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Psychiatry > History Taking > Flashcards

History Taking Flashcards

1
Q

4 key features of psych history

A

History
MSE
Selective PE
Collateral info

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2
Q

Appearance expansion

A
  • Attire
  • Signs of Self neglect
  • Facial Expression
  • Scars / Tattoos / Self Harm or Abuse
  • Physical Disease signs - Jauncice, exophalamous, spider naevi
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3
Q

Behaviour MSE

A
  • Cooperation, rapport, eye contact
  • Social Behaviour - aggression or disinhibition
  • Overactivity - agitation or compulsions
  • Underactivity - stupor or motor retardation
  • Abnormal activity - posturing, involuntary movements, quick glances or distraction
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4
Q

Speech MSE

A
  • Articulation - stammer or dysarthria
  • Quantity - mutism or garrulousness
  • Rate - Pressured or slowed
  • Volume - Whispering or shouting
  • Pressure - Mania
  • Slurred or clear
  • Tone and Quality - accent or emotionality - montonous
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5
Q

Clang associations

A

Thought connected by their similar sound rather than meaning

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6
Q

Echolalia

A

Repetition of the interviewers words

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7
Q

Mutism

A

absence of speech without impaired consciousness

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8
Q

Neologism

A

An invented word

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9
Q

Word salad

A

loss of meaningful words, usually loss of grammatical inaccuracy

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10
Q

Blunting

A

loss of normal emotional sensitivity to experiences

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11
Q

Catastrophic reaction

A

An extreme emotional and behavioural over-reaction to a trivial stimulus

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12
Q

Flattening

A

Loss of the range of normal emotional responses

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13
Q

Incongruity

A

A mismatch between the emotional expression and the associated thought

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14
Q

Lability

A

Superficial rapidly changing and poorly controlled emotions

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15
Q

Subjective vs objective

A

Low, euthymic, high

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16
Q

Circumstantiality

A

Trivia and digressions disrupting the flow but not the direction of thought

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17
Q

Concrete thinking

A

Inability to think abstractly

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18
Q

Flight of ideas

A

Rapid shifts from one idea to the other

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19
Q

Loosening of associations

A

logical sequence of ideas is impaired

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20
Q

Perseveration

A

Inability to shift from one idea to the next

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21
Q

Pressure of thought

A

Increased rate and quality of thoughts

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22
Q

Linear, circumstantial and tangential

A

Circu (long winded story but gets back to point) / Tangential (Goes off on tangent and does not come back to main point)

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23
Q

Clanging

A

similar sounding words linking thoughts

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24
Q

Punning

A

different definitions of the same word linking thoughts

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25
Q

Hypochondriasis

A

Unjustified belief in suffering from a particular disease in spite of examination and reassurance

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26
Q

Morbid thinking

A

Depressive ideas - guilt, burden and unworthiness

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27
Q

Phobia

A

Senseless avoidance of a situation causing irrational fear

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28
Q

Preoccupation

A

Beliefs that are not that abnormal but start to dominate the patients thinking

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29
Q

Ruminitions

A

Repetitive, intrusive and senseless thoughts

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30
Q

Obsessions

A

Ruminations that persist despite resistance.

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31
Q

Delusion

A

An abnormal belief held with total conviction

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32
Q

Delusional perception

A

A delusion that arises fully formed from the false interpretation from a situation - has a special meaning - e.g. red flashing light means devil is watching me.

33
Q

Magical thinking

A

Irrational belief that certain actions and outcomes are linked

34
Q

Overvalued ideas

A

Beliefs are held, valued and expressed more than normal for what should be.

35
Q

Thought broadcasting

A

Belief patients thoughts are heard by others

36
Q

Thought insertion

A

Belief patients having thoughts put into their head

37
Q

Thought withdrawal

A

Belief patients having thoughts put into their head

38
Q

Grandiose delusions

A

beliefs of exaggerated self-importance

39
Q

Delusions of reference

A

objects, events or people have a significant relevance - comment on Tv is directed to them alone

40
Q

Delusion of guilt

A

Ungrounded feeling of remorse or guilt of delusional intensity

41
Q

Delusional jealousy

A

a psychiatric phenomenon in which an individual has a delusional belief that their spouse (or sexual partner) is being unfaithful

42
Q

Munchauses biproxy

A

a mental illness and a form of child abuse. The caretaker of a child, most often a mother, either makes up fake symptoms or causes real symptoms to make it look like the child is sick.

43
Q

Persecutory delusions

A

believe someone or something is mistreating, spying on or attempting to harm them (or someone close to them).

44
Q

Nihilism delusions

A

Nihilism is the belief that nothing has any value or meaning. It can also include the belief that nothing really exists

45
Q

Cottard delusions

A

a belief that one has lost organs, blood, or body parts to insisting that one has lost one’s soul or is dead.

46
Q

Depersonalisations

A

Feeling unreal

47
Q

Derealisation

A

Surrounding environment is unreal

48
Q

Hallucination

A

False perception arising without a valid stimulus from the real world

49
Q

Types of hallucinations

A

Auditory
Command
Visual
Tactile
Gustatory or olfactory
Functional

50
Q

Functional hallucination

A

False perception arising from an unrelated stimulus - turning tap on and water is talking

51
Q

Illusion

A
  • False interpretation of a real stimulus but is understandable
52
Q

Pseudohallucination

A

False perception perceived as part of ones internal experience.

