Symposium 1 - Hx, Examination, Dx Flashcards
What are the two fundamental components of Psychiatric Interviewing?
Collection of clinical data
Understanding the patient
- Empathy
- Descriptive Psychopathology
What are the important factors in the setting for psychiatric clinical examination?
Privacy, avoiding interruptions
Informal settings
Easy exit
What are the important factors in the risk assessment for psychiatric clinical examination?
Treatment team
Violence is unusual
Inform staff
Be aware of posture/aggression during interview
What factors should be considered in a patients psychiatric personal history?
Developmental milestones Schooling/education Occupational history Relationships Pre-morbid personality
How do you introduce yourself to a psychiatric patient?
Verbal introduction
Non-verbal clues
Give purpose of interview + likely duration
Note taking
What skills/styles can be important in a psychiatric interview?
Eye contact Non-threatening posture Be unhurried Facilitative noises Non-verbal cues No advice/opinion too early
What are the objectives of a psychiatric interview/history?
Form rapport Gather info Explore Symptoms and personality Explore external factors Examine mental state
What are the typical opening questions of a psychiatric interview?
Open questions
Circumstances of referral
- who, why?
How is presenting complaint typically questioned in a psychiatric history?
“can you tell me, in your own words, why you are here?”
Record in own words
How is history of presenting complaint typically questioned in a psychiatric history?
Clarify each complaint in turn Onset, precipitant, course, severity Any change Associated symptoms Response to treatment?
How are related symptoms typically questioned in a psychiatric history?
“Have others (fam, friends) noticed changes?”
Specific symptoms
Systematic enquiry for other symptoms
How are psychotic symptoms explored with the patient?
Patient perception
Beliefs/thoughts
How are patients perceptions of psychotic symptoms explored with the patient?
Change in thoughts?
Hearing voices?
Does it seem possible?
How is past psychiatric history typically questioned in a psychiatric history?
Past episodes/Diagnoses Previous treatments Inter-episode functioning Previous admissions Attempted suicide Previous sections
How is past medical history typically questioned in a psychiatric history?
Developmental issues Head injuries Endocrine abnormalities Liver damage Vascular risks
How is drug history typically questioned in a psychiatric history?
Ask about all
Discontinues within past 6mo
ADR/allergies
How is illicit drug history typically questioned in a psychiatric history?
Regular/intermittent Amount Pattern Dependence/withdrawal Impact on life CAGE screening
How do you assess a pre-morbid personality?
Difficult to be comprehensive
Emphasis on consistent patterns of behaviour/mood
Importance of corroboration
What factors are considered in a mental state examination?
Appearance Behaviour Mood Speech Thoughts Beliefs Perceptions Suicide/homicide Cognitive function
What appearance factors are considered in a mental state examination?
Height/build
Clothing
Personal hygiene
Accessories/makeup
What behaviour factors are considered in a mental state examination?
Greeting Non-verbal cues Gesturing - abnormal Abnormal movements Cooperative or defensive
What mood behaviour factors are considered in a mental state examination?
Eye contact
Mood rating/10
Psychomotor function
What speech factors are considered in a mental state examination?
Spontaneity Volume Rate Rhythm Tone Dysarthria Dysphasia
What abnormal thought factors are considered in a mental state examination?
Manifests with speech Phobias Obsessions Flight of ideas Derailment
What abnormal belief factors are considered in a mental state examination?
Preoccupations
Over valued ideas
Delusional beliefs
What abnormal percepts factors are considered in a mental state examination?
Illusions
Hallucinations - which domain?
What suicide/homicide factors are considered in a mental state examination?
Must always ask Ideation Intent Plans Risk
What cognitive function factors are considered in a mental state examination?
Orientation
Concentration
Short/long term memory
Concerns - MMSE/MOCA
What insight factors are considered in a mental state examination?
Spectrum Varies Symptoms due to illness? Is this a mental illness? Do they agree with treatment?
What is psychopathology?
Concern with abnormal experience, cognition, behaviour
What is descriptive psychopathology?
Abnormal experience as described by the patient
What is phenomenology?
Understanding of psychological event so that observer can know what the patient’s experience felt like
What factors are investigated in an mental state examination?
Appearance/behaviour Affect Mood Speech Thinking Perceptual Anomaly Cognitive function Insight Risk assessment
What is mood?
Patients subjective report on their current state in terms of how they rate themselves
What is affect?
Emotions conveyed/observed during interview in terms of:
Range
Types of mood
Congruity
What are the 4 sections of thinking?
Speed and tempo of thoughts
Types of thoughts demonstrated
Linkage and thought form
Possession of thoughts
When may speed of thoughts be retarded?
Severe depression
Dementia
When may speed of thoughts be sped up?
Hypomania/mania
May lead to incoherence
What are delusions?
Unshakeable idea/belief which is out of keeping with the persons social/cultural background, held with extraordinary conviction
Under SCAN, how does one ask a patient about their delusional beliefs?
Ask if they’re being persecuted
Ask of partial/full delusion (is any part of them aware it isn’t real?)
How does a formal thought disorder present?
Thought blocking Fusion Loosening of associations Tangential thinking Derailed thoughts
What are the main classes of perceptual disturbance?
Hallucinations
Pseudohallucinations
Illusions
What are hallucinations?
Full force and clarity of true perception
No external stimulus
Not willed or controlls
All senses
