history taking, mental state examination and diagnosis Flashcards
2 fundamental components of clinical method in psychiatric interviewing
collection of clinical data
intuitive understanding of the patient as an individual
- collection of clinical data
- descriptive psychopathology
psychiatry history taking; the setting
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
psychiatry history taking: safety/risk assessment
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
overview of psychiatric history: main subheadings
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
psychiatry history taking: introduction
greet verbally and introduce yourself non-verbal cues orientate and check; -purpose of interview -likely duration interview -not taking, confidentiality, part of team
advantages of asking open questions
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
objectives of psychiatric history
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
asking about related symptoms
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
exploring psychotic symptoms
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?
past psychiatric history
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
past medical history
developmental problems head injuries liver damage, oesophageal varices, peptic ulcers vascular risk factors
drug history
tablets, injections medication recently any drugs discontinued how long meds been taking for and what dose adverse reactions and allergies
family history
major mental illnesses
social history
social circumstances, incl occupation financial situ/stressors smoking, alcohol, ilicit drugs releationships children - contact
alcohol/ilicit drug history
regular or intermittent amount (know the units) pattern dependence/withdrawal symtpoms impact on work, relationships, money screening questionnaires
forensic history
contact with police, charged with any crime
offences incl sentences
recidivism
particular attention to violent or sexual crimes
personal history
developmental milestones early life schooling occupational relationships (sexual + marital history) financial friendships, hobbies, interests
pre-morbid personality
difficult to be comprehensive
emphasis on consistent patterns of behaviour, interaction, mood
‘how would your best friend describe you as a person’
mental state examination
appearance behaviour mood speech thoughts beliefs percepts suicide/homicide cognitive function insight
mental state exam: appearance
height/build
clothing: approp/inapprop, kemot, bizzare
personal hygiene: clean, unshaven
makeup, jewellery, accesosries
mental state exam: behaviour
greeting non-verbal cues gesturing: normal, abnormal abnormal movements: tremor, choreioathetoid movements cooperative, rapport
mental state exam: mood
eye contact
affect: objective manifestation of mood at i/v
mood rating: subjectively and objectively (out of 10)
psychomotor function - retarded, agitated
mental state exam: speech
spontaneity volume rate rythm tone
mental state exam: abnormal thoughts
phobias
obsessions
flight of ideas
formal though disorder - broadcoast, echo, insertion
