History Taking Flashcards
What is the basic outline of a psychiatric history?
Patient Details Presenting Complaint History of Presenting Complaint Previous medical and psychiatric history Drug and allergies Family medical and psychiatric history Personal history Social history Drugs and Alcohol Forensic History Pre-morbid personality Mental State Examination
What aspects are considered in a mental state examination?
Appearance & Behaviour Mood – Subjective, Objective & Affect Speech Thought-form Thought-content (delusions) Abnormal Perceptions Thoughts of self harm Suicidal and homicidal ideation Insight Cognition
What things should be asked about in a past psychiatric history?
Past episodes/ diagnoses / contacts
Previous treatments (psychological, drug and physical)
Inter-episode functioning
Previous admissions to hospital
Attempted suicide/ repeated DSH
Previous detentions under Mental Health Legislation
What things should be asked about in the family psychiatric history?
Parents, siblings, grandparents etc
Age, employment, circumstances, health problems, quality of relationship
Major mental illness in more distant relatives is important
What psychiatry aspects are important in a past medical history?
Developmental problems Head injuries Endocrine abnormalities Liver damage, oesophageal varices, peptic ulcers Vascular risks factors Epilepsy
What should be asked about in a drugs and alcohol history?
Regular or intermittent Amount (know the units) Pattern Dependence/ withdrawal symptoms Impact on work, relationships, money, police Screening questionnaires eg CAGE
What questions are asked in the cage screening test for alcohol use?
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
What should be asked about in the personal history?
Developmental milestones Early life Schooling Occupational Relationships (sexual & marital history) Financial Friendships, hobbies and interests
What is a good question to assess the pre-morbid personality of a patient?
How would your best friend describe you?
What aspects are considered in the appearance section of the MSE?
Height/Build
Clothing - appropriate/inappropriate, kempt, bizarre
Personal hygiene - clean/unshaven/malodorous
Make up, jewellery, accessories
What aspects are considered in the behaviour section of the MSE?
Greeting Non verbal cues Gesturing - normal, expansive, bizarre Abnormal movements - tremor, choreioathetoid movements, posturing, akathisia Cooperative, rapport
What aspects are considered in the mood section of the MSE?
Eye contact
Affect – objective manifestation of mood at i/v
Mood rating – subj & obj; rate out of 10;
Psychomotor function - retarded, agitated
What aspects are considered in the speech section of the MSE?
Spontaneity Volume - loud, quiet, poverty Rate - pressured, slowed Rhythm - rhyming and punning Tone - monotonous, lilting Dysarthria Dysphasia - expressive/receptive
What are some aspects of abnormal thought in the MSE?
Speed and tempo of thoughts Types of thoughts demonstrated Linkage and thought form Possession of thoughts Close relationship to speech - external manifestation of thoughts Phobias Obsessions Flight of ideas Formal thought disorder – broadcast, echo, insertion, block, withdrawal Knight’s move, derailment, loosening
What are some aspects of abnormal beliefs in the MSE?
Preoccupations
Over valued ideas
Delusional beliefs - fixed, false belief out of cultural context; extraordinary conviction
What are some aspects of abnormal perceptions in the MSE?
Illusions
Hallucinations
What aspects are considered in the suicide section of the MSE?
Must always ask about suicidal thoughts Ideation Intent Plans - vague, detailed, specific, already in motion Also homicidal risk
What aspects are considered in the cognitive function section of the MSE?
Orientation - time, place, person
Attention/concentration - throughout i/v
Short term memory - 3 objects; name & address
Long term memory - personal history
If any concerns - perform objective tests eg MSQ, MMSE, MOCA, FAS, Clock drawing, executive function tests
What aspects are considered in the insight section of the MSE?
Best seen as spectrum that is very rarely 100% present/absent and varies over time/illness 3 questions – Are symptoms due to illness? Is this a mental illness? Do they agree with treatment/Mx plan?
What is psychopathology?
Psychopathology is concerned with abnormal experience, cognition and behaviour
What is descriptive psychopathology?
Descriptive Psychopathology describes and categorizes the abnormal experience as described by the patient
What is phenomenology?
Phenomenology in psychiatry refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patient’s experience feels like
What is the difference between primary and secondary delusions?
Primary delusions are not understandable and are psychologically irreducible, while secondary delusions are understandable in the context of preceding affects or other experiences
What are delusions?
A delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction
grandiose
paranoid (correctly persecutory)-is anyone trying to kill you?
hypochondriacal
self referential
What are the three classes of perceptual disturbances?
Hallucinations
Pseudohallucinations
Illusions
What are hallucinations?
Have the full force and clarity of true perception
located in external space
no external stimulus
not willed or controlled
Can affect the 5 special senses-auditory, visual, tactile, olfactory and gustatory
What are pseudohallucinations?
A pseudohallucination is an involuntary sensory experience vivid enough to be regarded as a hallucination, but considered by the person as subjective and unreal, unlike “true” hallucinations, which are considered real by patients
What is an illusion?
An illusion has an external stimulus and is something that appears diffferent to what it actually is
What is the ICD diagnostic criteria for depression?
Key symptoms:
persistent sadness or low mood;and/or
loss of interests or pleasure
fatigue or low energy
at least one of these, most days, most of the time for at least 2 weeks
if any of above present, 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
the 10 symptoms then define the degree of depression and management is based on the particular degree
mild depression (four symptoms)
moderate depression (five to six symptoms)
severe depression (seven or more symptoms, with or without psychotic symptoms)
