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Psychiatry > History Taking, Mental State Exam and Making a Diagnosis > Flashcards

History Taking, Mental State Exam and Making a Diagnosis Flashcards

1
Q

What should be considered when choosing the setting for the history taking?

A
  • Privacy, avoid interruptions
  • Informal setting
  • Avoid barriers and respect personal space
  • Easy exit
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2
Q

What factors should be considered when considering safety when taking a psych history?

A
  • Treating team
  • Violence (unusual)
  • Inform staff who you are interviewing and where
  • Look out for autonomic overactivity, posture and verbal aggression
  • If uncomfortable end the interview
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3
Q

What should be included in a psych history?

A
  • PC/HPC
  • Past psychiatric history and PMH
  • Current and recent medication
  • Social history
  • Family history
  • Personal history: developmental milestones, schooling/education, occupational history, relationships and pre-morbid personality
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4
Q

When asking about the presenting complaint what would you ask about?

A
  • Why they are here (note each complaint and assess separately
  • Oncet, precipitants, course and severity
  • Associated symptoms
  • Effect on daily living
  • Getting worse or better
  • Has it responded to treatment
  • Has your partner/family/friends noticed any changes in you
  • Systematic enquiry: depression, obsessions, anxiety and psychosis
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5
Q

Which questions might you use to explore perception (psychotic symptoms)?

A
  • Have you seen or heard anything that other people have not been aware of?
  • Have you heard any people talking when there was nobody around?
  • What do they think is causing them?
  • Does it seem possible?
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6
Q

Which questions might you use to explore beliefs/thoughts (psychotic symptoms)?

A
  • Has anything in particular been playing on your mind?
  • Do you know why this is happening?
  • Have you noticed any change in your thoughts?
  • Has anyone interfered with your thoughts?
  • Does anyone else have access to your thoughts
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7
Q

What do you need to ask the patient about their past psychiatric history?

A
  • Past episodes/diagnoses/contacts
  • Previous treatments
  • Inter-episode functioning
  • Previous admissions to hospital
  • Attempted suicide/repeated DSH
  • Previous detentions under Mental Health Legislation
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8
Q

What is important to ask about the patient’s family history?

A
  • Parents, siblings, grandparents etc.
  • Age, employment, circumstances, health problems and quality of relationship
  • Major mental illness in more distant relatives
  • Genogram
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9
Q

What is important to ask about in a patients PMH?

A
  • Developmental problems
  • Head injuries
  • Endocrine abnormalities
  • Liver damage, oesophageal varices and peptic ulcers
  • Vascular risk factors
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10
Q

What is important to ask about a patients medication?

A
  • Tablets and injections
  • Recent medications
  • Discontinued drugs (within the last 6 months)
  • How long the medication has been taken for and at what dose
  • Adverse reactions and allergies
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11
Q

What should be asked about a patient’s social history?

A
  • Social circumstances incl. occupation
  • Current financial situation/stressors
  • Smoking/alcohol/illicit drug use
  • Current relationship/stressors
  • Children: contact
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12
Q

What needs to be asked in an alcohol/illicit drug history?

A
  • Regular or intermittent
  • Amount
  • Pattern
  • Dependence/withdrawal symptoms
  • Impact on work, relationships, money and police
  • Screening questionnaires e.g. CAGE
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13
Q

What needs to be asked as part of a personal history?

A
  • Developmental milestones
  • Early life
  • Schooling
  • Occupational
  • Relationships
  • Financial
  • Friendships, hobbies and interests
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14
Q

What should be asked in a forensic history?

A
  • Contact with the police, charges
  • Offences including sentences
  • Recidivism (reoffending)
  • Particular attention to violent or sexual crimes
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15
Q

What is pre-morbid personality

A
  • Patterns of behaviour, interaction and mood
  • Important to corroborate
  • How would their best friend describe them?
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16
Q

What is assessed in a mental state exam?

A
  • Appearance
  • Behaviour
  • Mood
  • Speech
  • Thoughts
  • Beliefs
  • Percepts
  • Suicide/homicide
  • Cognitive function
  • Insight
17
Q

Which features of the patients appearance would you take note of?

