Psychiatric history taking, mental state examination and making a diagnosis (symposium 1) Flashcards
1
Q
Setting of history taking
A
- Emphasis on privacy
- Avoid interruptions → phones and pagers
- Informal setting, avoid barriers, repeat personal space
- Easy exit → interviewer must have immediate access
2
Q
Suggested structure of a psychiatric history
A
- Presenting complaint(s)
- History of Presenting Complaint(s)
- Past Psychiatric History
- Past Medical History
- Current and Recent Medication
- Social history → alcohol, smoking and drugs
- Family History
- Forensic History
- Personal history
- Developmental milestones
- Schooling/ education
- Occupational history
- Relationships
- Pre-morbid personality
3
Q
Important tips
A
- Eye contact (but don’t stare into their soul)
- Relaxed non-threatening posture
- Open language gestures
- Non-verbal cues
- Polite authority over talkativeness
- Avoid advice and opinions too early
- Clarification and summary → allows for misperceptions to be rectified
4
Q
Presenting complaint
A
- Normal structure: what has brought them her
5
Q
History of presenting complaint
A
- Find detail into each complaint
- Onset, precipitant, duration, severity
- Associated symptoms
- Worst of better
- Response to treatment
- An absence of any particular symptoms
- SOCRATES
6
Q
Systematic enquiry
A
- Mood → depressed, euthymic, elated
- Anxiety/ panic symptoms
- Memory problems/ confusion
- Abnormal thought content → odd ideas, paranoia, obsessions, hypochondriacal concerns
- Perceptual abnormalities/ hallucinations
- Risk to self/ others
- Insight into illness → need for medication, treatment or hospital admission
7
Q
Exploring psychotic symptoms
A
- Seen or heard things that other people aren’t aware of
- Hear people taking when no one is around
- Insight into what is causing symptoms
- Beware commands
8
Q
Past psychiatric history
A
- Past episodes/ dx/ contacts
- Past treatments
- Inter-episodic functioning
- Previous hospital admissions
- Attempted suicide/ deliberate self harm
- Detention under mental health act
9
Q
Past medical history
A
- Developmental problems
- Head injuries
- Endocrine problems
- Liver damage, oesophageal varies, peptic ulcers
- Vascular risk factors
10
Q
Current/ recent medications
A
- Tablets/ injections
- Recent medications
- Discontinued drugs (within 6 months)
- Length and dosage of medication
- Adverse reactions and allergies
11
Q
Family history
A
- Major mental illness in distant relatives
- Genogram is helpful
12
Q
Social history
A
- Occupation
- Current financial situation/ stressors
- Smoking/ alcohol/ illicit drug use
- Current relationships/ stressors
- Children - contact
13
Q
Alcohol/ illicit drug history
A
- Regular/ intermittent
- Amount (units)
- Pattern
- Dependance/ withdrawal
- Impact on work, relationships, money, police
- Screening questions → CAGE
14
Q
Forensic history
A
- Contact with police
- Offences/ reoffends
- Violence and sexual crimes
15
Q
Personal history
A
- Developmental milestones
- Early life
- Schooling
- Occupation
- Relationships
- Financial
- Friendships, hobbies, interests
16
Q
Pre-morbid personality
A
- Difficult to attain → explanation by proxy
- ‘How would someone in your life describe you as a person’
- Emphasis on consistent patterns of behaviour, interactions, mood
17
Q
Fundamentals of mental state examination
A
- Appearance
- Behaviour
- Mood
- Speech
- Thought
- Beliefs
- Percepts
- Suicide/ homicide
- Cognitive function
- Insight
18
Q
Appearance
A
- Height/ build
- Clothing → appropriate/ kept/ bizzare
- Personal hygiene → clean/ unshaven/ malodorous
- Makeup, jewellery, accessories
19
Q
Behaviour
A
- Greeting
- Non-verbal cues
- Gesturing
- Abnormal movements → tremor, chores-athetoid movements, posture, akathisia
- Cooperative, rapport
20
Q
Mood
A
- Eye contact
- Affect → objective manifestation of mood
- Mood rating
- Psychomotor function → agitated, retarded
21
Q
Speech
A
- Spontaneity
- Volume
- Rate
- Rhythm
- Tone
- Dysarthria
- Dysphasia
22
Q
Abnormal thoughts
A
- Close relationship to speech → a manifestation of thoughts
- Phobias
- Obsessions
- Flight of ideas
- Formal thought disorder
23
Q
Abnormal beliefs
A
- Preoccupation
- Over valued ideas
- Delusional beliefs
24
Q
Abnormal perception
A
- Illusions
- Hallucinations
- Auditory, visual, somatic/ tactile, olfactory and gustatory
- Can be associated with specific conditions → Lewy body dementia
25
Q
Suicidal/ homicidal thoughts
A
- Ideations
- Intent
- Plans → vague, detailed, specific, already in motion
- Homicidal risk too
26
Q
Cognitive function
A
- Orientation → time, place and person
- Attention/ concentration
- Short-term memory
- Long-term memory
- Objective tests → MSQ, MMSE, MOCA, FAS Clock drawing, executive function tests
27
Q
Insight
A
- Spectrum
- Very rarely 100% present or absent
- Are symptoms due to illness
- Is this a mental illness
- Do you agree with mx plan
28
Q
Important definition
A
- Psychopathology → abnormal experience, cognition and behaviour
- Descriptive psychopathology → categorises abnormal experience as described by patient
- Phenomenology → Observation and understanding of patients experience of the psychological event ‘what it feels like for the patient’
29
Q
Physical examination in psychiatry
A
30
Q
Abnormal thoughts displayed at MSE
A
- Preoccupation
- Phobias
- Obsession
- Overvalued ideas → hypochondriacal ideas, body image distortion
- Delusions → primary and secondary
31
Q
Delusion
A
- Unshakeable idea or belief outwit person’s social and culture background
- E.g grandiose, paranoid, hypochondriacal, self-referential
32
Q
Thought disorder
A
- Pattern of interruption or disorganisation of thought processes
- E.g thought blocking, fusion, loosening of association, tangential thinking, derailment of thought, Knight’s move thinking
