PSYC Oral Exam Flashcards
Psychiatric evaluation -
Components
- Source of information
- Identifying information
- Chief complaint
- History of present illness (HPI)
- Psychiatric review of systems
- Past psychiatric history
- Assessment of suicidality
- Assessment of homicidality
- Drug/alcohol history
- Past medical/surgical history
- Medications/allergies
- Family psychiatric history
- Psychosocial history
- Mental status exam
- Mini-mental state exam (MMSE)
Psychiatric evaluation -
Identifying information:
Components
- Age
- Sex
- Ethnicity
- Marital status
- Relevant psychiatric history
- Number of psychiatric hospitalizations, including most recent (location, date)
- Means of presenting
- Symptoms
- Context of symptoms
Example: This is a 46-year-old married white woman with a past psychiatric history of depression who presents to the ED in an ambulance with worsening depression and suicidal ideation in the context of recent economic and relationship stressors
Psychiatric evaluation -
History of present illness (HPI):
Components
- Nature of symptoms
- Onset of symptoms (e.g., acute, insidious)
- Duration of symptoms: How long ago symptoms began
- Aggravators/alleviators of symptoms
- Precipitator(s) of symptoms: Recent stressors, medical conditions, drugs/alcohol
- Degree of incapacity experienced 2/2 symptoms, as well as influence of symptoms on personal/family life
- Any treatments received for symptoms: Dosages, duration of treatment(s), and effectiveness of treatment(s)
Psychiatric evaluation -
Psychiatric review of systems:
Components
- Depression
- Mania
- Psychosis
- Anxiety
Psychiatric evaluation -
Psychiatric review of systems:
- Depression
Components
Major depressive episode (MDE): Defined by 5 or more of the following symptoms, 1 of which must be depressed mood or anhedonia. All symptoms must occurs in the same 2-week period, be present a minimum of most of the day on most days, and result in clinically significant social, occupational, or interpersonal impairment.
SIGECAPS
- Sleep (increased or decreased)
- Interest (anhedonia)
- Guilt (feeling worthless or hopeless)
- Energy (decreased)
- Concentration (decreased)
- Appetite (increased or decreased)
- Psychomotor agitation/retardation
- Suicidal ideation
Psychiatric evaluation -
Psychiatric review of systems:
- Mania
Components
Manic episode: At least 3 of the following symptoms must be present (or at least 4 if mood is only irritable) for at least 1 week
DIGFAST
- Distractibility
- Impulsivity/excessive pleasure
- Grandiosity
- Flight of ideas, racing thoughts
- Activity (increased)
- Sleep (decreased need)
- Talkativeness (excessive/pressured speech)
Psychiatric evaluation -
Psychiatric review of systems:
- Psychosis
Components
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Psychiatric evaluation -
Psychiatric review of systems:
- Anxiety
Components
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Psychiatric evaluation -
Past psychiatric history:
Components
- The past psychiatric history should begin by noting the age at which the patient was first seen for psychiatric evaluation and the number of past hospitalizations or episodes.
- Thereafter, past episodes should be described in chronological order, with some information about duration of episodes, types of symptoms present, severity of symptoms, treatments received, and response to treatment.
(1) Previous psychiatric diagnosis/diagnoses and age(s) at diagnosis
(2) Previous hospitalizations: When? Where? Why?
(3) Previous medication trials: Treatments received? Response to treatments?
(4) History of ECT?
(5) History of suicidal ideation/attempt?
Psychiatric evaluation -
Drug/alcohol history:
Components
ALCOHOL
(1) How many times per week do you drink?
(2) When you drink:
- What do you drink?
- How many drinks do you have?
(3) Has drinking ever caused any problems for you?
(3) History of withdrawal symptoms:
- Heart racing, sweating
- Tremor
- Nausea, vomiting
- Sleep problems
- Hallucinations
- Seizures, delirium tremens
SUBSTANCE
- Substance used
- Amount
- Time since last use
- Treatment history
- Impact of alcohol/drugs on personal, professional, and social functioning
- Motivation to address alcohol/substance use/abuse
STREET DRUGS
(1) Have you ever used any street drugs?
(2) What did you use? How frequently?
PRESCRIPTION DRUGS
(1) Have you ever used sleeping medications, tranquilizers, weight loss medicines, or painkillers?
(2) Did you get hooked/addicted to it?
(3) Did you ever take more than prescribed?
(4) Did you ever take when not prescribed to you?
Psychiatric evaluation -
Assessment of suicidality:
Components
Currently experiencing, or previous history of:
- Recurrent thoughts of death
- Suicidal ideation (SI) without a plan
- SI with a plan
- Suicide attempt (SA)
Suicide screen
- In the last 48 hours (1 month), have you had any thoughts that life is not worth living or that you would be better off dead?
- Have you had any thoughts of wanting to harm yourself?
- Have you had any thoughts of wanting to end your life? Plan to end life? Means to end life?
- ACCESS TO FIREARMS? *
Psychiatric evaluation -
Assessment of homicidality:
Components
Homicide screen
- Have you had any thoughts of wanting to harm others?
- Have you made any threats to others?
- Have you had homicidal thoughts (thoughts of wanting to kill others)?
- Do you have a history of violence toward others?
Psychiatric evaluation -
Past medical/surgical history:
Components
Specifically, history of:
- Head trauma, traumatic brain injury (TBI), concussion, loss of consciousness, seizure
- Cognitive disorder(s)
- Chronic pain
Psychiatric evaluation -
Medications/allergies:
Components
- Medications, indications, dosages
- Any side effects from medications
- Compliance with prescribed medications
- Problems/difficulties filling prescriptions
- Over-the-counter medications, vitamins, supplements, herbals, diet pills
- Allergies to any medications
- If yes, reaction to medication(s)
Psychiatric evaluation -
Family psychiatric history:
Components
- Psychiatric condition
- Type of relative (relation, maternal v. paternal)
- History of suicide attempt(s)
- History of completed suicide(s)
Psychiatric conditions:
- MDD, bipolar disorder, schizophrenia or other psychotic disorders, substance use disorders, dementia, suicide
