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Psychiatry > History & Examination > Flashcards

History & Examination Flashcards

1
Q

Name the components of a psychiatric history

A
  • History of presenting complaint
  • Past psych history
  • Past medical history
  • Drug history
  • Family history
  • Personal and social history
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2
Q

What should be included in the history of presenting complaint?

A

Clarify and quantify details of symptoms - onset, character, associated symptoms, timing, severity, exacerbating/relieving factors

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3
Q

How is the aetiology of psychiatric illness mapped out?

A 
Predisposing 
Precipitating 
Perpetuating 
Protective 
All of which are either physical, psychological, social
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4
Q

What are the components of a mental state examination?

A 
Appearance and behaviour 
Speech 
Mood and affect 
Thoughts
Perception
Cognition 
Insight
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5
Q

What aspects of patient appearance should be considered?

A

Age, gender, race, body habits, grooming, attire, posture, abnormal gait, odd movements (tics, tremor, stereotypes)
Injury/illness - self harm, abuse, fights, drug use signs
Smell - alcohol, urine, vomit, body odour

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6
Q

What aspects of a patients behaviour should be considered?

A

Eye contact, rapport, open/guarded/suspicious, agitation, psychomotor retardation - no movement, disinhibition/overfamiliarity

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7
Q

What aspects of a patients speech should be considered?

A

Rate - fast or slow, volume, delay
Amount - increased/pressured or decreased and monosyllabic
Variation in tone

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8
Q

Define flight of ideas

A

Jump from one topic to another using inappropriate links

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9
Q

What is thought broadcast?

A

Patient feels they are understood by others without talking - everyone knows their thoughts

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10
Q

What is thought insertion?

A

Thoughts are planted in a patients mind by someone else

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11
Q

What is thought withdrawal?

A

Patient’s thoughts are taken away from them - outwith their control

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12
Q

Define mood

A

Subjective - how the patient feels/says they feel

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13
Q

Define affect

A

Objective - how the patient appears, important to consider their baseline and how it varies

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14
Q

What is the name for normal mood?

A

Euthymic

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15
Q

What do labile and incongruous mean?

A

Labile - different emotions rapidly follow one another

Incongruous - expression fails to match thoughts/actions

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16
Q

State the factors that make up cognitive function

A

Orientation to time, place and person
Concentration
Memory - anterograde and retrograde

17
Q

What is insight?

A

Ability of the patient to recognise they are unwell and accept need for help

18
Q

What is a hallucination?

A

A perception which occurs in the absence of an external stimulus

19
Q

Name some types of hallucinations

A
  • auditory
  • visual
  • olfactory
  • gustatory
  • somatic
20
Q

What is a somatic hallucination?

A

Bodily sensations - feeling of insects under skin or being touched

21
Q

Describe a visual hallucination

A

Associated with altered consciousness/impairment
Simple - flashes of light
Complex - face or figure

22
Q

Which areas of the brain are affected in auditory hallucinations?

A

Supplementary motor area that monitors self generated actions
Hippocampus detects mismatch between perceived and expected activity

23
Q

Name three types of auditory hallucination

A

Second person - voice directly addresses patient
Third person - voices discuss the patient or provide running commentary
Thought echo - patients thoughts are spoken/repeated out loud

24
Q

Describe passivity phenomena

A

Behaviour is experienced as being controlled by an external agency rather than the individual - can affect thoughts/actions/feelings

25
Q

What abnormality can be seen on PET scan in passivity phenomena?

A

Parietal and cingulate cortices are abnormal - areas involved in interpretation of sensory information

26
Q

Define loosening of associations

A

Speech is muddles and difficult to follow - cannot be clarified, no information gained with jumps in topics and no logical connection

27
Q

What is neologism?

A

Patient makes up a new word/phrase with no accepted meaning but makes sense to the patient

28
Q

What is a delusion?

A

False belief inappropriate to socio-cultural background firmly held int he face of logical argument/evidence, very individualised

29
Q

Name some themes of abnormal beliefs

A
  • disease, poverty, sin, guilt seen in depression
  • control, religion, love, persecution in schizophrenia
  • grandiosity, religion, persecution in mania
30
Q

Define primary delusion

A

Appear suddenly, no preceding events - full conviction

31
Q

Define secondary delusion

A

Derived from a preceding morbid experience

Psychiatry (18 decks)

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