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
What abnormal belief factors are considered in a mental state examination?
Preoccupations Over valued ideas Delusional beliefs
26
What abnormal percepts factors are considered in a mental state examination?
Illusions | Hallucinations - which domain?
27
What suicide/homicide factors are considered in a mental state examination?
``` Must always ask Ideation Intent Plans Risk ```
28
What cognitive function factors are considered in a mental state examination?
Orientation Concentration Short/long term memory Concerns - MMSE/MOCA
29
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? ```
30
What is psychopathology?
Concern with abnormal experience, cognition, behaviour
31
What is descriptive psychopathology?
Abnormal experience as described by the patient
32
What is phenomenology?
Understanding of psychological event so that observer can know what the patient's experience felt like
33
What factors are investigated in an mental state examination?
``` Appearance/behaviour Affect Mood Speech Thinking Perceptual Anomaly Cognitive function Insight Risk assessment ```
34
What is mood?
Patients subjective report on their current state in terms of how they rate themselves
35
What is affect?
Emotions conveyed/observed during interview in terms of: Range Types of mood Congruity
36
What are the 4 sections of thinking?
Speed and tempo of thoughts Types of thoughts demonstrated Linkage and thought form Possession of thoughts
37
When may speed of thoughts be retarded?
Severe depression | Dementia
38
When may speed of thoughts be sped up?
Hypomania/mania | May lead to incoherence
39
What are delusions?
Unshakeable idea/belief which is out of keeping with the persons social/cultural background, held with extraordinary conviction
40
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?)
41
How does a formal thought disorder present?
``` Thought blocking Fusion Loosening of associations Tangential thinking Derailed thoughts ```
42
What are the main classes of perceptual disturbance?
Hallucinations Pseudohallucinations Illusions
43
What are hallucinations?
Full force and clarity of true perception No external stimulus Not willed or controlls All senses