Psychiatric History Taking, Mental State Examination and Diagnosis

Question 1

Presenting Complaint

Answer 1

“can you tell me in your own words why you are here?” This should always be recorded in the patients own words

Question 2

History of presenting complaint

Answer 2

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?

Question 3

Related Symptoms

Answer 3

What other changes have you noticed in your behaviour?

Question 4

Past Psychiatric History

Answer 4

Past episodes
Previous treatments
Inter-episode functioning
Previous admissions to hospital
Attempted suicide/repeated DSH
Previous detentions under Mental Health Legislation

Question 5

Family History

Answer 5

Parents, siblings, grandparents. Genogram can be helpful

Question 6

Past medical history

Answer 6

Developmental problems
Head injuries
Endocrine abnormalities
Liver damage, oesophageal varices, peptic ulcers
Vascular risk factors

Question 7

Medication history

Answer 7

Ask about tablets and injections
Any drugs discontinued
How long for and what dose
Adverse reactions and allergies

Question 8

Social History

Answer 8

Occupation, current financial situation, smoking, alcohol, current relationships, children

Question 9

Alcohol history

Answer 9

Is the amount regular or intermittent, amount, pattern, dependence/withdrawal symptoms, impact on work, relationships. CAGE

Question 10

Personal History

Answer 10

Developmental milestones
Early life
Schooling
Occupational
Relationship (sexual and marital status)
Financial 
Friendships, hobbies and interests

Question 11

Forensic History

Answer 11

Any contact with the police
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes

Question 12

Pre-morbid personality

Answer 12

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

Question 13

Components of the Mental State Examination

Answer 13

Appearance 
Behaviour
Mood
Speech
Thoughts
Beliefs
Percepts
Suicide/Homicide
Cognitive function
Insight

Question 14

Appearance

Answer 14

Height/build
Clothing - is it appropriate
Personal hygiene - clean/unshaven/malodorous
Make up, jewellery, accessories

Question 15

Behaviour

Answer 15

Greetings
Non verbal cues
Gesturing - normal, expansive, bizarre
Abnormal movements - tremor, posturing, akathisia
Are they cooperative

Question 16

Mood

Answer 16

Eye contact
Affect - external manifestation of mood
Mood rating - rate out of 10
Psychomotor function - retarded, agitated

Question 17

Speech

Answer 17

Spontaneity
Volume
Rate
Rhythm
Tone
Dysarthria
Dysphasia

Question 18

Abnormal Thoughts

Answer 18

Close relationship to speech
Phobias
Obsessions
Flight of ideas
Formal though disorder
Knights move

Question 19

Abnormal Beliefs

Answer 19

Preoccupations
Over valued ideas
Delusional beliefs

Question 20

Abnormal Percepts

Answer 20

Illusions

Hallucinations - auditory, visual, somatic/tactile, olfactory, gustatory

Question 21

Suicide/Homicide

Answer 21

Must always ask this
Ideation 
Intent
Plans - are they vague, detailed, specific, already in motion
Homicide risk

Question 22

Cognitive function

Answer 22

Orientation - time, place, person
Attention throughout the interview
Short term memory - 3 objects, name and address
Long term memory - personal history

Question 23

Insight

Answer 23

Best seen as a spectrum

3 questions - are the symptoms due to illness? Is this a mental illness? Do they agree with treatment plan?