History taking, Mental state examination and making a diagnosis

Question 1

setting for a psychiatric interview

Answer 1

privacy - avoid interruptions (phones, pagers

informal setting, avoid barriers, respect personal space

easy exit

Question 2

what is talked about when orientating the patient in the introduction of the history?

Answer 2

purpose

duration

note taking, confidentiality

Question 3

describe body language and behaviour used in the history

Answer 3

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

Question 4

describe the overview of history

Answer 4

• 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

Question 5

history of presenting complaint

Answer 5

clarify each complaint - onset, precipitants, course, severity

associated symptoms

response to treatment

“what other changes have your partner/family/friends noticed in you?”

Question 6

past psychiatric history

Answer 6

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?”

Question 7

past medical history

Answer 7

developmental problems

head injuries

endocrine abnormalities

liver damage, Oesophageal varices, Peptic ulcers (can indicate if alcohol problems)

vascular risk factors

Question 8

current and recent medication

Answer 8

tablets and injections, medications

drugs discontinued

medication - duration and dose

adverse drug reactions and allergies

Question 9

What to ask about alcohol/illicit drug use

Answer 9

Regular or intermittent
Amount (know the units)
Pattern
Dependence/withdrawal 
Impact on work, relationships, money, police 
Screening questionnaires e.g. CAGE

Question 10

What to ask in a forensic history

Answer 10

Offences including sentences
Recidivism
Particular attention to violent or sexual crimes

Question 11

Recidivism meaning

Answer 11

Tendency to reoffend

Question 12

Mental state examination involves….

Answer 12

Appearance
Behaviour
Mood 
Affect 
Speech 
Thoughts
Beliefs
Percepts 
Suicide/homicide 
Cognitive function 
Insight

Question 13

What is looked at when assessing appearance?

Answer 13

Height/build
Clothing (appropriate, kempt, bizarre)
Personal hygiene
Make up, jewellery

Question 14

What is looked at when assessing behaviour?

Answer 14

Greetings
Non-verbal cues
Gesturing
Abnormal movements (tremor, posturing etc)
Response to unseen stimuli
Cooperative, raport
Evidence of intoxication, or medication side effects

Question 15

What is looked at to assess mood?

Answer 15

Self rating scale
Eye contact
Affect
Psychomotor function (retarded, agitation)

Question 16

What is looked at when assessing speech?

Answer 16

Spontaneity
Volume (loud, quiet, poverty)
Rate (pressured, slowed)
Rhythm (rhyming and punning)
Tone (monotonous, lilting)
Dysarthria 
Dysphagia (expressive, receptive)

Question 17

What is an illusion?

Answer 17

When the stimulus is there, but you may interpret something different

Question 18

What is a hallucination?

Answer 18

There is no stimuli, but they see something these

Question 19

What domains can abnormal percepts be experienced?

Answer 19

Auditory 
Visual 
Somatic/tactile
Olfactory 
Gustatory

Question 20

What should be asked about suicidal thoughts?

Answer 20

Ideation
Intent
Plans (vague, detailed, specific, already in motion)
Also homicidal risk

Question 21

What is used to assess cognitive function?

Answer 21

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)

Question 22

Most key symptom of depression

Answer 22

Low mood

Question 23

What indicates more likely to kill yourself?

Answer 23

The more effort you make to kill yourself

Question 24

What does tolerance mean in respect to drinking?

Answer 24

You need to drink more to have the same effect.

Question 25

How long roughly does citalopram take to work? (anti-depressant)

Answer 25

About 2 weeks

Question 26

Hypothyroid is related to what psychiatric disorder?

Answer 26

Depression

Question 27

Hyperthyroid is related to what psychiatric disorder?

Answer 27

Anxiety

Question 28

What does premorbid personality look at?

Answer 28

Are they different now to what they were normally like before?

Question 29

Definition of psychopathology

Answer 29

Concerned with abnormal experience, cognition and behaviour

Question 30

Definition of Descriptive psychopathology

Answer 30

Describes and categorises the abnormal experience as described by the patient

Question 31

Definition of phenomenology

Answer 31

Refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patients experience feels like

Question 32

Mood definition

Answer 32

Generally held to be the patient’s subjective report on their current mood state in terms on how they rate themselves from depressed through euthymic (neutral) to elated

Question 33

Definition of Affect

Answer 33

Affect held to be the emotions conveyed and observed objectively during interview in terms of

• types of affect observed
• range and reactivity of affect
• Congruity of affect

Question 34

Low mood and psychotic symptoms together mean what?

Answer 34

Severely depressed

Question 35

Definition of Delusion

Answer 35

An unshakable idea or belief which is out of keeping with the person’s social and cultural background

Question 36

Broadly 3 classes of perceptual disturbance

Answer 36

Hallucinations
Pseudohallucinations
Illusions

Question 37

Features of hallucinations

Answer 37

Have the full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled

Question 38

What should insight be conceptualised as?

Answer 38

A spectrum - rarely 100% absent or present

Question 39

3 Questions for the continuum of insight

Answer 39

Do you think you are ill?
If you are ill, is it a mental illness?
If you are ill and it is a mental illness, do you agree broadly with the current treatment plan?

Question 40

Symptoms of a depressive episode

Answer 40

Persistent sadness or low mood
Loss of interests and pleasure
Fatigue or low energy
At least one of these, most days, most of the time for at least two weeks (above)

disturbed sleep 
poor concentration or indecisiveness
low self confidence 
Poor or increased apetite 
suicidal thoughts or acts
agitation or slowing of movements
guilt or self blame

Question 41

How many symptoms are classed as mild depression?

Answer 41

4

Question 42

How many symptoms are classed as moderate depression?

Answer 42

5-6 symptoms

Question 43

How many symptoms are classed as severe depression?

Answer 43

seven or more symptoms, with or without psychotic symptoms

Question 44

What is the SSRI choice in children and adolescents?

Answer 44

Fluoxetine