History taking, Mental state examination and making a diagnosis Flashcards
setting for a psychiatric interview
privacy - avoid interruptions (phones, pagers
informal setting, avoid barriers, respect personal space
easy exit
what is talked about when orientating the patient in the introduction of the history?
purpose
duration
note taking, confidentiality
describe body language and behaviour used in the history
eye contact
relaxed non-threatening posture and appear unhurried
facilitated noises (I see, okay etc)
pick up on non verbal cues
acknowledge what they are saying
describe the overview of history
- presenting complaint
- history of presenting complaint
- past psychiatric history
- past medical history
- current and recent medication
- social history: alcohol, drugs, smoking
- family history
- forensic history
- personal history
history of presenting complaint
clarify each complaint - onset, precipitants, course, severity
associated symptoms
response to treatment
“what other changes have your partner/family/friends noticed in you?”
past psychiatric history
previous episodes, diagnoses, contacts
previous treatments
inter-episode functioning
“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?”
“has anything particular been playing on your mind?”
“do you know why is this happening?”
“have you noticed any change in your thoughts?”
“has anyone interfered with your thoughts?”
“does anyone else have access to your thoughts?”
past medical history
developmental problems
head injuries
endocrine abnormalities
liver damage, Oesophageal varices, Peptic ulcers (can indicate if alcohol problems)
vascular risk factors
current and recent medication
tablets and injections, medications
drugs discontinued
medication - duration and dose
adverse drug reactions and allergies
What to ask about alcohol/illicit drug use
Regular or intermittent Amount (know the units) Pattern Dependence/withdrawal Impact on work, relationships, money, police Screening questionnaires e.g. CAGE
What to ask in a forensic history
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes
Recidivism meaning
Tendency to reoffend
Mental state examination involves….
Appearance Behaviour Mood Affect Speech Thoughts Beliefs Percepts Suicide/homicide Cognitive function Insight
What is looked at when assessing appearance?
Height/build
Clothing (appropriate, kempt, bizarre)
Personal hygiene
Make up, jewellery
What is looked at when assessing behaviour?
Greetings
Non-verbal cues
Gesturing
Abnormal movements (tremor, posturing etc)
Response to unseen stimuli
Cooperative, raport
Evidence of intoxication, or medication side effects
What is looked at to assess mood?
Self rating scale
Eye contact
Affect
Psychomotor function (retarded, agitation)
What is looked at when assessing speech?
Spontaneity Volume (loud, quiet, poverty) Rate (pressured, slowed) Rhythm (rhyming and punning) Tone (monotonous, lilting) Dysarthria Dysphagia (expressive, receptive)
What is an illusion?
When the stimulus is there, but you may interpret something different
What is a hallucination?
There is no stimuli, but they see something these
What domains can abnormal percepts be experienced?
Auditory Visual Somatic/tactile Olfactory Gustatory
What should be asked about suicidal thoughts?
Ideation
Intent
Plans (vague, detailed, specific, already in motion)
Also homicidal risk
What is used to assess cognitive function?
Orientation
Attention/concentration
Short term memory (3 objects, name and address)
Long term memory (personal history)
If any concerns perform objective tests e.g. MSQ, MMSE, executive function tests)
Most key symptom of depression
Low mood
What indicates more likely to kill yourself?
The more effort you make to kill yourself
What does tolerance mean in respect to drinking?
You need to drink more to have the same effect.
