicidal thoughts?

Yes. The tutorial explicitly prompts direct questions about ideation, intent, plan and access to means.

[Communication] What is trauma-informed care trying to achieve?

Care that prioritises safety, trust, collaboration, choice and empowerment while avoiding re-traumatisation.

[Communication] What does MORE PIES stand for? Active listening framework

Minimal Encouragers (showing attention), Open-ended Questions (encouraging exploration), Reflecting/Mirroring (matching body language and tone), Emotional Labelling (acknowledging feelings), Paraphrasing (rewording to confirm understanding), I Messages (expressing concerns using “I” statements), Effective Pauses (allowing time for thought), and Summary (recapping key points). These techniques build trust, improve understanding, reduce defensiveness and miscommunication, and support mutually beneficial outcomes.

[Communication] Name vulnerable populations from Week 1.

Refugees; culturally and linguistically diverse people; people experiencing homelessness; incarcerated people; Indigenous Australians; older people; youth; LGBTQI+ people; people experiencing family violence; people with chronic illness.

[Communication] How can paramedics reduce barriers for vulnerable patients?

Use respectful person-centred communication, consider language and cultural needs, and assess social circumstances and access barriers.

[Risk & care] What are key suicide-risk questions?

Ask about current thoughts, duration, intent, specific plan, access to means, previous attempts, intoxication and protective supports.

[Risk & care] Suicide risk: why does previous attempt matter?

A previous suicide attempt is an important factor associated with increased risk.

[Risk & care] Suicide risk: why ask about access to means?

A specific plan and access to potentially lethal means indicate increased concern.

[Risk & care] Why assess protective factors?

They help understand the person's supports and safety needs alongside risk factors.

[Risk & care] What must be prioritised for a self-harm patient with active bleeding?

Scene safety and immediate physical assessment/treatment, including haemorrhage control, while communicating non-judgementally.

[Risk & care] Why does a suspected overdose need a medical assessment?

Altered consciousness can reflect life-threatening poisoning or other medical causes, not only a mental health crisis.

[Risk & care] What is decision-making capacity?

A decision-specific ability to understand, retain, use/weigh relevant information and communicate a choice; verify the applicable legal framework.

[Risk & care] Does a mental health diagnosis automatically mean no capacity?

No. Capacity must be assessed for the particular decision and circumstances.

[Risk & care] What determines transport or referral planning?

Clinical findings, immediate risk, capacity, safety, available supports and relevant legal/guideline requirements.

[Risk & care] What must be verified about Queensland mental health legislation?

Current principles and criteria for involuntary assessment, treatment and care; use current legislation and QAS guidance.

[Risk & care] What is the first priority in acute behavioural disturbance?

Scene safety, de-escalation and assessment for reversible medical causes, with escalation if needed.

[Risk & care] What does SAT refer to?

Sedation Assessment Tool; review the exact scoring anchors in current QAS/Canvas material.

[Risk & care] What should be checked before restraint or sedation?

Indications, safety, least-restrictive options, medical causes, guideline requirements and monitoring capability.

[Risk & care] What monitoring is important after sedation?

Airway, breathing, oxygenation, circulation, consciousness and adverse effects, according to current clinical guidelines.

[Risk & care] What must be memorised for ABD sedation medications?

Medication, indication, route, dose, repeat interval, contraindications, adverse effects and monitoring; verify against current QAS guidelines.

[Risk & care] Week 10 case: name 5 possible explanations for agitation/confusion.

Psychosis, head injury, substance intoxication, withdrawal, and medication-related effects; assess rather than assume.

[Risk & care] Week 10 case: what evidence raises concern for head injury?

Forehead laceration, dried blood and altered mental state.

[Risk & care] Week 10 case: what evidence raises concern for psychosis?

Persecutory statements, disorganised conversation and possible response to unseen stimuli.

[Risk & care] Week 10 case: which observations were supplied?

HR 108; BP 145/75; RR 16; SpO2 96%; temperature 36.1°C; BGL 5.2 mmol/L; GCS 14.

[Risk & care] Why is GCS 14 relevant in the Week 10 case?

It documents altered consciousness and supports assessment for medical, toxicological and traumatic causes.

[Pharmacology] Main medication class for psychotic disorders?

Antipsychotics are the main medication class used to treat psychotic disorders, such as schizophrenia.

[Pharmacology] What are extrapyramidal side effects (EPS)?

Movement-related adverse effects associated with antipsychotics.

[Pharmacology] Name EPS discussed in the tutorial.

Extrapyramidal Side Effects — movement-related adverse effects commonly associated with antipsychotic medications. Dystonia, akathisia, parkinsonism/rigidity, tremor and tardive dyskinesia.

[Pharmacology] What is tardive dyskinesia?

A potentially persistent involuntary movement disorder associated with dopamine-receptor-blocking medications.

[Pharmacology] What is akathisia?

A distressing subjective sense of restlessness with a need to move.

[Pharmacology] What is acute dystonia?

Sudden sustained involuntary muscle contractions or abnormal postures.

[Pharmacology] What serious antipsychotic complications are listed in the study guide?

Neuroleptic malignant syndrome, extrapyramidal effects and anticholinergic syndrome.

[Pharmacology] What should be reviewed about antidepressants?

Major classes, serotonin syndrome and discontinuation syndrome.

[Pharmacology] What is serotonin syndrome associated with?

Serotonergic medication exposure or interactions; A potentially life-threatening condition caused by excessive serotonergic activity, commonly associated with antidepressants or interactions between serotonergic medications

[Pharmacology] What does TCA stand for?

Tricyclic antidepressant

[Pharmacology] Why is TCA overdose important for paramedics?

It can cause serious cardiovascular and neurological toxicity; requires urgent assessment and monitoring.

[Pharmacology] Which mood stabiliser toxicity is explicitly emphasised?

Lithium toxicity, including contributing factors and clinical features.

[Pharmacology] Which substances are used in Week 9 tutorial comparisons?

Alcohol, cannabis, amphetamines and opioids.

[Pharmacology] What substance-use topics should be compared?

Intoxication, withdrawal, pharmacological interventions, interactions with mental health conditions/medications and paramedic care.

[Pharmacology] Which medication examples appear in the Week 10 case?

Fluoxetine (SSRI) and quetiapine/Seroquel (antipsychotic).

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