Lecture - Psychiatric history taking Flashcards
What are the aspects of the mental state examination?
- Appearance and behaviour
- Speech and thought form
- Mood
- Thought content
- Cognition
- Insight
- Perception
What are the components of the psychiatric history?
When presenting start with gender, age, single/married, occupation. Where seen, how they were admitted and whether admitted formally or informally.
- PC + HPC
- Past psychiatric history
- PMH
- DH
- FH
- Sx - substance misuse, forensic history, premorbid personality
- Personal history
- Collateral history - need consent but not to only listen
What are the components of cognition? How can it be tested briefly?
- Attention
- Concentration
- Orientation
- Memory
- Language
Can be tested quickly using a MMSE
What is insight?
- The patient’s awareness that something is wrong, that they are unwell in some way
- That the problem is concerning their mental health.
- That they require treatment.
Insight is often partial eg patient knows something is wrong but doesn’t think it is to do with mental health or is willing to take medication but doesn’t think they are unwell. Dellusions and hallucinations feel real and it is difficult to accept that they are not.
What questions should you ask to explore insight?
- What do you think it going on for you?
- Do you think you are your usual self at the moment?
- Are your family worried about you? Is that reasonable?
- Could your mind be playing tricks on you?
- Sometimes we can have strange experiences when we are under a lot of stress. Could this explain what’s been going on for you recently?
- How would you feel about having some treatment?
What is included in thought content when assessing a patient?
This describes the main themes of a patient’s thoughts
- Depressive
- Anxious
- Obsessional thoughts
- Overvalued ideas
- Delusions
What is important to note about a patient’s mood?
If what they say (mood) is congruent with what you see (affect)
Give examples of formal thought disorder.
- Poverty of thought
- Racing thoughts
- Too much info but still making sense e.g. circumstantial, tangential, over-inclusive
- Abrupt stop in speech e.g. thought block or thought withdrawal
- Flight of ideas with puns
- Clang associations
- Distraction
- Derailment, knights move thinking, word salad
- Neologisms
What is labile affect?
When someone’s mood appears to change several times throughout the consultation
How do you describe speech?
- Rate - normal, fast, slow
- Volume - normal, soft, loud
- Tone - calm, hostile, sarcastic
- Flow - spontaneous,hesitant, uninterruptible
Rate can be changed in anxiety, mania, psychosis
What is knights move speech?
there is no link between the ideas or words
What is derailment vs word salad vs neologisms?
Derailment aka knights move thinking e.g. “the traffic is rumbling along the main road. They are going to the north. Why do girls always play pantomime heores.”
Word salad e.g. “picture cake chocolate rambling UFO solar here fuse barking”
Neologisms - made-up words
What are clang associations?
Words sound the same but do not mean the same things
What is the word used to describe when someone’s thoughts and behaviours are in conflict with their needs and goals of the ego? What condition does this occur in?
Egodystonic (ego alien) occurs in OCD
What should be included when describing appearance and behaviour?
- age, gender, build
- levels of self care, clothing
- scars, pircings, tattoos
- facial expression, posture
- eye contact
- level of activity
- odd movements
- engagement
What is auditory verbal hallucination? Is it alway abnormal? What questions should you ask?
Internal monologue experienced as external/other
Experienced by ~5% of the healthy population
An antecedent of clinical disorders when combined with negative emotional states, specific cognitive difficultues and poor coping, plus family history of psychosis etc