GENERAL CLINICAL ASSESSMENT

Question 1

What are the 9 components of a psychiatric history?

Answer 1

1. Presenting complaint
2. History of presenting complaint
3. Past psychiatric history
4. Medical history
5. Family history
6. Personal history
7. Social history
8. Forensic history
9. Pre-morbid personality

Question 2

What is included in a forensic history?

Answer 2

Criminal activities

Question 3

What is included in the pre-morbid portion of the history?

Answer 3

How patients see themselves when well. How they think others see them.

Question 4

What are the 8 components of a mental state examination?

Answer 4

• Appearance and Behaviour • Speech • Mood • Perceptions • Thought Form • Thought Content • Cognition • Insight

Question 5

What are the componen of mood examination (2)?

Answer 5

– Subjective • Prevailing state or disposition • Patient’s description of mood: ‘low’ ‘high’ ‘worried’ • Include anxiety symptoms here – Objective • Affect: observed external manifestation of mood • Reactive (normal), labile, flattened or blunted

Question 6

What are the three important changes in perception?

Answer 6

• Sensory distortion
  
  • Intensity or quality of perception. Hyperacusis, visual hyperaesthesia
• Illusion
  
  • A misperception of a real object/stimulus –
• Hallucination
  
  • A perception without an object • In all five sensory modalities – Auditory most common – Visual in delirium tremens – Olfactory and gustatory more likely

Question 7

What are the 4 key components of thought form?

Answer 7

• Acceleration – flight of ideas

• Logical connection between each sequential idea

• Circumstantial

• Important facts not differentiated from detail (too muchinformation)

• Loosening of associations/derailment

• Loss of logical connections between sequential ideas

• Thought blocking

• Sudden stop in thought flow, as though ‘removed’

Question 8

What are the 3 key components of thought content?

Answer 8

• Obsessions
• Recurrent, intrusive, usually unpleasant thoughts, that the person recognises as their own and tries to resist
• Overvalued idea
• An acceptable, comprehensible idea pursued by the person beyond the bounds of reason and causes distress ordisturbed functioning
• Delusion

• A false (usually), unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background; it is held with extraordinary conviction and subjective certainty

Question 9

What is the difference between primary and secondary delusion?

What are the 3 main types of delusion

Answer 9

• Delusion
• Primary: not occurring in response to another psychopathology (e.g. mood disorder)
• Secondary: the delusion is understandable in the present circumstances (e.g. severely depressed mood)
• Types of delusions help with differential diagnosis:

1. • Paranoid
2. • Grandiose
3. • Nihilistic

Question 10

What is the key component of the social history?

Answer 10

Drug and alcohol use