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Yr4 - Psych > History and Examination > Flashcards

History and Examination Flashcards

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1
Q

Key features of a psych history

A 
History of presenting complaint
Past psychiatric history
Sociodemographic details
Past medical history
Medication history
Family history
Personal history
Pre-morbid personality
Mental state exam
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2
Q

Features of personal history

A 
Infancy and early childhood
- normal pregnancy
- developmental milestones
- who live with
Adolescence and education
- experience of school
Occupational record
Sexual development/relationships
- first relationship
Alcohol/drugs
Forensic
- police contact, prison, etc
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3
Q

Features of mental state exam

A 
Appearance and behaviour
Speech 
Mood
- subjective
- objective
Thought
- form
- content
Perceptions
Cognition
Insight
? Risk
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4
Q

Features of appearance and behaviour

A

Well kempt/unkempt
Eye contact - appropriate, sustained, intense
Level of rapport
Psychomotor retardation - significant slowing of speech and body movement
Psychomotor agitation - noticeable and marked increase in body movements
Distracted, responding to unseen stimuli

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5
Q

Features of speech

A

Comment on rate, rhythm and volume/tone - if normal state normal RRV
Evidence of formal thought disorder - can you follow flow
- circumstantiality - organised but over inclusive eventually gets to point in painstakingly slow manner
- tangential - occasional lapses, sudden change and never returns
- loosening of associates - frequent lapses between thoughts
- word salad - incomprehensible speech
- neologisms - words created by patient
- flight of ideas - flow extremely rapid but connections remain intact

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6
Q

Features of mood

A

Subjective
- how to they describe mood - mood scale
Objective
- low, expansive, euphoric, euthymic (normal)
- describe affect - emotional responsiveness
- blunted - decrease in amplitude of emotional expression
- flat - virtually complete absence of affective expression
- inappropriate - emotions expressed are not congruent with content of patients thoughts
- labile - unpredictable shifts in emotional state

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7
Q

Features of thought

A 
Form
- delusion
- over-valued idea, paranoid ideation
- obsessive rumination
- obsessive intrusive thought
- phobia
Content
- who thought relates to - spouse cheating (content) could be any form
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8
Q

Features of perception

A

Illusion - misinterpretation of sensory stimulus that can occur in any sensory modality
Hallucination - perceiving sound, sight, taste, smell or touch in absence of external sensory stimuli that seem indistinguishable from experience in reality
Depersonalisation - sense one is outside his/her self
Derealisation - vague sense of unreality in one’s perception of the external world

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9
Q

Features of cognition

A

Comment on orientation to time, place and person

- normal = oriented to time, place and person not formally tested

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10
Q

Features of insight

A

Persons understanding of their experience

  • do they believe they are unwell
  • do they believe they have a mental disorder
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11
Q

Features of risk

A

Risk to self harm - self-harm, suicide, self neglect
Risk to health - worsening mental illness, deteriorating physical health
Risk to others - paranoid delusions, command hallucinations

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12
Q

Define suicide

A

Fatal act of self injury, undertaken with more or less conscious self-destructive intent, however vague and ambiguous

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13
Q

Define para-suicide

A

Similar to suicide but victim survived the attempt

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14
Q

Define deliberate self harm

A

Act of self harm where action was not with the intention of death but to cause harm

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15
Q

Risk factors for suicide

A 
Being male
Living alone
Unemployment
Drug and alcohol misuse
Mental illness
Chronic physical illness
Past self harm
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16
Q

Clinical variables for suicide for mood disorders

A 
Greater severity of illness
Self neglect
Hopelessness
Alcohol abuse
Impaired concentration
History of suicidal behaviour
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17
Q

Clinical variables for suicide for schizophrenia

A 
Positive psychotic symptoms
Post psychotic depression
Young and male
First decade of illness
Relapsing pattern of illness
Recent discharge from hospital
Social isolation
Good insight into illness
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18
Q

Clinical variables for suicide for alcohol abuse

A 
Male sex
Longer duration of problems
Single/divorced/widowed
Multiple substance abuse
Co-morbid depressions
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19
Q

Clinical variables for suicide for chronic physical illness

A

Patients with chronic neurological, GI, CVS and cancer
Severe chronic pain leads to increased risk
Disfigurement
Chronic physical illness -> loss of job, role, family, money

20
Q

Features of deliberate self-harm

A 
Behaviour self-initiated
- harm is intended 
- results in injury of harm
Two main types
- self-poisoning
- self-injury
21
Q

Associations with repeated self harm

A 
Previous self-harm/psychiatric contact
Alcohol/drug misuse
Unemployment/social class
Hx of trauma, sexual or physical abuse
Criminal record/history of violence
Single/divorced/separated
Family hx
22
Q

Motivations underlying DSH

A

Wish to die, cry for help, communication with others, unbearable symptoms
Psychological characteristics
- impulsivity, cognitive rigidity, problem-solving deficits, hopelessness
Coping mechanism
- temporary relief of anxiety, stress, emotional numbness, sense of failure

23
Q

Features of a risk assessment

A 
Psychiatric examination
- protective factors
- risk factors 
     - dynamic/static
     - modifiable risk factors
- specific suicide inquiry
Risk level - low, med, high
24
Q

