history and exam

Question 1

what are the components of a mental state exam

Answer 1

Appearance: washed? Tired? Kempt? Weight?

Behaviour: rapport? Eye contact? Engaged? Fidget? Moving? Psychomotor retardation? Verbally responding? Agitated?

Speech: speed? Rate? Rhythm (number pauses)? Volume? Tone?

Mood: objective? Subjective? Congruent? Normal= euthemic

Thoughts: Form- fixed? (shape-how they’re thinking it eg flight of ideas (move rapidly between topics-manic), knights move or tangential (thoughts connect strangely-psychosis), circumstantiality (ramble on-anxiety), Function? Suicide ideation? Delusions? Over valued ideas? Thought disorder?

Perceptions: hallucinations- do they respond to unseen stimuli? Type?

Cognition: orientation? Could do MMSE, attention and concentration and memory?

Insight: do you think you’re unwell? Can you look after yourself? Do you need help? - partial insight means they know they are unwell but want to manage themselves

Question 2

What should you ask about in a risk assessment?

Answer 2

risk to self? -neglect, self-harm or suicide? Drugs? Accidents? Non-compliance? Gambling?

Planned? Method? How much? What taken? Note? Affairs? Regret it?

• risk to being taken advantage of? Are they vulnerable? Sexually?
• risk to property? Arson? Damages? Forensic hx?

Risk to others? -forensic, accidents, aggression, dependents SAFEGUARDING

Question 3

What do you ask about in a suicide history?

Answer 3

• current thoughts
• planning
• intent
• future planning
• protective factors

Question 4

What is the biopsychosocial model?

Answer 4

Evaluate the patient using the 4 Ps: predisose, precipitate, perpetuate and protective.
eg biologically predisposing are genetics, precipitating is illness or drugs and perpetuating is illness.

psychologically predispose are IQ, personality, precipitate is trauma and perpetuate is hopelessness.

Socially predisose is family, marital status and social class, precipitate is unemploment or divorce and perpetuate is ongoing unemployment, protective is children.

Question 5

What is different from a normal history and a psychoatric history?

Answer 5

Personal history- relationships, childhood and growing up, developmental milestones, school, academics, jobs and forensic history