PSYCHIATRIC HISTORY Flashcards
PSYCHIATRIC HISTORY
what are the different components?
- presenting complaint
- screen for other psych problems
- self harm/suicide risk assessment
- ICE
- past psych history(existing diagnoses, treatment)
- forensic history
- past medical history
- drug history
- family history (general and mental health)
- personal history (childhood, education, job, relationships)
- social history (living circumstances, ADLs, smoking, alcohol, drug use)
- insight
PSYCHIATRIC HISTORY
what are the key presentations/symptoms that you should ask about?
- low mood (depression)
- self-harm/suicide
- elevated mood + energy
- anxiety, panic attacks or phobias
- delusions and hallucinations
- obsessions or compulsions
- alcohol
- substance abuse
- issues around food or weight
PSYCHIATRIC HISTORY
what structure can you use to explore psych symptoms?
NOTEPAD
- nature
- onset
- triggers
- exacerbating/relieving factors
- progression
- associated symptoms
- disability
PSYCHIATRIC HISTORY
how would you explore symptoms of depression?
- how has mood been recently
- have you felt low
- have you felt little interest or pleasure in doing things
- low energy levels
- feeling more tired than usual
PSYCHIATRIC HISTORY
what other symptoms should you ask about depression?
- disturbed sleep
- change in appetite
- agitation or slowing down movements or thoughts
- poor concentration
- lack of hope for future
- feeling of worthlessness
- feeling excessive or inappropriate guilt
- reduced libido
- thoughts of self harm
- thoughts of depression
PSYCHIATRIC HISTORY
how would you explore symptoms of mania or hypomania?
- noticed any change in mood or energy
- felt more irritable
- any problems with job/relationships
- sleeping
- appetite
- can you do things other people might find difficult or impossible
PSYCHIATRIC HISTORY
what other symptoms are associated with mania/hypomania?
- increased self esteem
- reduced social interactions
- over-familiarity
- reduced attention
- spending recklessly
- inappropriate sexual encounters
- pre-occupation with extravagant or impractical plans
- persecutory delusions
- incomprehensible speech
- self-neglect
- loss of insight
PSYCHIATRIC HISTORY
how would you explore symptoms of anxiety?
- worry about a lot of things
- what sort of things are worrying
- feel tense or wound up
- always anxious or does it happen at certain times
- sudden attacks of anxiety
- are you able to put worries out of your mind
- do you avoid doing things that make you anxious
- do you feel detached from your surroundings
PSYCHIATRIC HISTORY
what symptoms are associated with anxiety?
- palpitations
- chest tightness
- breathlessness
- sweating
- dizziness
- dry mouth
- nausea and vomiting
- insomnia/difficulty sleeping
- parasthesia
PSYCHIATRIC HISTORY
how would you screen for hallucinations?
- do you ever hear noises or voice when no one else is there?
- do you ever feel someone is touching you when no one else is there
- have you ever been assaulted despite no one being present
- have you ever felt like insects are crawling beneath your skin
PSYCHIATRIC HISTORY
how would you screen for delusions?
PERSECUTORY
- have thoughts that others tell you are false
- any beliefs not shared by others
THOUGHT WITHDRAWAL
- anyone taking thoughts out of your head
THOUGHT INSERTION
- are your thoughts your own
- is anyone putting thoughts into your head
THOUGHT BROADCAST
- can anyone hear your thoughts
- do you ever hear your thoughts echoed or repeated
PSYCHIATRIC HISTORY
how would you explore obsessions and compulsions?
OBSESSIONS
- repeated unpleasant thoughts or images coming into your head
- do thoughts enter your head despite trying to keep them out
COMPULSIONS
- do you feel the need to repeatedly check things you have already done
- do you feel the need to arrange, touch or count things repeatedly
- do you try to resist thoughts or the urge to respond them
PSYCHIATRIC HISTORY
how would you explore alcohol misuse?
CAGE
- have you ever felt you should cut down?
- have people annoyed you by criticising your drinking?
- have you ever felt guilty about drinking?
- have you ever needed a drink first thing in the morning to steady nerves or get over a hangover?
PSYCHIATRIC HISTORY
how can you screen for substance dependence?
- feel a strong desire or compulsion to take ___?
- do you often take more than intended?
- have you experienced withdrawal?
- do you find you need to take more the achieve the same effect?
- has your use made you give up important commitments?
- have you continued use even though you know you have a problem?
PSYCHIATRIC HISTORY
how would you screen for eating disorders?
- typical daily food intake
- are you on a diet at the moment
- what has your weight been like in the past
- how often do you weigh yourself
- what do other people say about your body
PSYCHIATRIC HISTORY
what other symptoms should you explore for eating disorders?
- amenorrhoea
- fatigue
- constipation
- dizziness
- haematemesis
- seizures
