Psychiatric history taking Flashcards
What are the components of a psychiatric history?
- history or presenting complaint
- past psych history
- past medical history
- drug history
- family history
- personal and social history
What are the components of the mental state examination?
- appearance
- behaviour
- speech
- mood
- thought
- perception
- cognition
- insight
Describe what is looked for in the appearance section of MSE
- age, gender, race
- body habitus
- grooming (neat? unkempt?)
- attire
- posture
- gait, odd movements; tics, tremors, stereotypes, mannerisms
- evidence of injuries or illness; e.g. from self harm, abuse or fights, drug use
- smell; alcohol? urine? vomit?
Describe what is looked for in the behaviour section of MSE
- eye contact
- rapport
- open / guarded / suspicious
- agitated / psychomotor retardation
- disinhibition / overfamiliarity
Described what is looked for in the speech section of MSE
- rate; abnormally fast or slow
- amount; increase, decreased
- pressure, monosyllabic, mute
- variation in tone (prosody)
- speech delay
- volume
Describe what is looked for in the mood section of MSE
- subjective
- how does the patient feel today
- note down in patients own words
Describe what is looked for in the affect section of MSE
- objective assessment
- your observation of how the patient appears throughout the interview
- consider where their baseline is and to what extent does it vary
- e.g. low, anxious, elated, appropriately reactive, labile, unreactive, flattened, blunted, incongruent
What components are looked for cognitive function (MSE)?
- orientation to time, place and person
- concentration
- memory
What is insight?
Does the patient recognise that they are unwell, do they attribute it to a mental health problem, do they accept the need for treatment or hospitalisation
What is a hallucination?
A perception which occurs in the absence of an external stimulus
- is experienced as originating in real space, not just in thoughts
- same qualities as a normal perception
- is not subject to conscious manipulation
- can occur in any sensory modality
Describe the pathophysiology of auditory hallucinations
- pattern of brain activity during auditory hallucination is very similar to that in normal volunteers generating inner speech except;
- supplementary motor area (monitors self generated action)
- hippocampus; parahippocampal gyrus (detects mismatch between perceived and expected activity)
Describe the different types of auditory hallucination
- second person; voices which directly address the patient
- third person; voices which discuss the patient or provide a running commentary on his actions
- thought echo; the patient experiences his own thoughts spoken or repeated out loud
What is passivity phenomena?
- behaviour is experienced as being controlled by an external agency rather than by the individual
- can affect thoughts; thought insertion, thought withdrawal, thought broadcasting
- actions; made actions
- feelings; made feelings
Describe thought disorder
Disorder of the form of thought; there is evidence from the patients speech or writing that there is an abnormality in the way their thoughts are lined together, disturbance in organisation, control and processing of thoughts, the abnormality is in the form of their speech rather than its content
- two main examples are flight of ideas or loosening of associations
Describe flight of ideas
- words are associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders far from the original theme
- the patient jumps from topic to topic but with recognisable links such as rhyming, punning or environmental distractions
