Pscyhiatric history Flashcards
Medications that cause replicas of mental illness
Steroids, antidepressants, parkinsons drugs,
What metal presentation can steroids take?
Pscychosis
Structure of psychiatric history
PC, HPC
Past psychiatric AND medical history
Medication, drug and alcohol history
Family History
Social and persona history
Forensic history
Pre morbid personality
PC what to ask
Confirm identification / demographics ( name, age, sex, occupation, marital status, socioeconomic status, religion, residence ).
Where & when patient seen.
Legal status: voluntary or detained ?
What are the circumstances for referral?
Sources of information - Informant: relationship with patient.
What are the main complaints? In patients / informants own words.
HPC what to ask
What are the symptoms?
Onset, duration & progression of symptoms (course & intensity).
Chronological order of symptoms.
Any current stressors/ triggers? Exacerbating/Relieving factors?
Associated disturbance - What is the impact on sleep, appetite, libido etc.
Impact on activities of daily function ( work, personal care, relationships?)
Remember the symptoms of condition & ICD11 diagnostic criteria.
Associated Risks
Treatments tried? Effectiveness?
Patient’s view of the situation? Carers views & impact.
What do they think will help? What are their expectations?
Past psychiatric history what questions to ask
Any past problems with mental health.
Any past interventions for mental health problems including from counselling, voluntary sector, healthcare professionals, and GP treatments.
Any previous contact with psychiatric services?.
Any existing psychiatric diagnosis (date)
Ongoing treatment for psychiatric conditions (including psychological treatments).
Previous response to treatments & periods of remission.
Any previous admissions for psychiatric conditions ( hospital, date, duration, formal / informal?)
Past medical history
Prev medical conditons
Current medical problems
Signigicant surgical procedures
Disabilityies - sensory, mobility
Specific circumbstances relevant to psychiatry eg epilepsy, head injury
Why ask about cause of death in family hitsory of first degree family?
Risk of suicide themselves increases
Medication history what to ask
Any past problems with mental health.
Any past interventions for mental health problems including from counselling, voluntary sector, healthcare professionals, and GP treatments.
Any previous contact with psychiatric services?.
Any existing psychiatric diagnosis (date)
Ongoing treatment for psychiatric conditions (including psychological treatments).
Previous response to treatments & periods of remission.
Any previous admissions for psychiatric conditions ( hospital, date, duration, formal / informal?)
Drug and aclohol history what to ask
Use of illicit substances & alcohol.
What is taken? Quantify intake? Attitude? Assess pattern of use
Screening: CAGE questionnaire ( cut down, annoyed, guilt, eye-opener, )etc. – eye opener = alcohol problem, otherwise mix of 2 or 3
ICD diagnostic criteria for dependence (e.g. withdrawal, tolerance, impact on health, ADL etc.)
Smoking
Consider how this interplays with any other mental illness the patient may be suffering from
Consider attitude to use – do they wish to alter things at this time?
Family history information to gather
Use of illicit substances & alcohol.
What is taken? Quantify intake? Attitude? Assess pattern of use
Screening: CAGE questionnaire ( cut down, annoyed, guilt, eye-opener, )etc. – eye opener = alcohol problem, otherwise mix of 2 or 3
ICD diagnostic criteria for dependence (e.g. withdrawal, tolerance, impact on health, ADL etc.)
Smoking
Consider how this interplays with any other mental illness the patient may be suffering from
Consider attitude to use – do they wish to alter things at this time?
What is character?
How person would describe themselves or others would desvribe them eg shy
Risk assessment questions to ask
History of risk behaviour
Future planning
Hopefulness
Planning
Final setting of affairs eg finance
Protective factors
Factors of risk
Self harm
Suicide
Finances
Physical comorbidities
Neglect/vulnerability
Medication
Nutrition
Falls
Driving
Fire
Agression to others
Children at home/caring responsibilities
What is insight?
Having a perception of your condition
