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Year 3 > History Taking in Psychiatry > Flashcards

History Taking in Psychiatry Flashcards

1
Q

what is psychiatry often confused with?

A

Psychology
Psychotherapy
Freudian Imagines
Counsellors

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2
Q

What should you always do before talking to someone?

A

inform staff who and where you are going to interview

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3
Q

what are the sections of a psychiatric hx?

A 
PC
HPC
Past psychiatric Hx
PMHx
DHx
SHx
FHx
Personal Hx
Forensic Hx
Premorbid personality
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4
Q

briefly describe what you would ask about in the HPC in a psychiatric history

A

• Onset, precipitants, course, severity
• Associated symptoms, effects on daily living
• Getting worse or better?
• Response to treatment?
• Asking about related symptoms
o After patient has finished volunteering symptoms
o What changes have partner/family/friends noticed in you?
o Ask about specific symptoms
o Systematic enquiry to screen for other symptoms e.g. depression, obsessions, anxiety,
psychosis
• Exploring psychotic symptoms – percepts
o Have you seen or heard anything that other people have not been aware of?
o Have you heard any people talking when there was nobody around?
o What do they think is causing them?
o Does it seem possible?
o Beware commands
• Exploring psychotic symptoms – beliefs/thoughts
o Has anything in particular been playing on your mind?
o Do you know why this is happening?
o Have you noticed any change in your thoughts?
o Has anyone interfered with your thoughts?
o Does anyone else have access to your thoughts?

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5
Q

how would you explore psychotic symptoms of percepts?

A

o Have you seen or heard anything that other people have not been aware of?
o Have you heard any people talking when there was nobody around?
o What do they think is causing them?
o Does it seem possible?
o Beware commands

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6
Q

how would you explore psychotic symptoms of beliefs and thoughts?

A

o Has anything in particular been playing on your mind?
o Do you know why this is happening?
o Have you noticed any change in your thoughts?
o Has anyone interfered with your thoughts?
o Does anyone else have access to your thoughts?

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7
Q

what would you ask about in past psychiatric Hx?

A
  • Past episodes/diagnoses/contacts
  • Previous treatments (psychological, drug and physical)
  • Inter-episode functioning
  • Previous admissions
  • Attempted suicide/repeated DSH
  • Previous detentions under Mental Health Legislation
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8
Q

what would you ask about in PMHx in a psychiatric Hx?

A
  • Developmental problems
  • Head injuries
  • Endocrine abnormalities
  • Liver damage, oesophageal varices, peptic ulcers
  • Vascular risk factors
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9
Q

what would you ask about in SHx in a psychiatric Hx?

A 
• Social circumstances including occupation
• Current financial situation/stressors
• Smoking/alcohol/illicit drug use
o Regular or intermittent
o Amount (know the units)
o Pattern
o Dependence/withdrawal symptoms
o Impact on work, relationships, money, police
o Screening questionnaires e.g. CAGE
• Current relationship/stressors
• Children – contact
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10
Q

what would you ask about in personal Hx in a psychiatric Hx?

A
  • Developmental Milestones
  • Early life
  • Schooling/Education
  • Occupational Hx
  • Relationships (sexual and marital history)
  • Financial
  • Friendships, hobbies and interests
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11
Q

what would you ask about in forensic Hx in a psychiatric Hx?

A
  • Have you ever been in contact with the police? Charged with any crime?
  • Offences including sentences
  • Recidivism
  • Particular attention to violent or sexual crimes
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12
Q

how can you find out about premorbid personality?

A

o Difficult to be comprehensive
o Emphasis on consistent patterns of behaviour, interaction, mood
o Importance of corroboration
o How would your best friend describe you as a person?

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13
Q

what are the components of a mental state exam?

A 
appearance
behaviour
mood
speech
abnormal thoughts
abnormal beliefs
abnormal percepts
suicide/homicide
cognitive function
insight
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14
Q

describe the components of appearance in a mental state exam

A
  • Height/build
  • Clothing – appropriate/inappropriate, kempt, bizarre
  • Personal hygiene – clean/unshaven/malodorous
  • Make up, jewellery, accessories
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15
Q

describe the behaviour in a mental state exam

A
  • Greeting
  • Non-verbal cues
  • Gesturing – normal, expansive, bizarre
  • Abnormal movements – tremor, choreioathetoid movements, posturing, akathisia
  • Cooperative, rapport
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16
Q

describe the components of mood in a mental state exam

A
  • Eye contact
  • Affect – objective manifestation of mood
  • Mood rating – subjective and objective, rate out of 10
  • Psychomotor function – retarded, agitated
17
Q

describe the components of speech in a mental state exam

A
  • Spontaneity
  • Volume – loud, quiet, poverty
  • Rate – pressured, slowed
  • Rhythm – rhyming and punning
  • Tone – monotonous, lilting
  • Dysarthria
  • Dysphasia – expressive/receptive
18
Q

describe the components of abnormal thoughts in a mental state exam

A
  • Close relationship to speech – external manifestation of thoughts
  • Phobias
  • Obsessions
  • Flight of ideas
  • Formal though disorder – broadcast, echo, insertion, block, withdrawal
  • Knight’s move, derailment, loosening
19
Q

describe the components of abnormal beliefs in a mental state exam

A
  • Preoccupations
  • Overvalued ideas
  • Delusional beliefs – fixed, false belief out of cultural context; extraordinary conviction
20
Q

describe the components of abnormal percepts in a mental state exam

A

• Illusions
• Hallucinations – pseudo, true
• Many domains – auditory, visual, somatic/tactile, olfactory, gustatory
• Specific types may be associated with certain conditions e.g. complex visual hallucinations in
DLB

21
Q

describe the components of suicide/homicide in a mental state exam

A

• Must always ask about suicidal thoughts
o Ideation
o Intent
o Plans – vague, detailed, specific, already in motion
• Homicidal risk

22
Q

describe the components of cognitive function in a mental state exam

A

• Orientation – time, place, person
• Attention/concentration – throughout interview
• Short term memory – 3 objects, name and address
• Long term memory – personal history
• If any concerns perform objective tests – MSQ, MMSE, MOCA, FAS, clock drawing, executive
function tests

23
Q

describe the components of insight in a mental state exam

A

o Are symptoms due to an illness?
o Is this a mental illness?
o Do they agree with treatment/Mx plan?

Year 3 (164 decks)

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