A
  • Height/build
  • Clothing: appropriate/inappropriate, kempt and bizarre
  • Personal hygiene: clean/unshaven/malodorous
  • Make up, jewellery and accessories
  • Evidence of side effects of medication or intoxication
18
Q

Which features of a patient’s behaviour would you take note of?

A
  • Greeting
  • Non verbal cues
  • Gesturing: normal/expansive/bizarre
  • Abnormal movements: tremor, choreioathetoid movements, posturing and akathisia
  • Cooperation and rapport
  • Response to unseen stimuli
19
Q

Which features of a patient’s mood would you take note of?

A
  • Eye contact
  • Affect: objective manifestation of mood
  • Mood rating: subj and obj
  • Psychomotor function: retardation and agitation
20
Q

Which features of a patient’s speech would you take a note of?

A
  • Spontaneity
  • Volume: loud/quiet/poverty
  • Rate: pressured or slow
  • Rhythm: rhyming and punning
  • Tone: monotonous/lilting
  • Dysarthria
  • Dysphasia: expressive/receptive
21
Q

List the possible abnormal thoughts a patient might present with

A
  • Phobias
  • Obsessions
  • Flights of ideas
  • Formal thought disorder: broadcast, echo, insertion, block and withdrawal
  • Knight’s move, derailment and loosening
22
Q

List the possible abnormal beliefs a patient may have

A
  • Preoccupations
  • Over valued ideas
  • Delusional beliefs: fixed, false belief out of cultural context and extraordinary conviction
23
Q

List the abnormal percepts a patient may present with

A
  • Illusions
  • Hallucinations and pseudohallucinations
  • Auditory/visual/somatic/tactile/olfactory and gustatory
24
Q

What should be asked about suicidal/homicide in a mental state exam?

A
  • Must ask about suicidal thoughts
  • Ideation
  • Intent
  • Plans: vague, detailed, specific and already in motion
  • Homicidal risk
25
Q

How can cognitive function be assesed?

A
  • Orientation: time, place and person
  • Attention/concentration
  • Short term memory
  • Long term memory
  • If any concerns then perform objective tests (MSQ, MMSE, MOCA, FAS, clock function and executive function tests etc.)
26
Q

How can a patient’s insight be assesed?

A
  • Are symptoms due to illness
  • Is this a mental illness
  • Do they agree with the treatment/Mx plan?
27
Q

What is psychopathology?

A

Study of abnormal experience, cognition and behaviour

28
Q

What does descriptive psychopathology do?

A

It describes and categorises the abnormal experience as described by the patient

29
Q

What is phenomenology?

A

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

30
Q

What is a delusion?

A
  • An unshakeable idea or belief which is out of keeping with the person’s social and cultural background (it is held with extraordinary conviction)
  • E.g. grandiose, paranoia, hypochondriacal and self referential
31
Q

Which questions should you ask about delusional beliefs?

A
  • Is anyone deliberately trying to harm you
  • Even when you seem to be most convinced, do you really feel in the back of your mind that it might not be true, it might be your imagination?
32
Q

What is a though disorder?

A
  • A pattern of interruption or disorganisation of thought processes that is broadly referred to as a formal thought disorder
  • More specifically: thought blocking, fusion, loosening of associations, tangential thinking and derailment of though
33
Q

Which questions can be asked for abnormal possession of thoughts/thought alienation?

A
  • Can you think clearly or is there any interference with your thoughts?
  • Can anyone read your mind?
  • Is anything like hypnotism or telepathy going on?
34
Q

Describe the difference between the 3 classes of perceptual anomalies

A
  • Hallucinations: perception of something in the absence of a stimulus (e.g you can see an object or hear a voice that isn’t there)
  • Pseudohallucinations: an involuntary sensory experience that the patient can recognise is not real
  • Illusion: there is a real perception but it is perceived to be something it is not
35
Q

Which questions should you ask in a present state examination?

A
  • Do they ever hear noises or voices when there is no one about and nothing else to explain it
  • Also is that true of visions or other unusual experience with touch/taste/smell

Psychiatry (16 decks)

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