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*Psychiatry > Symposium 1 - Hx, Examination, Dx > Flashcards

Symposium 1 - Hx, Examination, Dx Flashcards

1
Q

What are the two fundamental components of Psychiatric Interviewing?

A

Collection of clinical data
Understanding the patient
- Empathy
- Descriptive Psychopathology

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2
Q

What are the important factors in the setting for psychiatric clinical examination?

A

Privacy, avoiding interruptions
Informal settings
Easy exit

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3
Q

What are the important factors in the risk assessment for psychiatric clinical examination?

A

Treatment team
Violence is unusual
Inform staff
Be aware of posture/aggression during interview

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4
Q

What factors should be considered in a patients psychiatric personal history?

A 
Developmental milestones
Schooling/education
Occupational history
Relationships
Pre-morbid personality
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5
Q

How do you introduce yourself to a psychiatric patient?

A

Verbal introduction
Non-verbal clues
Give purpose of interview + likely duration
Note taking

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6
Q

What skills/styles can be important in a psychiatric interview?

A 
Eye contact
Non-threatening posture
Be unhurried
Facilitative noises 
Non-verbal cues 
No advice/opinion too early
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7
Q

What are the objectives of a psychiatric interview/history?

A 
Form rapport
Gather info 
Explore Symptoms and personality 
Explore external factors 
Examine mental state
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8
Q

What are the typical opening questions of a psychiatric interview?

A

Open questions
Circumstances of referral
- who, why?

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9
Q

How is presenting complaint typically questioned in a psychiatric history?

A

“can you tell me, in your own words, why you are here?”

Record in own words

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10
Q

How is history of presenting complaint typically questioned in a psychiatric history?

A 
Clarify each complaint in turn
Onset, precipitant, course, severity 
Any change 
Associated symptoms
Response to treatment?
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11
Q

How are related symptoms typically questioned in a psychiatric history?

A

“Have others (fam, friends) noticed changes?”
Specific symptoms
Systematic enquiry for other symptoms

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12
Q

How are psychotic symptoms explored with the patient?

A

Patient perception

Beliefs/thoughts

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13
Q

How are patients perceptions of psychotic symptoms explored with the patient?

A

Change in thoughts?
Hearing voices?
Does it seem possible?

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14
Q

How is past psychiatric history typically questioned in a psychiatric history?

A 
Past episodes/Diagnoses
Previous treatments
Inter-episode functioning
Previous admissions
Attempted suicide
Previous sections
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15
Q

How is past medical history typically questioned in a psychiatric history?

A 
Developmental issues
Head injuries
Endocrine abnormalities
Liver damage
Vascular risks
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16
Q

How is drug history typically questioned in a psychiatric history?

A

Ask about all
Discontinues within past 6mo
ADR/allergies

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17
Q

How is illicit drug history typically questioned in a psychiatric history?

A 
Regular/intermittent
Amount
Pattern
Dependence/withdrawal
Impact on life
CAGE screening
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18
Q

How do you assess a pre-morbid personality?

A

Difficult to be comprehensive
Emphasis on consistent patterns of behaviour/mood
Importance of corroboration

19
Q

What factors are considered in a mental state examination?

A 
Appearance
Behaviour
Mood
Speech
Thoughts
Beliefs
Perceptions
Suicide/homicide 
Cognitive function
20
Q

What appearance factors are considered in a mental state examination?

A

Height/build
Clothing
Personal hygiene
Accessories/makeup

21
Q

What behaviour factors are considered in a mental state examination?

A 
Greeting
Non-verbal cues
Gesturing - abnormal
Abnormal movements 
Cooperative or defensive
22
Q

What mood behaviour factors are considered in a mental state examination?

A

Eye contact
Mood rating/10
Psychomotor function

23
Q

What speech factors are considered in a mental state examination?

A 
Spontaneity
Volume
Rate
Rhythm
Tone 
Dysarthria
Dysphasia
24
Q

What abnormal thought factors are considered in a mental state examination?

A 
Manifests with speech
Phobias
Obsessions
Flight of ideas 
Derailment
25
Q

What abnormal belief factors are considered in a mental state examination?

A

Preoccupations
Over valued ideas
Delusional beliefs

26
Q

What abnormal percepts factors are considered in a mental state examination?

A

Illusions

Hallucinations - which domain?

27
Q

What suicide/homicide factors are considered in a mental state examination?

A 
Must always ask
Ideation
Intent
Plans
Risk
28
Q

What cognitive function factors are considered in a mental state examination?

A

Orientation
Concentration
Short/long term memory
Concerns - MMSE/MOCA

29
Q

What insight factors are considered in a mental state examination?

A 
Spectrum
Varies
Symptoms due to illness?
Is this a mental illness?
Do they agree with treatment?
30
Q

What is psychopathology?

A

Concern with abnormal experience, cognition, behaviour

31
Q

What is descriptive psychopathology?

A

Abnormal experience as described by the patient

32
Q

What is phenomenology?

A

Understanding of psychological event so that observer can know what the patient’s experience felt like

33
Q

What factors are investigated in an mental state examination?

A 
Appearance/behaviour
Affect
Mood
Speech
Thinking
Perceptual Anomaly
Cognitive function
Insight
Risk assessment
34
Q

What is mood?

A

Patients subjective report on their current state in terms of how they rate themselves

35
Q

What is affect?

A

Emotions conveyed/observed during interview in terms of:
Range
Types of mood
Congruity

36
Q

What are the 4 sections of thinking?

A

Speed and tempo of thoughts
Types of thoughts demonstrated
Linkage and thought form
Possession of thoughts

37
Q

When may speed of thoughts be retarded?

A

Severe depression

Dementia

38
Q

When may speed of thoughts be sped up?

A

Hypomania/mania

May lead to incoherence

39
Q

What are delusions?

A

Unshakeable idea/belief which is out of keeping with the persons social/cultural background, held with extraordinary conviction

40
Q

Under SCAN, how does one ask a patient about their delusional beliefs?

A

Ask if they’re being persecuted

Ask of partial/full delusion (is any part of them aware it isn’t real?)

41
Q

How does a formal thought disorder present?

A 
Thought blocking
Fusion
Loosening of associations
Tangential thinking
Derailed thoughts
42
Q

What are the main classes of perceptual disturbance?

A

Hallucinations
Pseudohallucinations
Illusions

43
Q

What are hallucinations?

A

Full force and clarity of true perception
No external stimulus
Not willed or controlls
All senses

*Psychiatry (18 decks)

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