Symposium 1 - psych history and MSE Flashcards
The setting
privacy
avoid interruptions
easy exit
informal setting, avoid barriers, respect personal space
Safety/risk assessment
inform who you are interviewing and where
during iv - feel uncomfortable then stop
violence is unusual
Overview of a psychiatric history
Presenting complaint HPC past psychiatric history PMH current and recent medication social history FH personal history
3 important things to establish at start of history
purpose of interview
likely duration
note taking and confidentiality
Important things in your manner
eye contact, non hurried, relaxed, facilitative noises, acknowledge non verbal cues, open questions
Objectives of interview
form rapport and gather information establish and explore symptoms inform and motivate patient mental state begin formulation circumstance of referral
Presenting complaint
record each
“can you tell me in your own words why you are here?”
HPC
clarify each in turn onset, severity, precipitants, course associated symptoms, QOL worse or better? responded to any treatment?
Related symptoms
family noticed any change in you?
specific symptoms - closed
systematic enquiry eg depression, psychosis, anxiety
percepts
Seen or heard anything others are not aware of?
cause? is this possible?
Beliefs
playing on your mind? change in thoughts eg interference, access
Past psychiatric history
past episodes/diagnoses previous treatments inter episode functioning previous hospital admissions attempted suicide or DSH? previous detentions under mental health legislations
FH
siblings, parents, grandparents etc
major mental health in distant relatives
age, employment, relationship, health
What might be useful in the FH?
genogram
5 main things to explore in PMH?
head injuries endocrine developmental abnormality liver, oesophageal varices, peptic ulcer vascular risk factors
Current and recent medications
tablets and injections discontinued drugs in last 6 months how long and dose adverse reactions and allergies adherence
Social history
social circumstances and occupation finances/stressors smoking, alcohol, illicit drugs relationships children
Alcohol/illicit drugs
intermittent or regular?
amount, pattern
withdrawl/dependence
impact
Screening questionnaires for alcohol
CAGE
Personal history
developmental milestones occupational friends, hobbies, interests early life education relationships finance
Forensic history
ever been in contact with police? charged?
offences eg violent or sexual?
MSE
appearance mood speech thoughts beliefs perception insight behaviour suicide/homicide cognitive function
Appearance
build/height
clothing
personal hygiene
makeup, jewellery, accessories
Behaviour
greeting non verbal cues gesturing abnormal movements co-operative
Mood
eye contact
affect
mood rating
psychomotor function - retarded, agitated
speech
spontaneity
volume, rhythm, tone, rate
dysarthria, dysphasia
Abnormal thoughts
close relationship with speech
phobias, obsessions
formal thought disorder - insertion, withdrawal, echo
knights move
Abnormal beliefs
preoccupations
overvalued beliefs
delusional
Abnormal percepts
illusions
hallucinations
suicide/homicide
suicidal thoughts, ideation, plan, intent
homicidal risk
Cognitive function
orientation
attention and concentration
short and long term memory
MMSE/MOCA
Insight
spectrum which varies
3 questions for insight
symptoms due to an illness?
mental illness?
management and agree with treatment?
psychopathology
abnormal experience, cognition and behaviour
descriptive psychopathology
describes and categorises the abnormal experience
phenomology
observation and understanding of event - empathy
euthymic
neutral
mood versus affect
mood - patients subjective report on current mood state
affect - objectively observed by emotions conveyed
blunted affect seen in?
schizophrenia
thinking - 4 categories
speed and tempo
type
linkage
possession
delusion
unshakeable idea or belief which is out of keeping with person’s social and cultural background eg grandiose, paranoid, hypochondriac
SCAN - thoughts
persecutory = anyone deliberately trying to harm you?
differential - might not be true?
think clearly? anyone read your mind?
Where do pseudohallucinations occur?
internal space
Where do hallucinations occur?
external space, no external stimuli
Hallucinations senses
all 5 - olfactory, visual, auditory, tactile, gustatory
hypnopompic hallucination
end of sleep
hypnagogic hallucination
going to sleep
Formulation of case
allows consideration of diagnosis in context of history
management and treatment
formulation - factors
organic, psychological and social
predisposing, precipitating, perpetuating
