Psychiatric history

Question 1

What do you do before taking a history?

Answer 1

Intro self
pt deets
explain
consent
confidentiality

Question 2

What are the sections of a psychiatric history?

Answer 2

PC
HPC
Past psychiatric Hx
PMHx
DHx
SHx
FHx
Personal Hx
Forensic Hx
Premorbid personality

Question 3

Briefly describe what you would ask about in the HPC in a psychiatric history

Answer 3

Onset, precipitants, course, severity
Associated symptoms, effects on daily living
Getting worse or better?
Treatments? / Response to treatment?
Ask about related symptoms
Exploring psychotic symptoms
first time or happened before?
Explore mood symptoms

Question 4

What would you want to ask about in past psychiatric history?

Answer 4

Past episodes/diagnoses/contacts
Previous treatments (psychological, drug and physical)
Inter-episode functioning
Previous admissions
Attempted suicide/repeated DSH
Previous detentions under Mental Health Legislation

Question 5

What would you ask about in PMH?

Answer 5

Any Chronic illnesses?
Any physical health conditions?
Developmental problems
Head injuries
Endocrine abnormalities
Liver damage, oesophageal varices, peptic ulcers
Vascular risk factors

Question 6

What would you ask about in SHx

Answer 6

Social circumstances including occupation
Current financial situation/stressors
Smoking/alcohol/illicit drug use
- Regular or intermittent
- Amount (know the units)
- Pattern
- Dependence/withdrawal symptoms
- Impact on work, relationships, money, police
- Screening questionnaires e.g. CAGE
- Current relationship/stressors
Children – contact

Question 7

What would you ask about in personal Hx

Answer 7

Problems during your mum’s pregnancy / your birth?
Developmental Milestones
Early life
Schooling/Education
Occupational Hx
Relationships (sexual and marital history)
Financial
Friendships, hobbies and interests

Question 8

What would you ask about in forensic Hx

Answer 8

Have you ever been in contact with the police? Charged with any crime?
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes

Question 9

How can you find out about premorbid personality?

Answer 9

Difficult to be comprehensive
Emphasis on consistent patterns of behaviour, interaction, mood
Importance of corroboration
How would your best friend describe you as a person?

Question 10

What are the components of a MSE?

Answer 10

appearance
behaviour
mood
speech
thoughts
perception
cognitive function
insight

Question 11

What do we look at in appearance

Answer 11

Observe the patient’s general appearance:

Apparent age
physical state
Weight - significantly underweight or overweight.
Stigmata of disease
Personal hygiene
Clothing and accessories

Question 12

What do we look for in behaviour

Answer 12

Engagement and rapport
Eye contact
Facial expressions and body language- agitation
abnormal movements - ?psychomotor retardation / restlessness

Question 13

what do we look for in speech

Answer 13

rate
rhythm
tone
volume
pressure of speech
psychomotor retardation
mute state
how talkative?
Is what they are saying relevant?

Question 14

What do we look for in mood?

Answer 14

Subjective and objective
- euthymic / depressed / elated / irritable
Affect - reactive / labile / blunted / incongruous
What does the same mean?
ask them to rate out of 10

Question 15

What do we look for in thoughts?

Answer 15

Flow / coherence and speed - ?evidence of thought disorder
Content of thought - delusions / obsessions / compulsions / overvalued ideas
Suicidal thoughts
Homicidal thoughts

Question 16

Questions to screen for thought content abnormalities

Answer 16

“What’s been on your mind recently?”
“Are you worried about anything?”
“Do you sometimes have thoughts that others tell you are false?”
“Do you have any beliefs that aren’t shared by others you know?”
“Do you ever feel that people are out to do you harm?”
“Do you ever feel that specific events in the world are related to you in some way?”
“Are there any thoughts you have a hard time getting out of your head?”
“Do you sometimes feel the need to perform certain behaviours repetitively, despite understanding these are irrational?”
“Do you ever think about ending your life?”
“Have you ever felt your life was not worth living?”
“Have you ever attempted to end your life?”
“Do you ever think about harming others?”

Question 17

questions to screen for thought possession abnormalities

Answer 17

“Do you think people can put ideas in your head, without your control?”
“Have you ever felt like people have removed memories or thoughts from your mind?”
“Do you ever feel like others can hear what you’re thinking?”

Question 18

What do we look for in perceptions

Answer 18

Auditory and visual hallucinations
Illusions
Misinterpretations
depersonalisation
derealisation

Question 19

questions to screen for perceptual abnormalities

Answer 19

“Do you ever see, hear, smell, feel or taste things that are not really there?”
“Did you think this was real at the time?”
“Do you still believe it was real?”
“Do you ever feel like you’ve changed or that you don’t recognise the person you currently are?”
“Do you ever feel like the world around you isn’t real?”

Question 20

What do we look for in cognition

Answer 20

Oriented to time, place and person

Question 21

What do we look for in insight / screening questions

Answer 21

Do you think there is a problem?
what do you think is the cause of the problem?
Do you think you need treatment or help for this problem?

Question 22

Acronym used for low mood PC

Answer 22

SADAFACES

Question 23

what does SADAFACES stand for?

Answer 23

poor Sleep
Anhedonia
Lack of enjoyment of previously enjoyed activities
Dysthymia
Low mood
poor Appetite
Fatigue
Agitation
poor Concentration
poor self Esteem
Suicidality

Question 24

Acronym used for high mood PC

Answer 24

FIDGET

Question 25

what does FIDGET stand for?

Answer 25

Flight of ideas
Insomnia
Distractibility
Grandiosity
Energy
Talkativeness

Question 26

Acronym used for suicide risk

Answer 26

SADPERSONS

Question 27

What does SADPERSONS stand for?

Answer 27

Sex
Age
Depression
Past attempts
Excessive alcohol / substances
Rational thinking loss
Social supports
Organised plan
No support
Sickness

Question 28

what questions do you want to ask about self harm?

Answer 28

triggers
type(s)
severity
deliberate