Psychiatry Flashcards
What are the components of a psychiatric history?
- PC
- HPC
- Past Psychiatric Hx
- PMHx
- DHx - Substance misuse is key
- FHx
- Personal Life
- Premorbid personality
- SHx
- Forensic Hx
- Collateral Hx
What questions should you ask for suspected postpartum mental disorders?
What questions should you ask for suspected mania/if you are suspecting BPAD?
- You seem so happy, is this usual for you?
- You seem to have a lot of energy, is this usual for you?
- How much sleep are you actually getting?
- Do you feel special/better than others?
- Can you do things that other people can’t? Do you have special powers?
- How are you getting on with people these days?
- Sounds like you’ve been incredibly busy recently, do you have time to eat or sleep?
In a psych history, what do you need to find out about the history of PC?
- Begin with patient’s own narrative and explore
- Clarify terms - e.g. patient says she is “depressed”
- Timing - onset, triggers, progression
- Severity, frequency, duration
- Screen for other possible associated symptoms
- Has treatments been initiated
- Changes and effects
- Impact of illness
In a psych history, what must be assessed surrounding PPH?
- Nature
- Duration of illness
- Previous treatments – Did it work?
- Admissions/MHA – dates/lengths of admissions
- Suicide attempts or self harm/other risks
In a psych history, what must be assessed surrounding PMH?
- Breif full medical history including medications
- Endocrine
- Neurological
- Head injury
- Infections
In a psych history, what must be assessed surrounding FH?
- Ages
- Occupations
- Physical health
- Psychiatric history
- Relationship with patient
- Divorces/separations/conflicts
- Genogram
In a psych history, what must be assessed surrounding the patients personal history?
- Pregnancy and birth details
- Early childhood development
- Childhood health
- Early emotional stresses (separation/abuse)
- Education
- Occupational history
- Key relationships and psychosexual history
- Realtionship
In a psych history, what must be assessed surrounding the patients premorbid personality?
- Relationships – how relate to others
- Predominant mood
- Moral/religious beliefs
- Activities and interests
- Reaction to stressors
In a psych history, what must be assessed surrounding SH?
- Current occupation
- Finances
- Residence - Who are you currently living with
- Social contacts
- Interests and hobbies
In a psych history, what must be assessed surrounding Forensic history?
- Arrests
- Cautions/charges
- Convictions/sentences
- Crimes of violence
- Associated factors
- Have incidences been linkec with episodes of psychiatric illness
What are the components of a Mental state exam?
- Appearance and behaviour
- Speech
- Emotion/mood
- Perception
- Thoughts
- Insight
- Cognitive function
In a Mental state exam, what should be assessed under Appearance and behaviour?
- Describe a ‘picture of patient’
- Assess self-care/clothing
- Eye contact
- Posture and movements
- Psychomotor agitation/retardation/EPSE:akathisia/TD
- Level of activity
- Appropriateness of behaviour
- Responsiveness - distractibility
- Rapport/Guarded
In a Mental state exam, what should be assessed under Speech?
- Rate (fast/slow)
- Tone (emotional quality – sarcastic/angry)
- Flow (spontaneous/prompted/hesitant/long pauses/uninterruptible)
- Volume (loud/soft)
- Link to thoughts:
- Pressure of speech – pressure of thought
- Poverty of speech – poverty of thought
- Sudden stop – thought block
- Organic: Dysarthria, Dysphasia, Perseveration
- Unusual Content: neologisms, clang associations(rhyming), punning
In a Mental state exam, what should be assessed under Emotion?
- Subjective assessment
- Rating scale
- How much are you able to enjoy things that you used to like?
- Do you feel happier than usual?
- Record verbatim
- Rating scale
- Objective/Affect assessment
- Restricted, blunted, flattened
- Depression
- Elation
- Anxiety
- Guilt/worthlessness
- Suicidal ideation/Risk to others
What questions would you ask to assess emotions in suspected mania?
- You seem so happy, how are you feeling, is this usual for you?
- You seem to have a lot of energy today, is this usual for you?
- Sounds like you’ve been incredibly busy recently, do you have time to eat/sleep?
- How much sleep are you actually getting?
- Do you feel special? Better than other people? Can you do things that other people can’t do? Do you have special powers?
- How are you getting on with other people these days?
What is the difference between Affect and Mood?
- Affect = objective, short lived
- Mood = subjective and objective, more pervasive
- Affect = Weather
- Mood = Climate
What questions should you ask about suicide?
- ‘Have you ever had thoughts of harming yourself /ending it all?’
- If a patient has had specific thoughts, ask:
- ‘What particular thoughts went through your mind?’
- ‘Have you made any plans?’
- ‘How close have you come?’
- ‘What has stopped you doing anything?’
- ‘Have you actually tried to harm yourself?’
- If yes, ask:
- ‘What happened exactly?
