History Taking Flashcards
What do you need to ask about in a past psychiatric history?
Past episodes/ diagnoses/ contacts, Previous treatments, Inter-episode functioning, Previous admissions to hospital, Attempted suicide/ repeated DSH, Previous detentions under Mental Health Legislation
Relevant diseases to ask about in past medical history that can be relevant with psychiatry
Developmental problems, Head injuries, Endocrine abnormalities, Liver damage, oesophageal varices, peptic ulcers, Vascular risk factors
Things to ask about in social history section of psychiatric history?
Social circumstances including occupation, Current financial situation/ stressors, Smoking/ alcohol/ illicit drug use, Current relationship/ stressors, Children-contact
what sections are added to a psychiatric history that you wouldn’t find in a normal history?
Alcohol/ illicit drug history,
Personal history,
Forensic history,
Pre-morbid personality
Questions to ask in alcohol/ illicit drug section of psychiatric history
Regular or intermittent, Amount, Pattern, Dependence/ withdrawal history, Impact on work, relationships, money, police, Screening questionnaires
Questions to ask in personal history section of psychiatric history
Developmental milestones, Early life, Schooling, Occupational, Relationships, Financial, Friendships, hobbies and interests
Questions to ask in forensic section of psychiatric history
Offences including sentences,
Recidivism (reoffences),
Particular attention to violent or sexual crimes
Questions to ask in pre-morbid personality section of psychiatric history
Corroboration,
Emphasis on consistent patterns of behaviour, interaction, mood
What are you examining in mental state examination?
Appearance, Behaviour, Mood, Speech, Thoughts, Beliefs, Percepts, Suicide/ homicide, Cognitive function, Insight
What to look at in behaviour MSE of psychiatric patient
Greeting, Non verbal cues, Gesturing, Abnormal movements, Cooperative, Rapport
What to look at in mood MSE of psychiatric patient
Eye contact,
Objective manifestation of mood,
Mood rating,
Psychomotor function
What to look at in speech MSE of psychiatric patient
Spontaneity, Volume, Rate, Rhythm, Tone, Dysarthria, Dysphasia
What to look at in thoughts MSE of psychiatric patient
Any external manifestations of thoughts,
Phobias,
Obsessions,
Flight of ideas,
Formal thought disorder- broadcast, echo, insertion, block, withdrawal,
Knight’s move, derailment, loosening
What to look at in beliefs MSE of psychiatric patient
Preoccupations,
Over valued ideas,
Delusional beliefs
What to look at in percepts MSE of psychiatric patient
Illusions,
Hallucinations,
Look at different domains- auditory, visual, somatic/ tactile, olfactory and gustatory
What to look at in suicide/ homicide MSE of psychiatric patient
Ask about any suicidal thoughts, Ideation, Intent, Plans- vague, detailed, specific, already in motion, Homicidal risk
What to look at in congitive function MSE of psychiatric patient
Orientation- time, place, person,
Attention/ concentration,
Short term memory- 3 objects
Long term memory- personal history
What to look at in insight MSE of psychiatric patient
Ask them 3 questions:
Are your symptoms due to illness?
Is this a mental illness?
Do they agree with treatment/ Mx plan
What is psychopathology concerned with?
Abnormal experience, cognition and behaviour
Define descriptive psychopathology
Describes and categorises the abnormal experience as described by the patient
Define phenomenology
The observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patients experience feels like
What does SCAN stand for?
Schedules for
Clinical
Assessment in
Neuropsychiatry
In appearance and behaviour in a MSE what are some clinical signs that can be indicators of a psychiatric condition?
Responding to unseen stimuli,
Evidence of side effects of medication,
Evidence of intoxication,
Movement disorder (catatonia)
“Affect” in psychiatric history refers to what?
The emotions conveyed and observed objectively during the interview
Thinking in a psychiatric patient can be organised into 4 sections that need to be considered
Speed and tempo of thoughts,
Types of thoughts demonstrated,
Linkage and thought form,
Possession of thoughts
Different types of thoughts displayed at MSE
Preoccupations, Phobias, Obsessions, Overvalued ideas, Delusions (primary or secondary)
What is a delusion
An unshakeable idea or belief which is out of keeping with the persons social and cultural background; it is held with extraordinary conviction
Examples of types of delusions?
Grandiose,
Paranoid,
Hypochondriacal,
Self referential
What is meant by a formal thought disorder?
A pattern of interruption or disorganisation of thought processes, can be described more specifically as:
Thought blocking,
Fusion,
Loosening of associations,
Tangential thinking,
Derailment of thoughts, or knights move thinking
What are the 3 classes of perceptual disturbance?
Hallucinations,
Pseudohallucinations,
Illusions
Characteristics of a hallucination?
Have the full force and clarity of true perception,
Located in external space,
No external stimulus,
Not willed or controlled
3 factors that formulate a psychiatric condition?
Biological,
Psychological,
Social
What are the key symptoms of a depressive episode?
Persistent sadness or low mood,
Loss of interest or pleasure,
Fatigue or low energy
(For at least 2 weeks)
If key symptoms of a depressive episode are present what should you ask about?
Associated symptoms: Disturbed sleep, Poor concentration or indecisiveness, Low self-confidence, Poor or increased appetite, Suicidal thoughts or acts, Agitation or slowing of movements, Guilt or self-blame
What are the classes of a depressive episode?
Mild depression (4 symptoms) Moderate depression (5-6 symptoms) Severe depression (seven or more)
