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MBBS IV - Supplementary Courses > Psychiatry - History taking and Mental state exam (III) > Flashcards

Psychiatry - History taking and Mental state exam (III) Flashcards

1
Q

Define the 3 objectives of psychiatric diagnostic interview

A

1) Introduce yourself, build rapport
2) Communicate clearly
3) Demonstrate empathy

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2
Q

What style of questioning should you use for psychiatric Hx?

A

Open-ended first, then closed questions

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3
Q

Reasons to demonstrate empathy during psychiatric interview

A
  • Rapport
  • Facilitate Hx-taking by connecting questions
  • Improve Dx accuracy
  • Improve adherence
  • Improve outcome
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4
Q

What to do if patient is uncooperative during psychiatric interview

A

Stay calm

Review questions later

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5
Q

What to do if patient gives unclear info during psychiatric interview

A

Document everything
remain objective
review later

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6
Q

What to do if time runs out during psychiatric interview

A

Summarize condition
Set priorities
Ask about the main complaint
Ask about his/ her expectation of help

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7
Q

2 Diagnostic criteria for psychiatric interview

A

ICD-10

DSM-5

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8
Q

4 questions to assess history of presenting complaint during psychiatric interview

A

1) How are you feeling? Please describe.
2) What has been happening to upset you?
3) How long have you felt unwell?
4) Any other symptoms/ effects on daily functioning?

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9
Q

4 questions to assess risk of suicide/ harm during psychiatric interview

A

Hopeless: How do you see the future?

Helpless: Can anyone help you?

Worthlessness: Some people feel useless or lose confidence, do you feel that way?

Self-harm/ harm to others:
Any thoughts that life is not worth living?
Any thoughts/plans to harm self or other?
Any previous attempt of suicide?

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10
Q

3 types of Mental state exams.

A

Cross-sectional (at time of exam)

Continuous (done throughout interview)

Dynamic (stable history)

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11
Q

7 components of mental state exam

A 
Appearance and behavior
Speech 
Mood 
Thoughts 
Perception 
Cognition 
Insight
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12
Q

Assessment of appearance and behavior during psychiatric interview

A

1) Self-care/ grooming
2) Attire
3) Expression
4) Build
5) Posture
6) Movement

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13
Q

Patient:

  • Frown
  • Recent weight loss
  • slowed movement
  • Hunched posture with downward gaze

Likely psychiatric condition?

A

Depression

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14
Q

Patient:

  • Sweaty/ tense
  • No eye contact
  • Recent weight loss
  • agitated movements

Likely psychiatric condition?

A

Anxiety

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15
Q

3 types of restless movement?

A

Akathisia - motor restlessness, side effect of neuroleptic medication

Catatonia - abnormal repetitive or purposeless overactivity, disturbed mental state

Dyskinesia - abnormal involuntary movement

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16
Q

Assessment of speech during psychiatric interview

A

Form: ideas, association

Flow: pauses, hesitant

Rate: fast or slow

Amount: More or less

Content

17
Q

Patient:

  • Fast flow, constant and non-stop speech
  • Flight of ideas that continuous evolve

Likely psychiatric condition?

A

Mania

18
Q

Patient:

  • Slow speech with lots of pauses and hesitancy
  • Reluctant speech with very short replies

Likely psychiatric condition

A

Depression

Shyness?

19
Q

Define mood and Affect

A

Pervasive and sustained emotion that colors one’s perception of the world
Subjective - described by self

Affect = individual’s present emotional responsiveness
Objective - described by observer

20
Q

Define congruity

A

Consistency between mood and thoughts

Incongruity may suggest schizophrenia
e.g. laughing when talking about deeply tragic events

21
Q

How to describe abnormal thought

A

Form: association of ideas
Flow: stream of thought, broken or interrupted
Rate: Speed of though
Content: any hopelessness, helplessness, worthlessness, guilt, harm

22
Q

List 6 types of abnormal thought

A

Obsession and compulsion

Negative rumination/ views

Phobias

Suicidal or homicidal ideas

Preoccupation and worries

Delusion

23
Q

Define delusion

A

Abnormal belief (false reasoning) that is unshakable (fixed) and not shared with people from the same culture and religious background

24
Q

List some types of delusion

A 
Paranoid 
Though broadcast 
Thought insertion 
Thought withdrawal 
Grandiose 
Jealous 
Erotic
25
Q

Define Hallucination and Illusion

A

Hallucination = abnormal perception without sensory stimulus (visual, auditory, tactile…etc)

Illusion = abnormal perception with sensory stimulus

26
Q

Difference between Abnormal and physiological hallucinations

A

Abnormal = occur in clear consciousness

Physiological = related to sleep and wake cycle (Hypnagogic or Hypnopompic hallucination), both are normal

27
Q

Assessment of perception during psychiatric interview

A

1) What is the experience/ complaint?
2) Find source of stimulus
3) Assess character of abnormal perception (e.g. how vivid, loudness, controllability of halluncination…etc)
4) Setting (where does it occur? which people?)
5) Level of consciousness during abnormal perception (sleep/wake?)
6) Forms of auditory hallucination
7) Beliefs of origin of voices
8) Frequency and duration
9) Impact of hallucination: emotional, behavioral, cognitive, functional

28
Q

List a few forms of auditory hallucination

A
  • Elementary: simple sounds like phone ringing, knocking
  • 2nd person pronoun
  • 3rd person pronoun
  • Running commentary on actions
  • Command hallucination
  • Thought echo
29
Q

Assessment of cognition during psychiatric interview

A
  • Alertness and orientation
  • Attention, concentration, memory
  • Visuospatial ability
  • Abstract thinking
30
Q

Define attention and concentration

How to test?

A

Attention = ability to focus on specific issue
Test with immediate recall/ memory

Concentration - ability to sustain attention
Test with serial 7s or 3s (Count back from 100 in 7 or 3 intervals)
Spell some words backwards

31
Q

List 4 types of memory.

How to test during psychiatric interview?

A

Immediate = telephone number recall

Short term = Simple address repeated immediately, and again after 3 mins

Recent memory = verifiable news in the last 2 days

Remote memory = ask about verifiable past events e.g. world events

32
Q

Assessment of Insight during psychiatric interview

A

Degree of understanding of the problem/ illness

  • Awareness of problem
  • Is it physical or mental
  • Is the diagnosis correct
  • Is treatment needed
  • Consequences or complications

MBBS IV - Supplementary Courses (54 decks)

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