CASC Final Flashcards

1
Q

Alcohol Use

A
  • Could you please talk me through how much you’re drinking per day? (Ideally work out the units per week)
  • Any more on the weekend?
  • How long have you been drinking this much?

Dependency

  • Difficult to control the amount you drink after you have started?
  • Craving drinks in between sessions?
  • Needing to drink more over time to get the same effects?
  • Get sweats and shakes if you miss a drink or first thing in the morning?
  • Does it worry you that Alcohol may be causing you some harm?
  • Is alcohol taking increasing priority over other things in your life like leisure activities/friends etc.?

Impact

  • Who is at home with you? Does it affect your relationship with your wife/children? (DV)
  • Does it affect work?
  • How are finances?
  • Trouble with police?
  • Driving?
  • Physical health consequences?
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2
Q

Anxiety (GAD/Phobias) - (detailed)

A
  • Have you been feeling particularly anxious recently?
  • Would you describe yourself as an anxious person?
  • Any clear precipitating event/cause?
  • Do you worry about things you should not worry about?
  • How long have you been feeling like this? (>6 months for GAD)
  • Do specific situations or thoughts trigger anxiety?
    • Social - centre of attention? doing something embarassing? fear of public speaking?
    • Agoraphobia - not being able to escape from a situation? Crowds? Specific environments?
    • Specific phobias?
  • Are there situations you avoid due to anxiety?
  • Do you feel anxious all the time or does it vary?
  • What symptoms do you have when you are anxious? How does it feel?
  • Do you feel jittery/irritable/on edge?
  • Do you have panic attacks (sudden onset, 30-60mins, impending doom and +++ physical symptsoms)
  • Do you use alcohol or drugs to manage your anxiety?
  • What impact is it having on your life?
  • What is your sleep like?
  • Do you have difficulty concentrating?
  • Screen for depression/suicidal thoughts/trauma/OCD
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3
Q

Anxiety - OCD

A

Obsessions

  • Do you have thoughts or worries that keep bothering you?
  • Do they keep coming into your mind even if you try not to think about them?
  • How much of your time is occupied with obsessive thoughts?
  • How do they make you feel? Do they distress you?
  • How much control do you have over them? Can you resist them or distract yourself?
  • Where do these thoughts come from?
  • Are they true?
  • What do you do to manage the anxiety they cause?
  • How much does this interfere with your ability to get on with your life?
  • Do you avoid any situations because of them?

Compulsions

  • Do you every spend time doing the same thing over and over again?
  • Do you have any mental rituals to neutralise bad thoughts?
  • How frequently and for how much time?
  • What purpose does it serve? Does it make you feel less anxious? Is it linked to a specific thought?
  • Do you try to resist doing these rituals? Can you control doing them?
  • What happens if you do not do them?
  • How much do these interfere with your ability to get on with your life?
  • Would you say you have always been an obsessive person?
  • Are you a superstitious person?
  • Hoarding? Lucky numbers?
  • Screen for substance use/depression/suicidality
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4
Q

Anxiety - PTSD

A

Intrusion symptoms:

  • Could you describe the event? (ask first if this is okay or too difficult)
  • How often do you think about it?
  • Do thoughts about it come into your mind intrusively when you don’t want to be thinking about it?
  • Do you have nightmares about the event?
  • Do you have flashbacks of the event?
  • Do you ever relive the event?
  • Do you have difficulties remembering the event?

Avoidance:

  • Do you find yourself avoiding places/people/activities associated with that memory?
  • Have you been back to the place where the event took place?
  • How hard is it to talk about the event?

Alterations in arousal:

  • Since the event do you feel more on edge much of the time?
  • Are you easily startled?
  • Have you been feeling irritable?
  • How is your sleep?
  • How is your concentration?

Cognition and mood:

  • How has this affected your life?
  • How does it affect how you feel? Do you ever feel numb?
  • How have your relationships been effects?
  • How do you see the future?
  • Do you feel guilty for what happened?
  • Has your interest in activities been affected?
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5
Q

History Following Self-Harm Attempt

A
  • Can you tell me what happened?

Before

  • How long have you been planning this?
  • What preparations did you make? Did you buy things for the act? Did you put your affairs in order?
  • Did you tell anyone about these thoughts?
  • Were you alone at the time? Did you do anything to make sure you wouldn’t be interrupted?

During

  • What did you do?
  • If tablets - how many? of what? everything they had?
  • Did you take any alcohol or drugs before or during the event?
  • What did you think would happen? Did you expect to die?
  • Did any part of you want to live
  • How were you discovered? Did you seek help youself?

