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