53
Q

Cognition subcategories

A

Level of consciousness
Memory
Orientation
Intelligence
Clouding of consciousness
Confabulation
Visuospatial processing

54
Q

Insight

A

The degree to which the patient agrees that they are ill.
Either they understand their abnormal experiences are abnormal or that they believe it to be normal

55
Q

Risk Assessment

A

Harming self
Harming others
Ending life

56
Q

MMSE

A
  • Mental Test Abbreviated
    • Age
    • DOB
    • Time
    • Year
    • Hospital name
    • Recognition of two people
    • Recall address
    • Dates of the covid 19 pandemic
    • Name of the monarch
    • Count backwards from 20
    • A score of 8/10 or less indicates confusion - each scoring 1 point if able.
57
Q

CAGE

A
  • Cut down - have you felt you should cut down drinking
  • Annoyed - have people annoyed you by criticising your drinking?
  • Guilty - Have you ever felt bad or guilty about your drinking?
  • Ever - do you ever have a drink first thing in the morning to steady you?
58
Q

HPC

A
  • Nature
  • Onset
  • Triggers
  • Exacerbating/relieving factors
  • Progression
  • Associated symptoms
  • Disability
59
Q

Mood

A

How are you feeling?
What is your current mood?
Have you been feeling low/depressed/anxious lately?
Appetite/weight
Concentration
Hopeful for future?
Is life worthwhile?
How have you been taking care of yourself while feeling like this – personal hygiene, taking care of responsibilities.

60
Q

Risk

A

Sometimes when people are going through difficult things, they might have thoughts of warning to harm themselves – is this something you’ve
experienced?
Have you ever thought about ending your life?
Have you ever felt your life was not worth living?
Have you ever attempted to end your life or harmed yourself to cope with difficult emotions?
Do you ever think about harming others?
Do you have any plans to act on those thoughts?

61
Q

Thought content

A

What’s been on your mind recently?
Are you worried about anything?
Do you sometimes have thoughts that others tell you are false?
Do you ever feel that people are out to harm you?
Do you have any beliefs that aren’t shared by others you know?
Do you ever feel like others can hear your thoughts?
Have you ever felt like people have removed memories or thoughts from your mind?
Do you ever think people can put ideas in your head without your control?

62
Q

Perception HT

A

Do you ever see, hear, smell or feel things that are not really there?
Did you think these thoughts were real at the time?
Do you still believe it was real?
Do you ever feel like you’re not real or the world around you isn’t real?

63
Q

Cognition HT

A

Cognition timeline
MMSE or ACE-III

64
Q

Insight HT

A

What do you think the cause of the problem is?
Ideas, concerns, expectations

65
Q

Past psychiatric history

A

Experienced symptoms like this before?
Diagnosed with mental health problem?
Previous treatments and effectiveness
Been admitted for mental health problem before? If so, dates (rough length), informal or sectioned, admitted to PICU?

66
Q

Past medical history

A

Do you have any medical conditions?
Are you currently seeing a doctor regularly?

Have you had any operations?

67
Q

Childhood, education and occupation

A

How would you describe your childhood?
What age did you leave school? What qualifications did you leave with?
Did you enjoy school?
What jobs have you had in the past?

68
Q

Relationships

A

Who are the important people in your life?
Do you feel you have a good social support system?

69
Q

Trauma

A

Have you experienced any physical, emotional or sexual abuse in your life?
Do you feel safe at home?
Are there any difficult family dynamics at home?

70
Q

Pre-morbid personality

A

How would you describe yourself?
How would others describe you?
Do you think this has changed recently?
Do you have any hobbies or interests?
Are you religious?

71
Q

Forensic history

A

Have you had any contact with the police?
If yes, what happened? Were you charged?
Have you spent any time in prison?

72
Q

Social history

A

Where do you live currently?
Do you live with anyone else?
(Are they any children at home)? – ages and gender
How are you coping at home at the moment?
Do you feel able to look after yourself?
Do you have any worries at the moment about your living situation?
Thinking about the future, sometimes people have specific views about where they want to live or wouldn’t want to live. If things got more difficult for
you at home, is it important you stay in your own home or would you be ok with moving to somewhere else e.g. supported living or a care home if
you weren’t managing at home?
Occupation – Part time or full time? Stress levels and anything happening at work. Unemployed? – Benefit payments on time?
Hobbies – Do they still do things they enjoy or have they stopped
Social events – Do they still attend social occasions with friends or family?
Do they still make contact with close friends or family

73
Q

Drugs

A

Do you drink alcohol? (How much, how often, type and who with)
Do you smoke?
Do you use recreational drugs?

74
Q

Eating disorder

A

Periods of purging?
Laxative use? How much / often?
Ideal weight?

Any food that they will eat?
Any food been restricted specifically?
Pattern of restriction
Exercise
When started – gradual or sudden onset?
Weight problems in the past? - Childhood etc.

75
Q

Overdose

A

Before, during and after OD?
Who brought them in or how were they found?
What was taken and how much and in what time?
Thought or planned or sporadic?
Do they remember the events?

76
Q

Collateral history

A

Premorbid history
Duration
Drastic changes
Communication with friends and family
Change in normal social plans or activities

77
Q

Summarise and closing consultation

A

What hopes or future plans?
How would you like to be helped?
Do you have any concerns
Do you have any questions

78
Q

Plan of history taking

A

PC
HPC
Mood
Risk
PMH
PPH
FHx
DHx
Ax
SHx
Personal Hx
Forensic Hx
Premorbid Hx
Collateral Hx

79
Q
A

Psychiatry (17 decks)

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