history taking, mental state examination and diagnosis Flashcards

1
Q

2 fundamental components of clinical method in psychiatric interviewing

A

collection of clinical data

intuitive understanding of the patient as an individual

  • collection of clinical data
  • descriptive psychopathology
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2
Q

psychiatry history taking; the setting

A

importance of privacy, avoid interruptions - phone, pagers

informal setting, avoid barriers, respect personal space

easy exit: if only one exit interviewer should have immediate access

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3
Q

psychiatry history taking: safety/risk assessment

A

treating team/primary nurse
violence is unusual
inform staff who you are going to interview and where

during IV - autonomic overactivity; posture, verbal aggression
-if uncomfortable end interview

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4
Q

overview of psychiatric history: main subheadings

A
Hx PC
past psychiatric history 
PMH
Drug history 
social history 
FHx
forensic history 
personal history
-developmental milestones
-schooling/education 
-occupational history 
-relationships 
-pre-morbid personality
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5
Q

psychiatry history taking: introduction

A
greet verbally and introduce yourself 
non-verbal cues
orientate and check;
-purpose of interview
-likely duration interview
-not taking, confidentiality, part of team
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6
Q

advantages of asking open questions

A

allows patients 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 responses

allows a period of non-verbal response from interviewer, listening and facilitating

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7
Q

objectives of psychiatric history

A

form rapport and gather info
establish and explore symptoms in context of personality and circumstances
explore possible biological and social factors related to symptoms
inform and motivate patient
examine mental state
begin formulation

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8
Q

asking about related symptoms

A

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

ask about specific symptoms - may be closed q

systematic enquiry to screen for other symptoms e.g. depression, obsessions, anxiety

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9
Q

exploring psychotic symptoms

A

have you seen or heard anything that other people have not been aware of?
have you heard people talking when there was nobody around?
what do they think is causing them?

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10
Q

past psychiatric history

A

past episodes/diagnoses/contacts
prev treatments (psychological, drug, physical)
inter-episode functioning
prev admissions to hosp
attempted suicide/repeated DSH (deliberate self harm)
prev detentions under mental health legislation

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11
Q

past medical history

A
developmental problems 
head injuries
liver damage, oesophageal varices, 
peptic ulcers
vascular risk factors
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12
Q

drug history

A
tablets, injections 
medication recently 
any drugs discontinued
how long meds been taking for and what dose
adverse reactions and allergies
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13
Q

family history

A

major mental illnesses

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14
Q

social history

A
social circumstances, incl occupation 
financial situ/stressors
smoking, alcohol, ilicit drugs
releationships 
children - contact
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15
Q

alcohol/ilicit drug history

A
regular or intermittent
amount (know the units) 
pattern 
dependence/withdrawal symtpoms 
impact on work, relationships, money 
screening questionnaires
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16
Q

forensic history

A

contact with police, charged with any crime
offences incl sentences
recidivism
particular attention to violent or sexual crimes

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17
Q

personal history

A
developmental milestones
early life
schooling 
occupational 
relationships (sexual + marital history) 
financial 
friendships, hobbies, interests
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18
Q

pre-morbid personality

A

difficult to be comprehensive
emphasis on consistent patterns of behaviour, interaction, mood

‘how would your best friend describe you as a person’

19
Q

mental state examination

A
appearance
behaviour
mood 
speech 
thoughts
beliefs
percepts
suicide/homicide
cognitive function 
insight
20
Q

mental state exam: appearance

A

height/build
clothing: approp/inapprop, kemot, bizzare
personal hygiene: clean, unshaven
makeup, jewellery, accesosries

21
Q

mental state exam: behaviour

A
greeting 
non-verbal cues
gesturing: normal, abnormal 
abnormal movements: tremor, choreioathetoid movements
cooperative, rapport
22
Q

mental state exam: mood

A

eye contact
affect: objective manifestation of mood at i/v
mood rating: subjectively and objectively (out of 10)
psychomotor function - retarded, agitated

23
Q

mental state exam: speech

A
spontaneity 
volume 
rate
rythm
tone
24
Q

mental state exam: abnormal thoughts

A

phobias
obsessions
flight of ideas
formal though disorder - broadcoast, echo, insertion

25
Q

mental state exam: abnormal beliefs

A

preoccupations
overvalued ideas
delusional beliefs - fixed, false belief out of cultural context

26
Q

mental state exam: abnormal precepts

A

illusions

hallucunations

27
Q

mental state exam: suicide/homicide

A

ideation
intent
plan
also homicidal risk

28
Q

mental state exam: cognitive function

A

orientated
attention/concentration
short term memory
long term memory

29
Q

mental state exam: insight

A

best seen as spectrum
very rarely 100% present/absent

are symptoms due to illness?
is this a mental illness?
do you need treatment/hosp?

30
Q

psychopathology

A

concerned with abnormal experience, cognition + behaviour - what the patient is telling you

31
Q

descriptie psychopathology

A

describes and categorises the abnormal experience as described by the patient

32
Q

phenomenology

A

in psychiatry refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patien’t experience feels like

33
Q

mood

A

patient’s subjective report on their current mood state

self raring scale 0-10 (10/10 best)

34
Q

affect

A

emotions conveyed and observed objectively during interview

35
Q

different types of thought displayed at MSE

A

preoccupations
phobias
obsessions
overvalued ideas e.g. body image distortion
delusions - primary (arise themself) or secondary (to something else)

36
Q

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

37
Q

formal thought disorfer

A

pattern of interruption or disorganisation of thought processes

  • thought blocking
  • fusion
  • loosening of associations
  • tangenital thinking
  • derailment of thoughts
38
Q

3 classes of perceptual disturbance

A

hallucinations
psuedohallucinations
illusions

39
Q

hallucinations

A

full force and clarity of true perception
located in external space
no external stimulus, not willed or controlled

perception with no stimulus

40
Q

formulation of case

A

consideration of diagnosis and in context of individuals particular personal and medical history

41
Q

illusion

A

misperception of a real stimulus

42
Q

psuedohallucination

A

like hallucination but not right character/fully realistic

43
Q

blunted affect

A

don’t react in way would expect them to (facial reactivity)

wouldn’t be able to read person

44
Q

congruity of affect

A

talking about something sad e.g. bereavment and appearing happy - smiling, laughing