Common Psychiatric Histories - Psychosis

Question 1

Key areas to explore in psychosis

-how might you approach this topic

Answer 1

Delusions

• I understand that you feel that others are …
• do you have any beliefs that others don’t seem to share?

Hallucinations - auditory, visual, gustatory, tactile, olfactory

• have you seen things that other people can’t seem to see
• 2nd, 3rd person (running commentary?)
• commands?

Thought manipulation

• do you feel like others can put thoughts into/remove thoughts into your head
• do you feel like other people can read your thoughts

Somatic passivity
-do you feel like someone is controlling your emotions/actions

Question 2

Systemic review

-key areas you’d like to explore

Answer 2

General

• weight loss, night sweats, back pain - brain tumour/mets?
• fevers - neuro infection?
• recent head trauma - traumatic brain injury?

Psych

• high and low mood screen - bipolar, depression with psychotic features
• risk screen

Neuro

• memory, behaviour changes - cognitive impairment?
• seizures - temporal lobe epilepsy?
• headaches - SOL?

Question 3

Past medical, psychiatric, drug, family history

-key areas you’d like to explore

Answer 3

Past medical history

• hospital admissions - cerebrovascular accident, head trauma
• thyroid disease?,

Past psychiatric history - have they been under the care of mental health services in the past

Medications

• steroids, dopaminergics
• stimulants, alcohol, cannabis

Family history
-any physical or psychiatric conditions in the family?

Question 4

Social history

-key areas you’d like to explore

Answer 4

Living

• who’s with them at home
• dependents?
• carers?
• impact on symptoms on ADLs

Occupation

• are they working? impact of symptoms on work?
• if not, how are they managing financially

Substances
-alcohol, smoking, recdrugs - are they contributing to her psychosis?

Forensic
-have you had any police involvement in the past?

Question 5

Possible differentials

• organic
• non organic

Answer 5

Organic
Substance related
-alcohol withdrawal
-cannabis induced
-corticosteroid/dopaminergic medication induced

Medical - neuro

• temporal lobe epilepsy
• head trauma
• brain mets/tumour/SOL
• delirium
• CVA related
• dementia, PD, HD

Medical - other

• thyrotoxicosis
• SLE

Non organic

• schizophrenia
• schizoaffective
• bipolar with psychotic features
• depression with psychotic features

Question 6

Investigations you’d consider

Answer 6

Aim - rule out organic causes first
Cognitive impairment - MMSE, GPCOG

FBC, CRP, ESR - infective/inflammatory causes
HbA1c, glucose - hyperglycemia
U&E - contributor to delirium?
Thyroid function - thyrotoxicosis
Vit B12, folate - required for nerve and brain functioning

EEG - temporal lobe epilepsy