Psychiatric History Taking, Mental State Examination and Diagnosis Flashcards
Presenting Complaint
“can you tell me in your own words why you are here?” This should always be recorded in the patients own words
History of presenting complaint
Clarify each complain in turn Onset, precipitants, course, severity Associated symptoms, effects on daily living Is it getting worse or better? Has it responded to any treatment?
Related Symptoms
What other changes have you noticed in your behaviour?
Past Psychiatric History
Past episodes Previous treatments Inter-episode functioning Previous admissions to hospital Attempted suicide/repeated DSH Previous detentions under Mental Health Legislation
Family History
Parents, siblings, grandparents. Genogram can be helpful
Past medical history
Developmental problems Head injuries Endocrine abnormalities Liver damage, oesophageal varices, peptic ulcers Vascular risk factors
Medication history
Ask about tablets and injections
Any drugs discontinued
How long for and what dose
Adverse reactions and allergies
Social History
Occupation, current financial situation, smoking, alcohol, current relationships, children
Alcohol history
Is the amount regular or intermittent, amount, pattern, dependence/withdrawal symptoms, impact on work, relationships. CAGE
Personal History
Developmental milestones Early life Schooling Occupational Relationship (sexual and marital status) Financial Friendships, hobbies and interests
Forensic History
Any contact with the police
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes
Pre-morbid personality
Difficult to be comprehensive
Emphasis on consistent patterns of behaviour, interaction, mood
“How would your best friend describe you as a person?”
Components of the Mental State Examination
Appearance Behaviour Mood Speech Thoughts Beliefs Percepts Suicide/Homicide Cognitive function Insight
Appearance
Height/build
Clothing - is it appropriate
Personal hygiene - clean/unshaven/malodorous
Make up, jewellery, accessories
Behaviour
Greetings Non verbal cues Gesturing - normal, expansive, bizarre Abnormal movements - tremor, posturing, akathisia Are they cooperative
Mood
Eye contact
Affect - external manifestation of mood
Mood rating - rate out of 10
Psychomotor function - retarded, agitated
Speech
Spontaneity Volume Rate Rhythm Tone Dysarthria Dysphasia
Abnormal Thoughts
Close relationship to speech Phobias Obsessions Flight of ideas Formal though disorder Knights move
Abnormal Beliefs
Preoccupations
Over valued ideas
Delusional beliefs
Abnormal Percepts
Illusions
Hallucinations - auditory, visual, somatic/tactile, olfactory, gustatory
Suicide/Homicide
Must always ask this Ideation Intent Plans - are they vague, detailed, specific, already in motion Homicide risk
Cognitive function
Orientation - time, place, person
Attention throughout the interview
Short term memory - 3 objects, name and address
Long term memory - personal history
Insight
Best seen as a spectrum
3 questions - are the symptoms due to illness? Is this a mental illness? Do they agree with treatment plan?
