Introduction to psyche Flashcards
What are the goals of conducting a psychiatric history
Collecting clinical data
Get an impression of the patient
In what setting should a psychiatric history be taken
What safety precautions should be taken before undertaking a psyche examination
Private- no pagers
Informal without barriers,
Easy exits in case things escalate
Let people know who you’re interviewing and where. Violence is unusual although if the interview becomes unstable then just end the interview and re-visit it later.
What is involved in the introduction of a psychiatric history
What is important to the introduction
Introduction, consent, highlight notes are confidential
You get a first impression of the patient but the patient gets a first impression of you. Be calm, friendly and open
What is involved during the History of presenting complaint
Discuss why the patient has come in
Find out associated symptoms- what have your family/friends noticed that different about you?
When completing the Systematic enquiry there may be some sensitive questions e.g. enquiring about hallucinations. use appropriate language in this situation
What is involved when enquiring the past psychiatric history?
Past diagnosis/episodes Previous treatments Inter-episode functioning Previous hospital admissions to hospital Attempted suicide/self harm Previous detentions under mental health act
What is crucial to find out in the FH
What is important to find out in the PMH
Disorders, Genogram
Head injuries Endocrine problems (thyroid) Liver damage, oesophageal varices, Peptic ulcers Vascular risk factors
What is important to assess in the medication history?
What tablets and injections they take,
what recent medications they have taken
What medications they have stopped in the past 6 months
Adverse reactions and allergies
What is important to determine from the social history
Stressors, Financial problems Support networks Children Smoking/alcohol/dug use occupation
What is involved when assessing the personal history
Developmental milestones Early life Schooling Occupations Relationships (sexual and marital history) Financial Friends, hobbies and interests
What is involved in someone with a premorbid personality?
Difficult to provide full detail
Consistent patterns of mood, behaviour and interactions
Importance of corroboration
How would your best friend describe you as a person
What is involved in the examination aspect of a mental state examination
Appearance Behaviour Mood Speech Thoughts Beliefs Perception Suicide/homicide Cognitive function Insight
What is assessed when looking at:
Appearance
Behaviour
Height/build, clothing , personal hygiene, accessories
Greeting, non verbal communication, Gesturing, Abnormal movements, co-operative, rapport
What is assessed when looking at:
Mood
Speech
Eye contact, affect, mood, rating, psycho motor function (retarded, agitated)
Spontaneous speech, volume, rate, rhythm, tone, dysarthia (Difficult to understand), dysphagia
What is assessed when looking at:
Thought
Beliefs
External manifestations of thoughts, phobias, obsessions, Knights move speech (jumping all over the place)
Preoccupations, over valued ideas, delusional beliefs
What is assessed when looking at:
Perception
Suicide/homicide
Illusions, hallucinations, auditory, visual, olfactory, gustatory, specific types may be associated with certain conditions
Ask about suicidal thoughts, ideas, intent, level of detail in their plan, already in motion, homicidal risk
