History + Examination Flashcards
1
Q
What would be included in PC + hPC?
A
- They may want to tell you their story before you start asking questions
- Think about each symptom described - when did it start, or if chronic when were they last better? Is it getting better or worse or stable? What are the triggers?
- Systems review - depression, anxiety, psychosis, mania, self harm, memory/cognition
2
Q
What would you include in the past psychiatric history?
A
- When were they last well?
- Treatment from GP
- Contact with mental health services - do they have a care coordinator
- Previous admission to psychiatric ward - informal or detained, sectioned
- Self harm?
3
Q
What is included in the PMH?
A
- Thyroid
- Epilepsy
- Head injury - LOC, post traumatic amnesia or epilepsy
- CV risk and diabetes
4
Q
What do you include in a drug history?
A
- Which medications are taken or if they can’t remember, what are the medications for?
- Any recent changes?
- Any past psychotropics?
- Concordance
- How is medication given? Self/carers/blister packs etc
- Any allergies
- Non prescribed: OTC, illicit, alcohol
- Features of dependence: craving, tolerance, withdrawal, salience, narrowing of repetoir, loss of control and re-instatement despite harm
5
Q
What do you include in the FH?
A
- Open questions e.g. ‘Tell me about your mother’
- Parents, siblings, significant others - age, occupation, relationship, health
- Does anyone in their family have mental health problems?
- Personal so approach subject carefully/slowly
6
Q
What is included in personal history?
A
- Where does personal history begin - were they a planned pregnancy?
- Where were they born - any known birth traumas?
- Developmental milestones
- Who provided childcare preschool - parents, nannies
- How did they do at school - social and academic achievements
- Any problems at school - bullying, behavioural problems, CAMHS
- Employment - is there consistency, causes for any change, how is their performance, do they get on with colleagues
- Current relationships - changes, breakdown
- Trauma
- Any children
7
Q
What should be covered in SH?
A
- Current living arrangements
- Job
- Finances
- Hobbies
- Social contacts
- Activities of daily living
- Drugs and alcohol - do they feel like they’ve lost control, pattern to it
8
Q
What is included in the forensic history?
A
- Any contact with the police - cautions, charges, convictions
- Prison?
- Patient view on impact on others involved
9
Q
What is pre-morbid personality?
A
Before all these issues or between episodes:
- How do you see yourself?
- How might others see you?
- Encourage both positive and negative points
10
Q
What sections are in a psychiatric history?
A
- Demographics
- PC/HPC
- Past psychiatric hx
- PMH
- DH
- FH
- Personal hx
- SH
- Forensic hx
- Premorbid personality
- Insight
11
Q
What are the sections included in a mental state examination?
A
- Appearance + behaviour
- Speech
- Mood
- Thoughts
- Perceptions
- Cognitions
- Insight
12
Q
What do you look at in appearance and behaviour?
A
This takes place from the first meeting and throughout the interview. In general consider:
- Kempt: dress, physical appearance, facial expressions, neglect
- Behaviour: normal, suspicious, paranoid, irritable, aggressive, preoccupied, distractible, withdrawn, abnormal movements
- Conscious levels, intoxication, engagement with interview (eye contact, rapport)
13
Q
What is examined in speech?
A
- Described in terms of its form, content and volume
- Reflects patients thoughts
- Form of speech - rate, rhythm + fluency of speech, can also comment on presence or absence of formal thought disorder
- Content of speech - what a person actually says (their thoughts)
14
Q
What do you examine in the patients mood?
A
- Nature e.g. anxious, depressed, euthymic etc) + affect/variability (lability, incongruity, flatness/blunting)
- Often described in terms of elevated or depressed mood
- Ask the patient to describe their mood subjectively and you describe objectively
- Important to enquire about other mood states e.g. anxiety + panic
- Cover key features of a mood disorder - subjectively their mood (rate 1-10), energy (depression vs mania), enjoyment
- Sleep, appetite, libido + concentration
- Ask how they feel about their future (biological syndrome) e.g. hopelessness
- Self harm, suicide - ‘Have you had any plans?’
15
Q
What is included in form of thoughts?
A
- How it’s being said
- Poverty (thought process is slow), pressure + total loss of association (one thought does not match the other)
- Coherence, preoccupation
- Flight of ideas, blocking, loosening of associations (Formal Thought Disorder)
- Circumstantiality - wandering around the topic
