Psych

Question 1

Psych Hx

Answer 1

1. Demographics - age, sex, marital status etc.
2. Reason for referral
3. Presenting complaint
   * What, where, why, when
4. History of present illness

• SOCRATES
• Impact

5. History of psychiatric illnesses
   * Including: primary care, drugs and alcohol, self harm, suicide
6. Family history
7. Medical history
8. Drug history

• Include allergies
• Recreational drugs and alcohol

9.Personal history

• Birth + development
• Child hood
• First relationships sexual and non-sexual
• Current relationships: marriage, children, friends, family
• Schooling + employment

10. Forensic history
11. Pre-morbid personality
    * What were you like before you became ill
12. Current social circumstances

• Living conditions
• Cohabitants
• Finances
• Occupation
• Dependents
• Other healthcare professionals involved

Question 2

MSE

Answer 2

Appearance and behaviour

• Basic descriptors: caucasion, height etc.
• Clothing and accessories
• Evidence of self-neglect (malodourous)
• Eye contact
• Rapport
• Any socially inappropriate behaviour

Speech

• Rate (how quick), volume (how loud), quantity (how much), fluency (halting, interuptible, spontaneous)

Mood

• Subjective - as they describe it
• Objective - how you would describe it (depressed, euthymic, elated)
• Affect ((over)reactive, blunted, inappropriate, labile)

Thought

• Form
  
  • Formal though disorder - flight of idea, tangentiality, circumstantial, thought blocking, poverty of speech, word salad, knights move thinking, derailment
• Content
  
  • Delusional beliefs
  • Overvalued ideas
  • Obsessional thoughts
  • Phobias

Perceptual abnormalities

• Hallucinations - perception without an object
• Illusions - misinterpretation of real percept
• Sensory distortion incl depersonalisation and derealisation

Cognitive function

• Orientated to time date and place

Insight

• Do you feel you are ill
• Do you feel you need medication/do you feel your medication serves a purpose

Question 3

Risk assessment

Answer 3

To Self

• Self harm and suicide
  
  • Previous attempts
  • Access
  • Final acts
  • Planning
  • Method
  • Help seeking behavouir
  • Current intent
• Self neglect
• Further deterioration of mental health or physical health
• Being exploited by others (vulnerable adult)
• To reputation

To other people

• Aggression and violence
• Risk to children

Other risk

• To property
• Driving
• Pets

Also think about age and sex

Question 4

Expressing risk

Answer 4

Level

• Low - requires standard/no care (defo community)
• Moderate - real risk of unwated event occuring requires active management (could be community or in patient
• High - highly likely almost defo in patient

Time frame

• Immediate - about to jump off a building
• Short (days) - will likely attempt suicide on returning home
• Medium (weeks/months) - will likely spiral into sever depression from moderate w/out treatement
• Long (months/years) - liver problems from exessive drinking