Psychiatry History Taking Flashcards by Emilia Sykes

What are the 2 fundamental parts of psychiatric history?

Collection of clinical data
- Clinical history
- Examination of mental state
Intuitive understanding of patient as an individual

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What are the different areas of the psychiatric history?

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”

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What would you ask about in the history of presenting complaint?

Onset, precipitants, course, severity
Associated symptoms
- Systematic enquiry
Getting better or worse
Responded to treatment

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What would you ask about in the past psychiatric history?

Past episodes/diagnosis
Previous treatments
Inter-episode functioning
Previous admissions
Attempted suicide/repeated self-harm
Previous detention under mental health act

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What would you ask about in the past medical history?

Developmental problems
Head injuries
Endocrine abnormalities
Liver damage, oesophageal varices, peptic ulcers
Vascular risk factors

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What would you ask about in the drug history?

Current medication
Drugs discontinued in last 6 months
Same as standard drug history

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What would you ask about in the family history?

Usual family history
Ask about age, employment, circumstances, health problems, quality of relationship
Major mental illness in distant relatives

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What would you ask about in the 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

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What would you ask about in the forensic history?

Contact with police
Particular attention to violent or sexual crimes

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What would you ask about in the personal history?

Developmental milestones
Schooling/education
Occupational history
Relationships
Pre-morbid personality
- “How would your best friend describe you as a person”

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What are some important general skills for psychiatric history?

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

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What are some of the objectives of the psychiatric history?

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

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What are some ways you could ask questions to explore psychotic symptoms?

“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

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What are the different areas of the mental state examination?

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

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How do you assess appearance?

Height/build
Clothing
Personal hygiene
Make up, jewellery, accessories

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How do you assess behaviour?

Greeting
Non-verbal cues
Gesturing (normal, expansive, bizarre)
Abnormal movements (tremor, choreioathetoid movements, posturing)
Co-operative, rapport

How do you assess mood and affect?

Eye contact
Mood rating – subjective and objective (out of 10)
Psychomotor function (retarded, agitated)

What is mood?

Mood = patients subjective report of their current mood from depressed to euthymic (neutral) to elated

What is neutral mood called?

Euthymic

What is affect?

Affect = emotions conveyed and observed objectively during interview

What are examples of psychomotor function comments?

Psychomotor function (retarded, agitated)

What are examples of abnormal movements?

Abnormal movements (tremor, choreioathetoid movements, posturing)

What are examples of describing gestures?

Gesturing (normal, expansive, bizarre)

How do you assess speech?

Volume (loud, quiet, poverty)
Rate (pressured, slow)
Rhythm (rhyming and punning)
Tone (monotonous, llilting)
Dysarthria
Dysphagia (expressive/receptive)

How do you assess abnormal thoughts?

* Phobias * Obsessions * Flight of ideas * Formal thought disorder * Knight’s move, derailment, loosening

How do you assess abnormal beliefs?

* Preoccupations * Overvalued ideas * Delusional beliefs

What are delusions?

* Delusion = unshakable idea or belief which is out of keeping with persons social and cultural background

What are examples of delusional beliefs?

* Examples – grandiose, paranoid, hypochondriacally, self-referential

How do you assess abnormal perception?

How do you assess suicide/homicide?

* Ask about thoughts * Intent * Plans (vague, detailed, specific)

How do you assess 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

How do you assess 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

How should delicate questions be asked?

* Schedules for Clinical Assessment in Neuropsychiatry * How to appropriately ask questions, such as “we ask everyone this, do you hear voices..”

What does SCAN stand for?

Schedules for clinical assessment in neuropsychiatry

WHat is psychopathology?

Psychopathology = the abnormal experience, cognition or behaviour

What is descriptive psychopathology?

Descriptive psychopathology = describes and categorises the abnormal experience as described by the patient

What is phenomenology?

Phenomenology = observation and understand of the psychological event or phenomenon so that the observe can as far as possible know that the patients experience feels like

What are: - predisposers - precipitants - perpetuators

Predisposers = things in background that put at risk Precipitants = things that make it happen now Perpetuators = things that keep it going