History Taking and Mental State Examination Flashcards
What are some important things to consider about setting when taking a psychiatric history?
Privacy
Avoid interruptions e.g. phone, electronic devices
Personal space- don’t get too close to the patient
Easy exit- if only one exit, interviewer needs to have priority to exit
When taking a history, you start with open questions and as the consultation progresses, you move to closed questions.
However, when may you want to start using closed questions in psychiatric circumstances?
If the patient has depression and may find open questions too overwhelming to start with.
-> think of starting with questions like ‘did you manage to sleep last night?’’ etc.
Just for GP interest.
90% of mental health conditions are solely managed in GP.
Summarise some of the presenting complaint questions for psychiatric history.
How long?
Getting worse?
Anything make it better or worse?
On any treatment?
Worse at any points in the day?
How is affecting day to day life?
What are some of the questions you may ask in past psychiatric history?
Past episodes?
Previous treatments- psychological, medicines, physical treatments?
Previous hospital admissions
Attempted suicide/repeated self-harm
Previous detentions under Mental Health Legislation
->will also ask about past medical history e.g. head injury, endocrine abnormalities, liver damage (alcohol)
Hypothyroidism is associated with low mood
What are some of the questions you may ask in social psychiatric history?
Social circumstances including occupation
Current financial situation/stressors
Smoking
Alcohol
Illicit drug use
Current relationship/stressors
Any contact with children
What are some of the questions you may ask in forensic psychiatric history?
Police contact
Offences including sentences
Particular attention to violent or sexual crimes
Recidivism
What is meant by pre-morbid personality?
Personality before the patient got ill
Which examination might be required when you have taken a psychiatric history?
Mental state examination
What are the different headings to cover in mental state examinations?
Appearance & behaviour
Speech
Mood
Thoughts
Beliefs
Perceptions
Cognitive function
Suicide/homicide
Insight
What would you want to mention in notes for a mental state examination regarding appearance?
Height/build
Clothing- appropriate/inappropriate
Personal hygiene- clean/unshaven
Make up, jewellery, accessories
What would you want to mention in notes for a mental state examination regarding behaviour?
Greeting?
Non verbal cues
Gesturing- normal, expansive, bizarre
Abnormal movements- tremor, posture
Cooperative, rapport
What would you want to mention in notes for a mental state examination regarding mood?
Eye contact
Affect-e.g. objective manifestation pf at mood at I.V
Mood rating
Psychomotor function- slowing of mind or thoughts, agitated
What would you want to mention in notes for a mental state examination regarding speech?
Spontaneity
Volume
Rate
Rhythm
Tone
Dysarthria- difficulty with articulation
Dysphasia- expressive
What would you want to mention in notes for a mental state examination regarding abnormal thoughts?
Phobias
Obsessions
Flight of ideas- going from one topic to the next quickly
->close relationship to speech, external manifestations of thoughts
–> if a patient says their thoughts are ‘echoing’, they almost always have schizophrenia
