Lecture 22: Clinical Assessment Karine

Question 1

Outline the structure of a psychiatric clinical history?

Answer 1

Presenting complaint

Review of other symptom clusters

Past psychiatric history

Risk history/forensic history

Past medical history

Family history

Medication history inc. adverse reactions, previous treatments & substance abuse

Psychotherapeutic interventions / self-management

Personal history & pre-morbid personality

Current social circumstances

Question 2

Outline the structure of a psychiatric clinical history?

Answer 2

Presenting complaint

Review of other symptom clusters

Past psychiatric history

Risk history/forensic history

Past medical history

Family history

Medication history inc. adverse reactions, previous treatments & substance abuse

Psychotherapeutic interventions / self-management

Personal history & pre-morbid personality

Current social circumstances

Question 3

Name the symptom clusters to be explored in depression & mania

Answer 3

Mood:
- Depression –> low, anhedonia, irritability, loss of interest

• Mania –> elevated expansive, irritable

Thought content / quality:
- Depression –> worthlessness, guilt, shame, pessimism, nihilistic delusions at severe end

• Mania –> delusions of grandeur, inflated self esteem, can get paranoid ideas

Cognitive symptoms:
- Depression –> difficulty concentrating, poor attention, poor memory

• Mania –> distractability, flight of ideas, racing thoughts, difficulty planning

Physical symptoms:
- Depression –> fatigue, muscle aches, reduced libido, hypersomnia/insomnia, appetite and weight changes

• Mania –> reduced need for sleep, heightened perception, increased energy

Behaviour:
- Depression –> inactivity, lack of self-care, movements slowed up, isolated

• Mania –> risky behaviour, overactivity, loss of inhibition

Question 4

What features may differentiate a bipolar to unipolar depression?

Answer 4

• Younger onset
• Previous treatment failure
• Shorter episode and cycle length
• More inter-episode mood shifts
• More psychosis
• More psychomotor retardation
• More substance abuse
• More mania in 1st degree relatives
• More mixed features

–> note can also look out for degree of bipoarity on anti-depressants - anti-D instability