Hx for overdose

A 
Triggers
Preparation - planning, final acts
Circumstances - alone, precautions against discovery, alcohol, what did they think would happen
After act
- seek help, regret failure, intent
Psych history
Ideation, intent and plans
25
Q

Risk management

A 
Treat psychiatric disorder
As an inpatient
- closer supervision
- adherence to treatment
- staff numbers
- staff training
- safe environment
26
Q

Risk to others

A

DPSD, alcohol/drug misuse, schizophrenia - cause small increased to others - but not affective disorders
Risk increased by
- specific persecutory delusions or hallucinations
- command auditory hallucinations

27
Q

Define capacity

A

Ability to make a decision

  • can involve personal welfare, healthcare and financial decisions
  • empowers adults to make as many decisions as possible
28
Q

Features of Mental Capacity Act 2005

A

Presumption of capacity at all times
- right to make unwise decisions
Single test of capacity
Legal right to support individuals in making own decision
Anything done for on behalf of people without capacity should be the least restrictive of their freedom and/or rights
- done in their best interests

29
Q

Features of testing capacity

A

Is there an impairment of, or disturbance in the functioning of the persons mind
Has it made the person unable to make a particular decision
Must be able to understand relevant information for the decision
- information must be retained long enough to make the relevant decision
- should be able to use/weigh information
- information must be believed
- must be able to communicate decision
Time and issue specific

30
Q

Key features of understanding capacity

A

Understand information
Retain information
Use/weight up information
Communicate decision

31
Q

Features of acting in best interest

A

Patient should participate even if lacking consent
If patient will regain capacity it may be appropriate to wait
Decision maker must ascertain and consider patients past and present wishes and feelings

32
Q

Features of advance decisions

A

Only relates to medical treatment
Only in the negative - to refuse medical treatment of a specific type
Cannot require a doctor to provide a treatment
Person must be over 18 and have capacity at the time
- may be withdrawn or altered orally if person still has capacity

33
Q

Features of lasting powers of atterny

A

Must be made on prescribed form and registered with Public Guardian
Enables mentally capable person to plan for incapacity
Can appoint one for property, welfare and healthcare matters
Decisions taken by attorney are still subject to best interest requirements

34
Q

Features of deprivation of liberty safeguards

A

For patients in hospital or care homes who lack capacity
MDT assessment lead by social workers
Prevent patients leaving but on set grounds - like visits x times a week

35
Q

Features of Mental Health Act 1983

A

Can only be used to enforce treatment for mental health conditions

36
Q

Guiding principles of MHA

A

Minimise undesirable effects of mental illness
Least restrictive
Participation of patient and NoK
Equity, effectiveness and efficiency

37
Q

Criteria for implementing the MHA

A

Presence of mental disorder as defined by law
Disorder is of certain nature of degree
Significant risk to the persons health, safety or safety of others
No alternative to hospital admission as means of safeguarding that risk

38
Q

Features of section 5(4) of MHA

A

Power granted to RMNs to detain an inpatient for up to 6 hours for medical assessment where medical illness is suspected
Form to be completed - pink paper
Forms submitted to hospital managers
Must be admitted to hospital - A&E does not count

39
Q

Features of section 5(2) of MHA

A

RMO or nominated deputy can detain an inpatient for up to 72 hours under the mental health act
No appeal
Legal form for hospital managers
To allow formal mental health act to be completed
Must be admitted to hospital - A&E does not count

40
Q

Features of section 2 of MHA

A

2 doctors - at least 1 of whom should be section 12(2) approved (reg/con psychiatrist)
1 AMHP - approved mental health practitioner
Community or inpatient - anywhere except prison
Section for maximum of 28 days for assessment and treatment of mental disorder
Appeal within first 14 days - heard within 7 days
Can be discharged at any point - con or NoK

41
Q

Features of section 3 of MHA

A

2 doctors - at least 1 of whom should be section 12(2) approved (reg/con psychiatrist)
1 AMHP - approved mental health practitioner
Community or inpatient - anywhere except prison
Section for maximum of 6 months for treatment of a mental disorder - can be renewed for another 6 months
1 appeal to both hospital managers panel and tribunal

42
Q

Features of section 136 of MHA

A

Police power to remove to a place of safety from a public place for an assessment by an AMHP and 1 doctor
Held up to 72 hours to allow assessment
Police stay with person
Must be public place - not own home

43
Q

Features of section 17 of MHA

A

Whilst detained in hospital under S2,S3 a patient may leave under S17
Leave to walk outside, go home, for several hours or overnights or longer

44
Q

Features of section 117 of MHA

A

Anyone who has been on section 3 is entitled to S117 aftercare from local authority for rest of life

45
Q

Features of community treatment order

A

Patient on S3 can be considered for a CTO
Patient is well enough to leave hospital but may default from treatment/follow up
Treatment is necessary for the patients health, safety or protection of others
Patient can be recalled to hospital if they do not comply with treatment, attend appointments etc
Can still appeal to tribunal

46
Q

Features of section 135 of mental health act

A

Used by police to assess and remove a person from their home if it is suspected they are suffering from a mental health disorder

Yr4 - Psych (13 decks)

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