Now/Future

  • How do you feel about what happened?
  • Do you regret anything?
  • Has anything changed for you between now and then?
  • How do you see the future?
  • Do you plan on doing something like this again?
  • If not what will happen if x trigger occurs again?

Risk

  • Have you ever tried to harm or kill yourself before?
  • Have you ever been seen for a mental health problem by a professional?
    • History of depression?
  • Do you have anyone who you can talk to about your worries? Who is at home with you?
  • Is there anything going on in your life that is causing you a lot of stress/worry? Relationships/finances/work/health?
  • Screen for depression/substance misuse
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6
Q

Behavioural and Psychological Symptoms in Dementia - Assessment

A
  • Start with open questions
  • Existing diagnosis? History?
  • Onset and progression?
  • Trigger/link with anything>
  • ABC of behaviours

Differentials

  • Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers?
  • Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself?
  • Medication - any recent changes to medication?
  • Environmental - any changes to staff, routine, activities, visitors?
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7
Q

Wandering History - Dementia (Carer)

A
  • When did this begin?
  • How many episodes?
  • Getting more frequent?
  • Daytime/ night-time?
  • Does she go for a walk every day?
  • Where does she go? Same place? Doing what?
    • Drinking/spending lots of money?
  • Who has been bringing her back and at what time?
  • Medical history?
  • Medications?
  • Risks:
    • To self - Crossing roads/falls
    • To others - Agression to others/disinhibition
    • From others - Exploitation by others including carers
    • Neglect - not taking medications? Eating and drinking? Exposure?
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8
Q

Dementia - History Taking

A
  • Onset of problem, any trigger, progression - gradual or stepwise?
  • 5As - memory, skills, disorientation, speech, personality
    • Memory
      • Misplaces things?
      • Forgets appointments?
      • What about the past?
    • Disorientation:
      • Muddled up with day and dates?
      • Gets confused at times?
      • Difficulty recognising people?
    • Speech:
      • Difficulties word finding?
      • Able to follow conversations?
  • Differential:
    • Low in mood before the onset of problems? (pseudementia due to depression)
    • Visual hallucinations? Movement difficulties? Falls? Fluctuating? (suggests LBD)
    • Cardiac risk factors - HTN, diabetes, hypercholesterolaemia, CVD? (suggests vascular)
    • Increased apathy? Impulsivity? Irritability? Insight? - (suggests frontal lobe)
  • Impact on functioning?
    • What is he having difficulties with?
      • Dressing, washing/toilet, walking, shopping, cooking, transport, finances?
  • Risk
    • Are there concerns about his behaviour?
    • Risk to self:
      • Episodes of wandering
      • Falls
      • Accidents due to fire/flooding at home?
    • Risk to others:
      • Episodes of aggression?
    • Risk from others:
      • Risk of exploitation/abuse by caregivers
  • Physical health
  • Past psych history
  • Medications
  • Drugs/ETOH
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9
Q

Mini Mental State Examination (MMSE)

A
  • Orientation:
    • Year, season, month, date, time
    • Country, town, district, hospital, ward
  • Registration:
    • I would like you to remember three objects and repeat them to me immediately, then again in 5 minutes:
      • Apple, table, penny
  • Attention and Calculation:
    • Can you spell the word WORLD for me?
    • Could you spell it backwards?
  • Recall:
    • Please repeat the three words I told you earlier back to me
  • Language:
    • Please name the objects I point at (pen, watch)
    • Please repeat the phrase: ‘no ifs, ands or buts’
    • Please follow my instructions (three stage command):
      • Place the index finger of your right hand on your nose, on your forehead then on your ear
    • Can you please read this sentence and do what it says: write ‘close your eyes’ on a piece of paper.
    • Could you give me a sentence with a subject and a verb
  • Copying:
    • Draw two intersecting pentagons and then ask patient to copy

Scoring:

24-30 = no cognitive impariment

18-23 = mild cognitive impairment

0-17 = severe cognitive impairment

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10
Q

Delerium - Assessment

A
  • Clarify presenting complaint
    • Onset and duration?
    • Fluctuating with time of day?
    • Aware of surroundings?
    • More alert or subdued?
  • Possible causes:
    • Any underlying medical conditions?
    • Seen recently by GP
    • Any new medications
    • Elimination
      • Complaints of constipation?
      • Difficulties PU? New odour, pain or increased frequency?
  • Comorbid psychiatric symptoms
    • Mood over the past 2 weeks?
    • Decreased interest in doing things recently?
    • Changes in appetite or sleep?
    • Responding to things that aren’t there?
    • More suspicious than usual?
  • Risk:
    • More agitated than usual?
    • Done anything to risk harming himself or others?
    • Wandering?
  • Underlying memory issues:
    • Prior to onset of confusion how was memory?
      • Issues with short term memory? Long term?
    • Word finding difficulties?
    • Not orientated to time?
    • Not recognising people?
  • Functioning and ADLs?
    • Grooming, dressing and finances?
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11
Q

