History & Examination Flashcards
Name the components of a psychiatric history
- History of presenting complaint
- Past psych history
- Past medical history
- Drug history
- Family history
- Personal and social history
What should be included in the history of presenting complaint?
Clarify and quantify details of symptoms - onset, character, associated symptoms, timing, severity, exacerbating/relieving factors
How is the aetiology of psychiatric illness mapped out?
Predisposing Precipitating Perpetuating Protective All of which are either physical, psychological, social
What are the components of a mental state examination?
Appearance and behaviour Speech Mood and affect Thoughts Perception Cognition Insight
What aspects of patient appearance should be considered?
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
What aspects of a patients behaviour should be considered?
Eye contact, rapport, open/guarded/suspicious, agitation, psychomotor retardation - no movement, disinhibition/overfamiliarity
What aspects of a patients speech should be considered?
Rate - fast or slow, volume, delay
Amount - increased/pressured or decreased and monosyllabic
Variation in tone
Define flight of ideas
Jump from one topic to another using inappropriate links
What is thought broadcast?
Patient feels they are understood by others without talking - everyone knows their thoughts
What is thought insertion?
Thoughts are planted in a patients mind by someone else
What is thought withdrawal?
Patient’s thoughts are taken away from them - outwith their control
Define mood
Subjective - how the patient feels/says they feel
Define affect
Objective - how the patient appears, important to consider their baseline and how it varies
What is the name for normal mood?
Euthymic
What do labile and incongruous mean?
Labile - different emotions rapidly follow one another
Incongruous - expression fails to match thoughts/actions
State the factors that make up cognitive function
Orientation to time, place and person
Concentration
Memory - anterograde and retrograde
What is insight?
Ability of the patient to recognise they are unwell and accept need for help
What is a hallucination?
A perception which occurs in the absence of an external stimulus
Name some types of hallucinations
- auditory
- visual
- olfactory
- gustatory
- somatic
What is a somatic hallucination?
Bodily sensations - feeling of insects under skin or being touched
Describe a visual hallucination
Associated with altered consciousness/impairment
Simple - flashes of light
Complex - face or figure
Which areas of the brain are affected in auditory hallucinations?
Supplementary motor area that monitors self generated actions
Hippocampus detects mismatch between perceived and expected activity
Name three types of auditory hallucination
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
Describe passivity phenomena
Behaviour is experienced as being controlled by an external agency rather than the individual - can affect thoughts/actions/feelings
What abnormality can be seen on PET scan in passivity phenomena?
Parietal and cingulate cortices are abnormal - areas involved in interpretation of sensory information
Define loosening of associations
Speech is muddles and difficult to follow - cannot be clarified, no information gained with jumps in topics and no logical connection
What is neologism?
Patient makes up a new word/phrase with no accepted meaning but makes sense to the patient
What is a delusion?
False belief inappropriate to socio-cultural background firmly held int he face of logical argument/evidence, very individualised
Name some themes of abnormal beliefs
- disease, poverty, sin, guilt seen in depression
- control, religion, love, persecution in schizophrenia
- grandiosity, religion, persecution in mania
Define primary delusion
Appear suddenly, no preceding events - full conviction
Define secondary delusion
Derived from a preceding morbid experience
