Psychiatric Assessment

Question 1

What is the difference between a symptom and a sign?

Answer 1

A symptoms is what the patient describes whilst a sign is what the clinician sees

Question 2

What are the six main components of a psychiatric assessment?

Answer 2

1. History
2. Mental state examination
3. Physical examination
4. Summary - especially of risk
5. Formulation/diagnosis
6. Plan

Question 3

What are the main components of a patients history?

Answer 3

▪️ Presenting complaints
▪️ History of presenting complaints (chronology, nature, precipitating etc)
▪️ Past psychiatric history
▪️ Past medical history
▪️ Medication history
▪️ Family history
▪️ Personal history (incl. in utero/birth, childhood, education, employment)
▪️ Social history
▪️ Premorbid personality

Question 4

What are the 7 components of the mental state examination?

Answer 4

1. Appearance and behaviour
2. Speech
3. Mood and affect
4. Thought
5. Perception
6. Cognition
7. Insight

Question 5

What short form measures could you use to test cognition during the MSE?

Answer 5

▪️ MoCA
▪️ MMSE

Question 6

What should be checked in the physical health exam?

Answer 6

▪️ General health (e.g., skin, hands, eyes, thyroid)
▪️ Cardiovascular
▪️ Respiratory
▪️ Gastrointestinal
▪️ Neurological

Question 7

What are the two parts of thought you should consider during the MSE?

Answer 7

▪️ Form
▪️ Content

Question 8

What is a tangential thought pattern?

Answer 8

Inclusion of excessive or irrelevant detail, never reaching the essential point or answer

Question 9

What is circumferential thought pattern?

Answer 9

Inclusion of extraneous/irrelevant detail but does eventually reach the point

Question 10

What is derailment?

Answer 10

Frequently jumping from one idea to the other, usually unrelated or barely related

(loosening of associations/knights move thinking)

Question 11

What is flight of ideas?

Answer 11

Similar to derailment with frequent jumping but typically much quicker and usually with reason

Question 12

What does NOTEPAD stand for when taking the history of the presenting complaint?

Answer 12

Nature of the problem
Onset
Triggers
Exacerbating/relieving factors
Progression
Associated symptoms
▪️ Disability

Question 13

In the MSE, can you report on things you cannot see?

Answer 13

No!

But still may be important to note absences

Question 14

What are true primary delusions?

Answer 14

Delusions that come out of the blue, without prior to mental health problems

Rare!

Question 15

What are secondary delusions?

Answer 15

Delusions that follow abnormal experience

Question 16

What is a partial delusion?

Answer 16

A delusion held with partial conviction

May be indicative or recovery or prodrome of psychotic episode

Question 17

What is the difference between mood and affect?

Answer 17

▪️ Mood = pervasive experience of patient (may be subjective or objective)
▪️ Affect = momentary changing stat observed from the outside (objective)

Question 18

What are the main components of formulation?

Answer 18

1. Case synopsis
2. Differential diagnosis
3. Risk (others, self, health)
4. Aetiology (predisposing, precipitating, perpetuating, protective, biopsychosocial)
5. Investigations
6. Management
7. Prognosis