Behavioural and Psychological Symptoms in Dementia - Assessment

A
  • Start with open questions
  • Existing diagnosis? History?
  • Onset and progression?
  • Trigger/link with anything>
  • ABC of behaviours

Differentials

  • Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers?
  • Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself?
  • Medication - any recent changes to medication?
  • Environmental - any changes to staff, routine, activities, visitors?
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12
Q
A
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13
Q

ADHD - History Background

A
  • Age?
  • Current education?
  • Onset of problems? How long for? (ADHD >6 months and onset before age of 7)
  • Birth/developmental issues?
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14
Q

Tics - Assessment

A
  • Age?
  • Known to CAMHs?

For both motor and vocal

  • Description
    • Motor where? simple or complex?
    • Vocal what? simple (sounds) or complex (words/phrases)
  • Onset? Any indentifiable event linked?
  • Frequency and severity
  • Duration? Periods free and for how long for?
  • Triggers/exacerbators?
  • Obscene gestures of words (copropraxia/lalia)
  • Any funny feelings before tics?
  • Able to consciously suppress?
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15
Q

Autism Assessment - Core Symptoms - Abnormal Reciprocal Social Interactions

A
  • Do they make eye contact when being spoken to?
  • Reciprocates when hugged?
  • Does he come to you when hurt?
  • Able to make friends with other children?
  • Can he play games and share toys with other children?
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16
Q

Autism Assessment - Core Symptoms - Communication Problems

A
  • Any difficulties using language?
  • Able to sustain a conversation?
  • Delay in speech/first words?
  • Tends to repeat things?
17
Q

Autism Assessment - Core Symptoms - Restricted, stereotyped or repetitive behaviour

A
  • Any unusual interests?
  • Any unusual interactions with toys?
  • Able to have imaginative play?
  • Does he do anything repeatedly?
  • Any rituals?
    • Repetitive movements? e.g. hand flapping
    • How does he react to changes in his environment/routine?
  • Sensitivity to certain stimuli?
18
Q

Autism Assessment - Developmental History

A
  • How was the pregnancy? Any complications before/during/after?
  • Did he meet developmental milestones?
    • When did he first smile, turn over, crawl, sit and walk?
  • Any skills he used to have he has now lost?
  • Any unusual physical characteristics?
  • Past medical history? Any history of seizures or head injury?
  • Has he had his hearing and vision checked?
19
Q

Autism Assessment - Comorbidities

A
  • How has mood been recently? Any loss of interest in things he used to enjoy?
  • Any things he is specifically afraid of?
  • How has sleep and appetite been?
  • Any agressive behaviour to others? Any self-harming behaviour?
20
Q

Conduct Disorder - Assessment D

A

Defiance

  • Frequently argumentative?
  • Violated set rules by adults?
  • Staying out after dark? Running away? Truanting?
  • Evidence of stealing?
  • Involvement in any crimes?
  • Relationship with peers?
21
Q

Conduct Disorder - Assessment Core AVD

A

Aggression/violence

  • Getting into fights?
  • Physically agressive to others?
  • Sexually coercive?
  • Cruel to others/animals?

Destruction of property

  • Any incidents of deliberately destroying things?
22
Q

Conduct Disorder - Assessment Risk Factors

A
  • Family history of mental health problems?
  • Crimes/substance use in family?
  • Financial situation at home?
  • Severe physical/verbal punishments when growing up?
23
Q

Conduct Disorder - Differentials/Comorbidities

A
  • How has mood been recently? Any loss of interest in normal things they used to enjoy?
  • Any evidence of increased anxiety?
  • Can they focus on things? Are they always on the go? Do they interrupt a lot?
  • Problems during infancy/growing up?
  • What was previous academic perfomance like? Always struggling? Paricular areas?
  • Any possibility using alcohol or drugs at the moment?
24
Q

Conduct Disorder - Follow-Up Qs

A
  • Impact - at home, at school, socially, bullying?
  • Past psych history
  • Past medical history
  • Medication