Psychiatric Assessment Flashcards
Psych Hx Structure
Introduction -
- Introduce yourself.
- Gain consent.
- Identifying information.
Presenting Complaint
HPC
ICE
Previous psychiatric illness
Previous Medical History
Medication History
Family History
Personal History
Social History
Alcohol and substance Misuse
Premorbid personality
What to include in HPC?
Onset -
- When was it that this all began?
- How long have you been feeling like this?
//
- Can you describe how things started.
Severity -
- How has this affected your life?
Progression -
- Have you had any fluctuations in the way you’ve been feeling?
E+R Factors -
- Has anything occured in your life recently that could explain how you’re feeling?
Assosciated symptoms:
- Screen for depression, psychosis and suicidal ideation.
How to screen for depression?
- Low mood - Have you noticed any changes to your mood recently?
- Anhedonia - Is there anything you enjoy or makes you happy?
- Lack of energy - How would you describe your energy levels? [Use a scale 1-10].
How to screen for psychosis?
Delusions -
- Is there anything that has been worrying you recently?
- Is there anything that you’ve been thinking about a lot recently?
- Do you feel unsafe or that you’re in any danger?
Hallucinations -
SIGNPOST: ‘I want to ask you about experiences that people sometimes have but can find difficult to talk about. And these are questions that I ask everyone.’
- ’Do you ever see or hear things that other people seem unable to hear?’
Auditory hallucinations -
‘Are the voices you hear speaking about you? Or are they speaking directly to you? Or are they commenting on the things that you are doing?’
’Do the voices ever tell you to do certain things? If so, what do they tell you?’
How to screen for suicidal ideation?
…
Past Psychiatric History
’Has anything like this ever happened to you in the past?’
’Do you have any psychiatric illness that you are aware of?’
’Have you ever been to hospital with that illness?’
Past Medical History and Medication history
- Other medical conditions - Anything you are seeing your doctor for regularly?
- Previous Surgery?
- Previous hospitalisation?
Specific conditions:
- Any head injury?
- Epilepsy?
- Thyroid disease?
- Taking any regular medications?
- Anything over the counter?
- Previous psychotropic medication and effect?
- Any allergies?
Family History
Psychiatric FHx - ‘Has anyone in your family ever experienced something similar to what you’re going through?’
Quality of relationships -
‘How do you get on with your family?’
’Do you see your family often?’
Medical FHx - ‘Are there any medical conditions which run in the family?’
Personal History
- Early childhood
- Education
- Employment
- Relationships
- Forensic History
SEE NOTABILITY FOR MORE DETAILS
Social History
- Accommodation - What is your living situation like at the moment?
- Social support - Who are you in contact with regularly?
- Financial situation - Any debts?
- Hobbies
Alcohol and substance misuse
- Alcohol Hx
- Smoking Hx
- Recreational Substances?
Premorbid Personality
‘How would people have described you before?’
’Would they describe you differently now?’
What are the components of the MSE?
- Appearance and behaviour
- Speech
- Mood
- Thoughts
- Perspective
- Insight
- Cognition
What is an alternative pneumonic to remember the MSE?
A - Appearance and behaviour
S - Speech
E - Emotion (mood)
P - Perspective
T - Thoughts
I - Insight
C - Cognition
What to consider when assessing appearance and behaviour?
- Physical State
- Clothing and accesories
- Personal Hygiene
- Eye Contact
- Facial expression
- Body Language
- Motor activity and abnormal movements
- Level of arousal
- Ability to build rapport
- Disinhibition
What to consider when assessing speech?
- Rate
- Volume
- Tone
- Poverty of speech (saying few words)
- Poverty of content of speech (normal quantity of words but conveying little message)
- Rhythm
- Dysarthria
- Dysphasia
What to consider when assessing mood and affect?
Subjective Mood - What is the patients view of their mood? Ask them directly.
How are you feeling in yourself?
Objective Mood - What is your view on the patient’s mood? Euthymic/Elated/Depressed
Affect -
What to consider when assessing thoughts? (Content)
Content -
- Delusions (see notability for types)
- Obsessional Thoughts: ‘Do certain ideas keep entering your mind even when you try to keep them out?’
- Preoccupations. Strongly held beliefs that preoccupy the patient. Thoughts can be put out of mind with effort.
What to consider when assessing thoughts? (Form)
Form -
- Pressure of speech
- Loosening of assosciation - Including derailment, tangentiality, word salad
- Circumstantiality
- Neologism
- Perseveration
- Echolalia
- Clanging
What to consider when assessing thoughts (stream)
Stream -
- Acceleration: Pressured thought or flight of ideas
- Retardation: Slow speed of thinking
- Thought Blocking: Abrupt cessation of thought flow. May be taken up again or replaced with another.
What are Schneider’s first rank symptoms?
- Delusional perception (a true perception that a patient attributes a false meaning).
- Third person auditory commentary hallucination.
- Thought interference (insertion, withdrawal and broadcast).
- Passivity phenomenon (Mood / actions are being controlled by someone else).
What types of hallucination may present and what is the most common?
- Auditory (most common)
- Visual
- Olfactory
- Somatic
- Gustatory (taste)
What are pseudohallucinations?
Includes the experience of hearing voices inside your own head.
What are illusions?
Misrepresentation of a real external stimulus.
E.g Seeing a cloud that looks like a baby.
