Psychiatry Flashcards
Psychiatric history
Presenting complaint
H/Pc
Past psychiatric illness
Past medical history
Family history
Personal & social history
- Antenatal problems
- Developmental problems
- Childhood
- School history & university- primary & high
- Job
- Menstrual
- Relationships
- Sexual history
- Children
- Housing including current financial
- Current ability with ADL
Drugs and alcohol
Forensic history
Personality
MSE
- Appearance & Behaviour (engagement & rapport; eye contact; facial expression; body language; movements)
- Speech (rate, quantity, tone, volume, reaction time)
- Mood & Affect (range & mobility of affect; congruent)
- Thought (FORM- amount & connection; CONTENT; POSESSION)
- Perception (Hallucination, Illusions, Depersonalisation- not themselves but someone different, Derealisation)
- Cognition
- Insight
Form of thought- amount/volume
Blocking
Poverty of thought
Pressure of thought
Perseveration
Form of thought- connection
- Loose association
- Knight’s move (severe version of LA, unexpected & illogical leaps from one idea to another)
- Circumstantial
- Tangential
- Flight of ideas (leads from one topic to another) (often in mania)
- Neologisms
- Clang association (related by rhyme/ sound similar)
- Word salad (incoherent speech but real words)
Thought content
Delusions: Firm, fixed belief on inadequate grounds (eg- persecutory) (do you have other beliefs which aren’t shared by others)
Obsession & Compulsions
Overvalued ideas (does a particular thought occupy your mind a lot?)
Suicidal thoughts/ worthlessness/ guilt
Homicidal/ Violent
Thought possession
Insertion
Withdrawal
Broadcast (everyone can hear their thoughts)
Definition of Schizophrenia
Mental health condition with distorted perception & thinking with blunted or inappropriate affect
Schizophrenia diagnosis
1m of having one or more of:
- Delusions
- Hallucinators
- Thought disorder- insertion, broadcast, withdrawal, echo (can hear thoughts aloud)
- Delusions of passivity, control, impulse
Hallucinations
Auditory
- Do you ever hear noises/ voices when nobody is there/ no one else can?
- Where do you hear them- ears or mind?
- How many voices?
- What do they say?
- Do you know who it is?
- When are the voices there- all the time?
- Do you have a conversation with them?
- Do you smell/ see anything at the same time?
Somatic
- Can you feel something touching you when nobody is there?
- Does it feel like bugs crawling under your skin/ what does it feel like?
Thought distortion
(MSE possession)
Thought blocking (sudden cessation of though, cannot recover what was previously said:
- Do you ever experience thoughts suddenly stopping as if there were no thoughts left?
- Do you feel able to think clearly?
- What is it like? Explain
Thought withdrawal:
- Do you feel like someone is taking your thoughts out? Who are they? Why do you think are they doing it? How do you know it’s happening
Thought insertion:
- Are they your own thoughts?
- If not, who’s are they?
- How do you know they are not yours? Where do they come from?
Broadcasting:
- Do you think I can hear your thoughts?
- Why do think that?
Delusions
(MSE- thought content)
- Do you have thoughts that others tell you are false?
- Do you have beliefs not shared by others?
- How do you know/ What evidence do you have for X?
- Do you think people are out to harm you?
- When you watch/ listen to tv/radio do you think some of the stories they mention refer to you?
Passivity
Not in control of their own actions, thoughts or perceptions- controlled by an external agent
- Do you think someone is controlling you- thoughts, actions, mood?
- Who do you think it is?
Lithium Counselling
- ICE (Do you know what Lithium is?)
- Pt history (Do they know why they are on it? Questions about their diagnosis)
- What is lithium & how does it work (changes the way in which your brain processes signals helping to stabilise your mood)
- How to take (Tablet/Liquid, Same time, Do not suddenly stop taking it, If you miss a dose do not take a double dose)
- Monitoring (Blood tests/ BMI/ Waist circumference before starting; Monitoring every week until levels stabilised → every 3m. TFT, U&E, eGFR every 6m)
- Side effects
- Pregnancy (Contraception; Birth defects; Pass to baby during breastfeeding. Speak to psych is wanting to become pregnant)
- PATIENT LEAFLET!
Lithium Side effects
- Lethargy
- Insipidus (diabetes)
- Tremor
- Hypothyroidism
- Insides (GI)
- Urine (lots)
- Metallic taste
Avoid taking NSAIDs as they can increase serum concentration of lithium
Suicide risk assessment
- BEFORE (Events leading up to it, Planned, Finals acts- will, suicide note, terminating contracts, Precautions to be found)
- DURING (Method & did you think this would kill; What was going through your mind during; How were you discovered?)
- AFTER (Feelings now; Regret)
- Future (Protective factors, Feelings about the future- if they’ve changed their mind, why; Future suicide plans)
Screen for Depression, Psychosis
Past psych history, Medication, FHx suicide, Social- drugs, alcohol, social/ living situation
