History

Question 1

What are the components of the psychiatric history?

Answer 1

• Introductions
• Reasons for referral
• Presenting complaint
• ICE
• Past psychiatric history
• Past medical history
• Drug history
• Family history
• Personal history
• Social history
• Premorbid personality

Question 2

What should be asked in reason for referral?

Answer 2

When was the patient admitted?

Why was the patient admitted?

Who was involved in the patient’s admission?

Voluntary or sectioned?

Question 3

What should be asked about presenting complaint?

Answer 3

“When did you realise things had changed?”

“How has this affected your life?”

“Any fluctuations in the way you’ve been feeling?”

Screen for depression, psychosis and suicidal ideation.

Question 4

Which questions to screen for depression?

Answer 4

Low mood

Anhedonia

Anergia (“describe your energy levels”)

Question 5

Which questions to ask about psychosis?

Answer 5

Any specific worries at the minute? (persecutory delusions)

Do you ever see or hear things that other people are unable to see or hear? (visual / auditory hallucinations)

Are the voices talking to you or about you? (auditory hallucinations)

Question 6

How to ask questions about anxiety disorders?

Answer 6

Would you say you’re an anxious person? (generalized anxiety)

Do you ever suffer from chest pain / SoB / palpitations / sweating / tremor? (panic attacks)

Do you have fears that others see as irrational (phobias)

Do any thoughts or worries keep coming back to your mind even though you try to push them away? (obsessions)

Question 7

What to ask about in past psychiatric history?

Answer 7

Previous psych diagnoses?

MHA implemented?

Previous treatments or hospital stays?

Question 8

What’s important to ask about in past medical history?

Answer 8

• Head injuries
• Cranial surgery
• Epilepsy
• thyroid disease

Question 9

What personal history should be asked for (predisposing factors)?

Answer 9

• Birthing complications?
• Developmental milestones (walk and talk at right age)?
• Childhood illness?
• What is your earliest memory?
• Childhood abuse?
• School? Mainstream? Bullied? Finish school?
• Employment history?
• Relationship history?
• Forensic history?

Question 10

What should be asked in social history?

Answer 10

• Accommodation (state of housing, heating, living conditions)
• Social support
• Financial circumstances
• Hobbies / leisure

Question 11

What is a mneumonic for the MSE?

Answer 11

ASEPTIC

Appearance

Speech

Emotion (mood)

Perception

Thoughts

Insight

Cognition

Question 12

What to comment for appearance and behaviour?

Answer 12

• Physical state: age? ethnicity? Physically unwell? Weight? Extrapyramidal side effects?
• Clothing? flamboyant or dirty?
• Personal hygiene? Self-neglect?
• Eye contact? staring in parkinsons or averting gaze in depression
• Body language? Relaxed, tense or withdrawn
• Motor activity? slow? agitated?

Question 13

What to comment for speech?

Answer 13

• Rate
• Rhythm: normal or flattened?
• Volume
• Content: excessive punning? monosyllabic? only in answers to questions?
• Quantity
• Dysarthria (disorder in articulating speech)

Question 14

What to comment on in mood and affect?

Answer 14

• Mood: subjective and objective
• Affect: flat, restricted, appropriate, stable/labile (‘reactive’ if no abnormalities)

Question 15

What is an incongrous affect?

Answer 15

e.g. schizophrenia who reports feeling suicidal with a happy facial expression

Question 16

What to comment on for thought?

Answer 16

• Content (delusions / preoccupations / obsessions)
• Form (derailment of thought / tangential thinking / word salad / circumstantiality / neologisms)
• Stream (pressured / flight of ideas / poverty of thought / thought blocking)

Question 17

What are the types of delusions?

Answer 17

Grandiose (e.g. chosen by god)

Persecutory (other people are conspiring against them)

Reference (random things have a special significance)

Guilt (one has done something shameful)

Hypochondrial (e.g. has a medical illness despite evidence otherwise)

Erotomania (an exhaulted person is in love with them)

Othello syndrome (thinks spouse is having an affair)

Capgras’ syndrome (familiar person has been replaced with duplicate)

Nihilistic (they are worthless or dying)

Infestation (one is infected by small organisms)

Folie a deux (delusional belief is shared between two people - usually from the same platform)

Delusional memory

Question 18

What to ask about in Thought?

Answer 18

• Form (loosening of association / circumstantiality / neologisms)
• Stream / flow (pressured speech / flight of ideas / retardation / thought blocking)

Question 19

What are schneider’s first rank symptoms?

Answer 19

• Delusional perception (true perception = false meaning e.g. sun coming down means chosen by god)
• 3rd personal auditory hallucinations
• Thought interference (insertion, withdrawal and broadcast)
• Passivity phenomenon (do you feel like your mood/actions are being controlled?)

Question 20

What to ask for perception?

Answer 20

• Hallucinations (perception in the absence of an external stimulus)

Question 21

What is a pseudohallucination?

Answer 21

Hearing voices inside your head, not a true external hallucination.

Question 22

When are visual hallucinations more commonly seen?

Answer 22

Organic brain disease / substance misuse

Question 23

How to assess cognition?

Answer 23

Orientated to time place and person?

MMSE, AMT

Impaired cognition usually seen in dementia and delerium