History taking, Mental state examination and making a diagnosis Flashcards
Setting for a psychiatric interview
Importance of privacy Avoid interruptions (phones etc) Informal setting Avoid barriers Respect personal space Easy exit
What is talked about when orientating the patient in the intro of the history?
The purpose of the history
Likely duration of interview
Let them know you are taking notes but it is definitely confidential
Body language and behaviour used in the history
Eye contact - raport Relaxed non-threatning posture and appear unhurried Use facilitated noises (I see, okay etc) Pick up on non verbal cues Acknowledge what they are saying Show willingness to understand Do not offer opinion/advice too early Control over talkativeness with polite authority at right time
Definition of Open question
A question in which there is not a closed yes/no answer
Advantages of open question
Allows patient to start talking about themselves and puts them at ease as they have the floor
Allows you time to think and plan areas of questioning as you assess their style and content of response
Allows a period of non-verbal response from interviewer; listening and facilitating
What question could you ask to the patient after they have stopped volunteering their symptoms?
“What other changes have your partner/family/friends noticed in you?”
Definition of Command hallucinations
A voice or person telling them do things
PMH relevant to ask about in a psychiatric history
Developmental problems Head injuries Endocrine abnormalities Liver damage, Oesophageal varices, Peptic ulcers (can indicate if alcohol problems) Vascular risk factors
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.
How long roughly does citalopram take to work? (anti-depressant)
About 2 weeks
Hypothyroid is related to what psychiatric disorder?
Depression
Hyperthyroid is related to what psychiatric disorder?
Anxiety
What does premorbid personality look at?
Are they different now to what they were normally like before?
Definition of psychopathology
Concerned with abnormal experience, cognition and behaviour
Definition of Descriptive psychopathology
Describes and categorises the abnormal experience as described by the patient
Definition of phenomenology
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
Mood definition
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
Definition of Affect
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
Low mood and psychotic symptoms together mean what?
Severely depressed
Definition of Delusion
An unshakable idea or belief which is out of keeping with the person’s social and cultural background
Broadly 3 classes of perceptual disturbance
Hallucinations
Pseudohallucinations
Illusions
Features of hallucinations
Have the full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled
What should insight be conceptualised as?
A spectrum - rarely 100% absent or present
3 Questions for the continuum of insight
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?
Symptoms of a depressive episode
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
How many symptoms are classed as mild depression?
4
How many symptoms are classed as moderate depression?
5-6 symptoms
How many symptoms are classed as severe depression?
seven or more symptoms, with or without psychotic symptoms
What is the SSRI choice in children and adolescents?
Fluoxetine
