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Psychiatry > Psychiatric History Taking, Mental State Examination and Making a Diagnosis > Flashcards

Psychiatric History Taking, Mental State Examination and Making a Diagnosis Flashcards

1
Q

What are the 2 fundamental components in psychiatric interviewing?

A

1 - Collection of clinical data

2 - Understanding of the patient as an individual

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2
Q

What are key components of being able to understand the patient as an individual?

A

1 - Empathy

2 - Descriptive psychopathology

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3
Q

What is involved in collecting clinical data from a psychiatric patient?

A

1 - Taking a clinical history

2 - Examining mental state

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4
Q

What are the additional areas that need to be explored in a psychiatric history taking on top of the normal history taking components?

A

1 - Past psychiatric history

2 - Recent medication (in addition to current medications)

3 - Family Psychiatric history:

4 - Forensic history

5 - Personal history:

  • Developmental milestones
  • Schooling/education
  • Occupational history
  • Relationships
  • Pre-morbid personality

6 - MSE

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5
Q

How should psychiatric histories begin?

A

1 - Start with open questions (“can you tell me in your own words why you are here?”)

2- Record each presenting complaint in the patients own words

3 - Clarify each complaint in turn (use appropriate parts of SOCRATES)

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6
Q

What are the systematic symptoms to enquire about during a psychiatric history?

A

1) Mood - depressed, elated
2) Anxiety/panic
3) Memory problems/confusion
4) Abnormal thought content (obsessions, paranoia)
5) Hallucinations
6) Risk of harm to self or others
7) Insight

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7
Q

What questions should be asked when exploring perceptual disturbances in psychiatric patients?

A

1 - “Have you seen or heard anything that other people have not been aware of?”

2 - “Have you heard any people talking when there was nobody around?”

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8
Q

What questions should be asked when exploring a psychiatric patients beliefs/thoughts?

A

1 - Has anything particular been playing on your mind?

2 - Do you know why this is happening?

3 - Have you noticed any change in your thoughts?

4 - Has anyone interfered with your thoughts?

5 - Does anyone else have access to your thoughts?

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9
Q

What are the components of the mental state examination?

A

1 - Appearance

2 - Behaviour

3 - Mood

4 - Speech

5 - Thoughts

6 - Beliefs

7 - Percepts

8 - Suicide/homicide

9 - Cognitive function

10 - Insight

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10
Q

What points should be considered when reviewing a patients appearance?

A
  • Height & build
  • Clothing - is it appropriate or not, are they kempt or bizarre looking
  • How is their personal hygiene - clean/unshaven/malodorous
  • Are they wearing make-up, jewellery or accessories
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11
Q

What should be considered when reviewing a patients behaviour?

A

1 - Their initial greeting

2 - Their non-verbal cues

3 - Gestures (normal, expansive, bizarre)

4 - Abnormal movements (tremor, choreiothetoid movements, posturing)

5 - Are they cooperative and can build a rapport

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12
Q

What should be considered when assessing a patients mood?

A

1 - Eye contact

2 - Rating of mood subjectively and objectively (score out of 10)

3 - Psychomotor function (retarded or agitated)

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13
Q

What should be considered when assessing a patients speech?

A

1 - Spontaneity (are they speaking without being asked questions)

2 - Volume (loud, quiet, poverty)

3 - Rate - pressured or slowed

4 - Rhythm - rhyming and punning

5 - Tone - monotonous, lifting

6 - Dysarthria (unclear articulation)

7 - Dysphasia - expressive or receptive (unable to generate or understand speech)

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14
Q

What should be considered when assessing a patient for abnormal thoughts?

A

1 - Close relationship of thoughts to speech

2 - Phobias

3 - Obsessions

4 - Flight of ideas

5 - Thought disorders (broadcast, echo, block, withdrawal)

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15
Q

What should be considered when assessing a patient for abnormal beliefs?

A

1 - Preoccupations

2 - Over valued ideas

3 - Delusional beliefs (fixed, false belief out of cultural context, extraordinary comviction)

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16
Q

What is the difference between illusions and hallucinations?

A

Illusions - A stimulii is present

Hallucinations - No stimulii is present

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17
Q

What should be considered when assessing a patients perception?

A

1 - Illusions

2 - Hallucinations

3 - Which domain is their perceptual disturbance? Auditory, visual, somatic/tactile, olfactory, gustatory

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18
Q

What should be considered when assesing a patient for suicide/homicide?

A

1 - Must always ask about suicidal thoughts

2 - Ideation (having ideas or thoughts about suicide or homicide)

3 - Intention

4 - Plans (vague, detailed, specific, already in motion)

5 - Homicidal risk

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19
Q

What should be considered as part of assesing a patients cognitive function?

A

1 - Orientation (time, place, person)

2 - Attention/concentration

3 - Short-term memory (3 objects; name and address)

4 - Long-term memory (personal history)

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20
Q

What tests are available for more advanced assesment of cognitive function if concerns arise from basic assesment?

A

1 - Mental Status Questionaire (MSQ)

2 - Mini-mental state examination (MMSE)

3 - Montreal Cognitive Assesment (MOCA)

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21
Q

What questions should a patient be asked when assesing their insight?

A

Ask the patient the following questions to check their understanding of their condition and ability to label their abnormal behaviours as part of their illness:

1 - Are their symptoms due to illness?

2 - Is this a mental illness?

3 - Do they agree with treatment and management plan?

