Psychiatry History Taking Flashcards
1
Q
What are the 2 fundamental parts of psychiatric history?
A
- Collection of clinical data
- Clinical history
- Examination of mental state
- Intuitive understanding of patient as an individual
2
Q
What are the different areas of the psychiatric history?
A
- Presenting complaint(s)
-
History of presenting complaint(s)
- Onset, precipitants, course, severity
- Associated symptoms
- Systematic enquiry
- Getting better or worse
- Responded to treatment
-
Past psychiatric history
- Past episodes/diagnosis
- Previous treatments
- Inter-episode functioning
- Previous admissions
- Attempted suicide/repeated self-harm
- Previous detention under mental health act
-
Past medical history
- Developmental problems
- Head injuries
- Endocrine abnormalities
- Liver damage, oesophageal varices, peptic ulcers
- Vascular risk factors
-
Drug history
- Current medication
- Drugs discontinued in last 6 months
- Same as standard drug history
-
Family history
- Usual family history
- Ask about age, employment, circumstances, health problems, quality of relationship
- Major mental illness in distant relatives
-
Social history
- Same as normal social history
- Financial situation/stressors
- Current relationship/stressors
- Alcohol/illicit drugs
- Regular or intermittent
- Amount (units)
- Pattern
- Dependence/withdrawal symptoms
- Impact on work, relationships
-
Forensic history
- Contact with police
- Particular attention to violent or sexual crimes
-
Personal history
- Developmental milestones
- Schooling/education
- Occupational history
- Relationships
- Pre-morbid personality
- “How would your best friend describe you as a person”
3
Q
What would you ask about in the history of presenting complaint?
A
- Onset, precipitants, course, severity
- Associated symptoms
- Systematic enquiry
- Getting better or worse
- Responded to treatment
4
Q
What would you ask about in the past psychiatric history?
A
- Past episodes/diagnosis
- Previous treatments
- Inter-episode functioning
- Previous admissions
- Attempted suicide/repeated self-harm
- Previous detention under mental health act
5
Q
What would you ask about in the past medical history?
A
- Developmental problems
- Head injuries
- Endocrine abnormalities
- Liver damage, oesophageal varices, peptic ulcers
- Vascular risk factors
6
Q
What would you ask about in the drug history?
A
- Current medication
- Drugs discontinued in last 6 months
- Same as standard drug history
7
Q
What would you ask about in the family history?
A
- Usual family history
- Ask about age, employment, circumstances, health problems, quality of relationship
- Major mental illness in distant relatives
8
Q
What would you ask about in the social history?
A
- Same as normal social history
- Financial situation/stressors
- Current relationship/stressors
- Alcohol/illicit drugs
- Regular or intermittent
- Amount (units)
- Pattern
- Dependence/withdrawal symptoms
- Impact on work, relationships
9
Q
What would you ask about in the forensic history?
A
- Contact with police
- Particular attention to violent or sexual crimes
10
Q
What would you ask about in the personal history?
A
- Developmental milestones
- Schooling/education
- Occupational history
- Relationships
- Pre-morbid personality
- “How would your best friend describe you as a person”
11
Q
What are some important general skills for psychiatric history?
A
- Eye contact
- Relaxed posture
- Facilitative noises such as “I see”, “okay”
- Do not offer advice or opinion too early
- Clarification and summary to fix any misperceptions
- Begin with open questions, and then closed questions
12
Q
What are some of the objectives of the psychiatric history?
A
- Form rapport and gather information
- Establish and explore symptoms
- Explore biological and social factors related to symptoms
- Inform and motivate patient
- Examine mental state
- Begin formulation
13
Q
What are some ways you could ask questions to explore psychotic symptoms?
A
- “Have you seen or heard anything that other people have not been aware of”
- “Have you heard any people talking when there was nobody around”
- What do you think might be causing them
- Beware commands – red flag symptom
14
Q
What are the different areas of the mental state examination?
A
-
Appearance
- Height/build
- Clothing
- Personal hygiene
- Make up, jewellery, accessories
-
Behaviour
- Greeting
- Non-verbal cues
- Gesturing (normal, expansive, bizarre)
- Abnormal movements (tremor, choreioathetoid movements, posturing)
- Co-operative, rapport
-
Mood and affect
- Mood = patients subjective report of their current mood from depressed to euthymic (neutral) to elated
- Affect = emotions conveyed and observed objectively during interview
- Eye contact
- Mood rating – subjective and objective (out of 10)
- Psychomotor function (retarded, agitated)
-
Speech
- Spontaneity
- Volume (loud, quiet, poverty)
- Rate (pressured, slow)
- Rhythm (rhyming and punning)
- Tone (monotonous, llilting)
- Dysarthria
- Dysphagia (expressive/receptive)
-
Abnormal thoughts
- Phobias
- Obsessions
- Flight of ideas
- Formal thought disorder
- Knight’s move, derailment, loosening
-
Abnormal beliefs
- Preoccupations
- Overvalued ideas
- Delusional beliefs
- Delusion = unshakable idea or belief which is out of keeping with persons social and cultural background
- Examples – grandiose, paranoid, hypochondriacally, self-referential
-
Abnormal perception
- Illusions
- Hallucinations (pseudo, true)
- Many domains (auditory, visual, somatic/tactile, olfactory and gustatory)
- Specific types may be associated with certain conditions
-
Suicide/homicide
- Ask about thoughts
- Intent
- Plans (vague, detailed, specific)
-
Cognitive function
- Orientation (time, place, person)
- Attention/concentration
- Short term memory (3 objects – name and address)
- Long term memory (personal history)
- If any concerns perform objective tests such as
- MSQ, MMSE, MOCA, FAS, clock drawing, executive function tests
-
Insight
- Best seen as spectrum
- Varies over time/illness
- 3 questions
- Are symptoms due to illness
- Is this a mental illness
- Do they agree with treatment plan
15
Q
How do you assess appearance?
A
- Height/build
- Clothing
- Personal hygiene
- Make up, jewellery, accessories
38
Q
What are:
- predisposers
- precipitants
- perpetuators
A
Predisposers = things in background that put at risk
Precipitants = things that make it happen now
Perpetuators = things that keep it going
