History Taking, MSE and Diagnosis Flashcards
Important factors in the setting of a psychiatry history?
- Privacy (avoid interruptions, phones, pagers)
- Informal setting, avoid barriers, respect personal space
- Easy exit (if only one exit interviewer should have immediate access)
Past psychiatric history?
- Past episodes
- Previous treatments
- Inter-episode functioning
- Previous hospital admissions
- Attempted suicide/repeated DSH
- Previous detentions under mental health legislation
Past medical history important questions?
- Developmental problems
- Head injuries
- Endocrine abnormalities
- Liver damage, oesophageal varices, peptic ulcers
- Vascular risk factors
Is major mental illness in more distant relatives important?
yes!
What tool can be helpful in the family history?
Genogram
Important factors in the social history?
- Social circumstances including occupation
- Current financial situation/stressors
- Smoking/Alcohol/Illicit drug use
- Current relationships/stressors
- Children - contact
Important questions to ask relating to alcohol/illicit drug use?
- Regular or intermittent
- Amount (know the units)
- Pattern
- Dependance/withdrawal symptoms
- Impact on work, relationships, money, police
- Screening questionnaires (CAGE)
What is asked as a forensic history?
- “Have you ever been in contact with the police? Charged with any crime?”
- Offences including sentences
- Recidivism
- Particular attention to violent or sexual crimes
Important questions as part of the personal history?
- Developmental milestones
- Early life
- Schooling
- Occupational
- Relationships (sexual + marital)
- Financial
- Friendships, hobbies and interests
What examination is required after a psychiatric history?
Mental State Examination
What does a mental state examination cover?
- Appearance
- Behaviour
- Mood
- Speech
- Thoughts
- Beliefs
- Percepts
- Suicide/Homicide
- Cognitive function
- Insight
What to look for in terms of a patients appearance in the MSE?
- Height/build
- Clothing (appropriate/inappropriate, kempt, bizzare)
- Personal hygiene (clean, unshaven, malodorous)
- Make up, jewellery, accessories
What to look for in terms of a patients behaviour in the MSE?
- Greeting
- Non verbal cues
- Gesturing (normal, expansive, bizzare)
- Abnormal movements (tremor, choreoathetoid movements, posturing, akathisia)
- Cooperative/rapport
What to look for in terms of a patients mood in the MSE?
- Eye contact
- Affect (object manifestation of mood at i/v)
- Mood rating
- Psychomotor function
What to look for in terms of a patients speech in the MSE?
- Spontaneously
- Volume
- Rate
- Rhythm
- Tone
- Dysarthria
- Dysphagia