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22
Q

What are important aspects of the family history when taking a psychiatric history?

A

1 - Family structure (divorce etc.)

2 - Family psychiatric history

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23
Q

What are important events to consider in the PMH of a psychiatric patient?

A

1 - Head injuries

2 - Neurological disease

3 - Developmental disorders

4 - Psychosomatic disorders

24
Q

What endocrine disorder can mimic the symptoms of depression?

A

Hypothyroidism

25
Q

What should be given special consideration when taking a social history?

A

Potential stressors

26
Q

What is descriptive psychopathology?

A

The description and categorisation of the abnormal experience as described by the patient

27
Q

What is phenomenology?

A

The observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patients experience feels like

28
Q

What is meant by empathy?

A

Empathy = feeling oneself into

  • Measure a patients internal subjective state using your own emotional and cognitive experience as a yardstick
29
Q

How is empathy achieved?

A
  • Precise insightful questioning until the doctor is able to give an account of the patients subjective experience
  • Questioning continues until the patient recognises the account re-told by the psychiatrist to be accurate
30
Q

What is SCAN in psychiatry?

A

Schedules for Clinical Assessment in Neuropsychiatry

31
Q

What are examples of appearance and behaviour that might be clinical signs?

A

1) Movement disorders (catatonia - wavy flexibility, forced grasping, opposition, aversion, negativism)
2) Responding to unseen stimuli
3) Evidence of side effects of medication
4) Evidence of intoxication

32
Q

What is meant by affect in terms of a psychiatric assessment?

A

Affect = the emotions conveyed objectively during interview

33
Q

What are examples of the types of affect that can be observed in a psychiatric interview?

A

1 - Anxiety

2 - Anger

3 - Euphoria

34
Q

What condition is characterized by blunted affect? Or loss of ‘social grace’?

A

Schizophrenia

35
Q

Under what sections should thoughts and thinking be organised when performing a psychiatric assessment?

A

1 - Speed and tempo of thoughts

2 - Types of thoughts demonstrated

3 - Linkage and thought form

4 - Possession of thoughts

36
Q

What type of thinking speed is displayed in depression?

A
  • Decreased speed of thought
  • ‘Poverty of thought’ (slowed thinking speed + limited content)
37
Q

What thinking speed is displayed in hypomania or mania?

A
  • “Flight of ideas”
  • Rapid speech with incoherence
38
Q

What are the different types of thought that can be displayed during an MSE?

A

1 - Preoccupations

2 - Phobias

3 - Obsessions

4 - Overvalued ideas

5 - Delusions

39
Q

What is the difference between primary and secondary delusions?

A

Primary - not understandable

Secondary - understandable in the context of preceeding affects or other experiences

40
Q

What is a delusion?

A

“A delusion is an unshakeable idea or belief which is out of keeping with the persons social or cultural background; it is held with extraordinary conviction”

41
Q

What are some examples of delusional thinking?

A

1 - Grandiose

2 - Paranoid

3 - Hypochondriacal

4 - Self referential

42
Q

What is meant by formal thought disorder?

A

A pattern of interruption or disorganization of thought processes

43
Q

What are some examples of formal thought disorder?

A
  • Thought blocking
  • Fusion
  • Loosening of associations
  • Tangential thinking
  • Derailement of thought/knights move thinking
44
Q

What are the commonly reported thought disorders in schizophrenia?

A

1 - Thought insertion & withdrawal

2 - Thought blocking

3 - Thought broadcasting

45
Q

What is SCAN used for?

A

A set of instruments aimed at assessing, measuring and classifying the psychopathology and behaviour associated with major psychiatric syndromes of adult life

46
Q

What are hypnagogic phenomena?

A

Perceptual anomalies occuring immediately before falling asleep

47
Q

What are hypnopompic phenomena?

A

Perceptual anomalies occuring immediately before awakening

48
Q

If a patient has psychotic symptoms, what stage of depression must they be suffering from?

A

Severe

49
Q

What medication can be used to treat movement disorders such as waxy flexability?

A

Benzodiazepenes

50
Q

What is a delusional perception?

A
  • Patient has a real perception (e.g. they see something)
  • Patient then has a delusional interpretation about the real perception
  • It is NOT a hallucination
51
Q

In which group of patients is nihilism most likely to occur?

A

Elderly (and it is always accompanied with depression)

52
Q

What is the difference between a hallucination and a pseudohallucination?

A

Hallucination - the patient considers it to be real

Pseudo-hallucination - the patient realises that the experience is unlikely to be true

53
Q

What is the ICD-10?

A

Provides clinical descriptions and diagnostic guidelines for mental and behavioural disorders

54
Q

What are the key symptoms of a depressive episode which must be present in order for a diagnosis to be made?

A

1 - Persistent sadness or low mood

2 - Loss of interests or pleasure

3 - Fatigue or low energy

55
Q

How is the severity of the depression assessed?

A

Mild depression = 4 additional symptoms on top of the key symptoms

Moderate depression = 5-6 additional symptoms on top of the key symptoms

Severe depression = 7 or > additional symptoms on top of the key symptoms

56
Q

What are the associated symptoms of depression which should be checked for if any of the key symptoms are present?

A

1 - Disturbed sleep

2 - Poor concentration or indecisiveness

3 - Low self-confidence

4 - Poor or increased appetite

5 - Suicidal thoughts or acts

6 - Agitation or slowing of movements

7 - Guilt or self-blame

57
Q
A

Psychiatry (18 decks)

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