- If yes, ask:
- If a patient has had specific thoughts, ask:
What two things are essential to assess following an episode of DSH?
- Intent
- How did they feel afterwards
In a Mental state exam, what should be assessed under Thoughts?
- Thought Form - Formal Thought Disorder
- Circumstantial speech – over-inclusive thinking (but you get to the goal)
- Flight of ideas (don’t get to the goal)
- Derailment – change topic, no logical connection (don’t get to the goal)
- Loosening of associations (also derailment, knights move thinking)
- Word salad
- Thought Content
- Preoccupations – worries and concerns
- Overvalued ideas
- Body image, belief they have a serious illness
- Obsessional thoughts and Compulsions
- Delusions
- Interference
What questions would you ask to assess emotions in a suspected anxiety disorder?
- Can you tell me what else you worry about?
- Is there anything specific that you are very scared of? Any particular situations?
- How do you feel in your body when you are worrying?
- Do you feel your heart racing? Do your palms gets sweaty? Do you sometimes find it hard to breathe?
- Do you avoid particular things/situations because of these unpleasant feelings?
- How do you cope in these situations?
What questions would you ask to assess emotions for suspected obsessions?
- Do you have any unpleasant thoughts that don’t go away however hard to try to ignore them?
- Do you worry about cleanliness, not having checked something, bad religious thoughts, doing something bad to someone, etc
- Where do these thoughts come from?
- Do you believe them?
- How do they make you feel?
- How do you manage these feelings?
What is the difference between delusional mood and delusional perception?
- Mood = ‘When you go somewhere, everything seems already set up for you like in a theatre – it’s really eerie, and you get terribly frightened’
- Perception = Objects/events gain a new meaning
What questions would you ask to assess emotions for suspected psychosis?
- Do you ever feel something strange is going on?
- ‘Do you ever feel that people are trying to harm you or hurt you?’
- ‘Do you ever feel that you are being watched or followed?
- Have you had any unusual experiences?
- Ideas of Reference - ‘Have you ever felt as if you were receiving messages from television, radio, newspapers?’
- Have you felt suspicious about things recently?
What questions would you ask to assess emotions for suspected thought interference?
- Thought Interference
- ‘Do you ever feel that your thoughts are being interfered with?’
- Thought Broadcasting
- ‘Do you ever feel that people can read your mind or that your thoughts are available to others?’
- ‘Thought Withdrawal
- Have you ever felt as if thoughts are being taken out of your head?’
- Thought Insertion
- ‘Do you feel that people are putting thoughts into your head?’
In a Mental state exam, what should be assessed under Perception?
- Illusions
- Depersonalisation/derealisation
- Hallucinations
- Auditory
- Visual
- Tactile
- Olfactory
- Gustatory
What questions would you ask to assess emotions for suspected hallucinations?
- ‘Do you ever hear someone talking when there seems to be no one around?’
- ‘Could you tell me more about what you hear?’
- Auditory
- ‘What do they say?’
- ‘Is there one person/voice or more than one person/voice?’
- ‘Do you recognize them?’
- ‘Do they seem to talk to you, like I’m talking to you or about you, as if you’re not there?’ – second or third person
- ‘Where do they seem to be coming from?’
- ‘Do they seem to come from inside or outside your head?’ – pseudo hallucinations versus hallucinations
- ‘Are they real or do you feel they are part of you?’ – hallucinations versus pseudo hallucinations
- ‘How much of the time are they there?’
- ‘Do you hear them in certain situations?’
- ‘How do they affect you?’
- ‘Do you ever hear your own thoughts spoken aloud?’ – thought echo
- ‘Do the voices ever tell you to do things?’ – commanding voice
- ‘What do they instruct you to do?’
- Do they ever tell you to do bad things, for example hurt yourself or others?’
- ‘Do you feel you have to act on them?’
What questions should you ask to determine whether a patients thoughts are a fixed delusion or overvalued idea?
- ‘Are you absolutely sure that that there is a plot against you, or is it possible that you might be mistaken?’
- ‘If somebody else said that to you, what would you make of it?’
- ‘Is there any chance you mind could be playing tricks on you?’
In a Mental state exam, what should be assessed under Cognition?
- Ideally a MMSE or MOCA
- Can do a short assessment of orientation, attention, concentration, memory for consult
In a Mental state exam, what should be assessed under Insight?
- Do others/you think you might be unwell?
- What do you think the problem is?
- Do you think you might need treatment?
- What do you think will help/has helped?
How might you counsel a patient with Bulimia nervosa?
- Explain the diagnosis (characterised by episodes of excessive eating followed by guilt and purging)
- Explain the complications (low self-esteem, depression, problems with relationships, dehydration, tooth and gum disease, heart problems)
- Explain the psychological management (guided self-help for 4 weeks to CBT-ED or just FT-BN)
- Consider medical (high-dose fluoxetine)
