Psychiatric History Taking, Mental State Examination and Making a Diagnosis Flashcards
- To present a basic format for a full psychiatric history taken in an outpatient/ inpatient setting.
- To establish the diagnostic importance of the mental state examination.
- To relate psychiatric history taking to the content of the lectures provided in the mental health course.
- To provide a foundation for the later acquisition of clinical skills in psychiatric assessment.
- To illustrate the importance of key definitions of clinical symptoms and signs.
- To be able to take a basic psychiatric history.
- To conduct a mental state examination.
- To present the findings of a mental state examination
The setting when taking a psychiatric history (3)
Privacy - no phones/pagers
Informal manner
Easy access to exit
Sections of a psychiatric history (9)
Presenting Complaint(s) History of the Presenting Complaint(s) Past Psychiatric History Past Medical History Current and Recent Medication Social History Family History Personal History (i.e. developmental milestones, educational attainment, occupational history, relationships) Forensic history Pre-morbid personality
Important general skills during the consultation
Eye contact
Relaxed posture
Facilitative noises
Pick up on non-verbal cues and acknowledge them (e.g. I see you are upset about that)
Control any over-talkativeness with polite authority
Don’t offer advice too early
Clarify and summarise to demonstrate interest and allow for any miscommunications to be cleared
Starting with an open question like “tell me how you were feeling before admission or tell me what brought you here?” is preferred
What are the advantages of open questions
Allows patient to give more detail and put them at ease
Gives you as the doctor time to think and plan questions to ask
Questions to ask in HPC (4)
Clarify each PC with appropriate parts of SOCRATES (O, A, T, E, S, effects on daily living)
What other changes have your family/friends noticed about you?
Specific symptoms questions (i.e. systematic enquiry)
Explore psychotic symptoms with questions like
- have you seen or heard things that other people don’t?
- what do you think is causing it/
- has anything been playing on your mind?
Questions to ask in past psychiatric history (6)
Past episodes/ diagnoses/ contacts
Previous treatments (psychological, drug and physical)
Function/wellbeing between episodes
Previous admissions to hospital
Attempted suicide
Previous detentions under Mental Health Legislation
Questions to ask in FH
Basic like normal history - parents, siblings, their health
Ask about major mental illness in distant relatives as well as immediate family
Questions to ask in PMH
Developmental problems
Head injuries
Endocrine abnormalities
GI problems - liver, oesophagus, peptic ulcers
Vascular risks factors - hypertension, hyperlipidaemia, obesity, DM, alcohol, old age
Questions to ask in DH
Current tablets and injections
- how long since first started
- dosage
- side effects
Any new medication
Any medication stopped (within past 6 months
Allergies
Questions to ask in SH
Same as normal
+ alcohol/ drug - amount (units), pattern, dependence, impact on work/relationships/money
+ financial situation
+ current relationship/stressors
+ children - contact
Questions to ask in personal history
Developmental milestones (when young) Early life Schooling Occupational Relationships (sexual & marital history) Financial Friendships, hobbies and interests
Questions to ask in forensic history
Have you ever been in contact with the police? Charged with any crime?”
Questions to ask in pre-morbid personality
Information of patient’s character prior to the illness
-How would your best friend or family describe you as a person?
Sections of a mental state examination (9)
Appearance & Behaviour Mood – subjective, objective & affect Speech Abnormal thoughts - thought-form, thought-content (delusions) Abnormal beliefs Abnormal perceptions Thoughts of self harm Suicidal and homicidal ideation Insight Cognition
