Psych - History and Mental State Flashcards
What is included in a psychiatric assessment?
- Introduction / modifications
- History of Presenting Complaint
- Past Psychiatric History
- Family History
- *- Personal History**
- Past Medical History
- Use of Medication / Drugs/Alcohol
- *- Forensic History
- Mental State Examination
- Physical Examination
- Risk Assessment**
What topics would you ask about in personal history when taking a psychiatric history?
- Birth
- Early development
- School - social / academic
- Home environment
- Qualifications
- Relationships and children
- Work
What questions would you ask about in personal history when taking a psychiatric history?
“Do you know if there were any problems with your birth or as a baby?”
“Tell me a bit about growing up in your family”
“How was school for you?”
“Why did you leave that job after just 3 months?”
“Was it a good relationship?”
“What was the reason you have so much time off school as a child?”
What topics would you think about in forensic history when taking a psychiatric history?
- Juvenile crime
- Court appearances
- Convictions
- Length of sentence
- Against person / property
- Experience of prison
What are the factors in a mental state examination?
ASEPTIC
- Appearance and Behaviour
- Speech
- Emotion
- Perception
- Thoughts
- Insight
- Cognition
What is involved with appearance and behaviour in a mental state examination?
- Eye contact
- Rapport
- Self-care
- Dress
- Psychomotor agitation/retardation
- Abnormal movements
- Distractibility
- Perplexity
- Cooperation
What is involved with speech in a mental state examination?
- Speed - slow, fast, hesitant, pressured
- Volume - loud, soft, muttered, shouted
- Language - accented, dysphasia,
- Neologisms, punning
What is involved with emotion in a mental state examination?
- Mood – subjective
Patient’s own words/ views - Affect - objective
euthymic, elated, sad, irritable, anxious
Reactive, flat, blunted, incongruent
What is involved with thoughts in a mental state examination?
- *Content**
- Obsession
- Preoccupation
- Delusions or overvalued ideas?
- *Form**
- Circumstantial, tangential, looseness of association
- *Stream**
- Poverty, racing, perseverative, thought insertion / withdrawal /broadcast,
What is involved with perceptions in a mental state examination?
-
5 senses
Auditory, visual, tactile, gustatory, olfactory -
Auditory
Content?
2nd person (you) or 3rd person (he/she)
Command?
What is involved with insight in a mental state examination?
Several layers, not binary (present or absent):
- Identify abnormal mental phenomena (symptoms)
- Attributes some or all of these to an illness model
- Willing to seek help for the illness producing these experiences
- Appreciates and accepts the need for treatment
- Appreciates risks associated with non-compliance, not - - engaging with follow-up, impact of their illness on others, their functioning etc
What is involved with cognition in a mental state examination?
- Orientated in time place and person
- Mini mental state examination MMSE (NB doesn’t include frontal tests)
- Formal cognitive assessment
What topics do you include for a risk assessment?
- Harm to self
- Suicide
- Harm to others
- Vulnerability to exploitation
- To children
- Self neglect
What questions do you ask in a risk assessment?
- Does it ever get to the point where you think about harming yourself?
- Did you really want to die?
- How do you resist the urge to hurt yourself?
- Have you ever felt the need to use things to protect yourself?
What are the 5 P’s of formulation?
- Presenting problem
- Predisposing factors
- Precipitating factors
- Perpetuation factors
- Protective factors
What are examples of the 5 P’s in formulation?
-
Presenting problem
“Mrs Jones is a 54 year old woman who has felt low in mood for the last 3 months and is experiencing unpleasant voices criticising her appearance. -
Predisposing factors
There is a family history of bipolar disorder and she experienced significant emotional trauma as a child. -
Precipitating factors
She was made redundant earlier this year and her mother recently died following a protracted battle with dementia. -
Perpetuation factors
Her current relationship is in difficulty and her daughter has emigrated to New Zealand. She is in financial difficulty with the bank - Protective factors
- She has several good friends through church although has not felt up to going recently. She has an interest in poetry which she used to enjoy and is disappointed that she has lost contact with friends from this time of her life.”
