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Psychiatry > Template - further assessment > Flashcards

Template - further assessment Flashcards

1
Q

Opening spiel for further assessment

A

I would like more information from patient
Information from corroborant
Aid diagnosis
Influence risk assessment and management plan

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2
Q

Subheadings for missing details from patient (8)

A
  1. HOPC + symptoms
  2. Screening tools
  3. Clarify/rule out conditions
  4. Clarify sequence of events
  5. DSH and Suicide
  6. BGH
  7. Co-morbid conditions screening
  8. MSE
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3
Q

HOPC + symptoms missing from patient (6)

A 
Onset
Potential triggering life events 
Duration 
Timing and progression 
Exacerbating and alleviating factors
Severity and impact on life
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4
Q

Details on DSH and suicide (12)

A 
Nature of morbid thoughts 
Method
Precipitants or triggers
Intent 
Planned/impulsive 
Precautions against discovery
Call for help
Final acts 
Details of past attempts
How to they feel now
Future plans
Protective factors
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5
Q

Further information about past psych history (3)

A

History of DSH/suicide
Past treatment/hospital
Other untreated psych symptoms

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6
Q

Further information about drug history (6)

A 
Doses
Adherence
Side effects 
Efficacy
New medications
Allergies
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7
Q

Further information in social history (3)

A

Living situation
Support network
Dependents/safe-guarding

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8
Q

Further information in substance history (7)

A 
Quantity
How long has this been a problem 
Pattern of use 
Evidence of dependence
Impact on life
Screening tools
Method of use (illicit drugs)
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9
Q

Further information in forensic history (4)

A

Violence and aggression
Details of offences
Relation to psych illness
Relation to substance misuse

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10
Q

Further information in personal history (3)

A

Education + age left school
Childhood - happy, relationship with parents
Major life events

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11
Q

Spiel for co-morbid conditions

A

Certain conditions are known to have increased prevalence with depression, so it would be important to enquire about symptoms of and screen for co-morbid conditions including - anxiety, substance misuse, alcohol misuse

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12
Q

MSE spiel

A

I would also like to assess further aspects of his/her MSE formally including…

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13
Q

Further information in thoughts (2)

A

Nature/content/danger of thoughts

Probe fixity of beliefs

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14
Q

Further information in perceptions (2)

A

Content/dangerous

Feeling threatened

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15
Q

Further information in cognition (2)

A

Particularly if over 60, alcohol problems, suspected cognitive impairment
Use screening tool - MoCA or MSE

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16
Q

Spiel for missing details from corroborant

A

It would be very useful/essential to obtain a corroborative history from relatives/friends/carer/employer, their GP and looks at their previous carenotes

17
Q

Subheadings for missing information from corroborant (4)

A

Presenting complaint
Pre-morbid personality
Relevant background history
Delusions and beliefs

18
Q

Further information in presenting complaint from corroborant (3)

A

Additional symptoms
Behavioural changes
If interview is representative of full spectrum of symptoms typically present on a daily basis

19
Q

Further information in background history from corroborant (10)

A 
Past psychiatric history 
Past medical history
Family history 
Suicide/DSH
Aggressive/violent 
Accidents
Confusion
Wandering 
Coping at home
Cognition and memory
20
Q

Further information in delusions and beliefs from corroborant (2)

A

Falsity/truth of delusions

Cultural background

21
Q

What should be included in the functional enquiry? (3)

A

Impact of illness on daily activities and relationships
Coping at home
Mobility

22
Q

Physical examination (6)

A 
Neurological signs
Endocrine system
Signs of self-neglect
Signs of DSH
Weight and height
Basic observations (including blood pressure, heart rate, temperature)
23
Q

Basic investigations (12)

A 
Bloods 
Urine dip 
UDS
ECG
Neuro-imaging
LP 
EEG
MoCA
Smoking status
Alcohol/substance intake 
QRISK score
VTE assessment
24
Q

What should be included in routine bloods (13)

A 
FBC and haematinincs
U&Es
Calcium
TFTs
LFTs
PTH, phosphate
Cortisol and ACTH
Lipid profile
Glucose
Auto-antibodies
Prolactin
Bone profile
HIV
25
Q

Which auto-antibodies would you screen for? (2)

A

NMDA, VGCC

26
Q

Investigations for co-morbid drinking (7)

A

Haematinics - B12 + folate
FBC - Hb and MCV(increased)
Blood alcohol (doesn’t distinguish acute and chronic)
GGT (raised in 80% of drinkers)
Carbohydrate-deficient transferrin (proportionate to alcohol intake)
urate levels (raised in half of drinkers)
LFTs (raised ALT and AST)

27
Q

When should you consider CT/MRI of head? (5)

A 
Dementia
Parkinson's
Cerebrovascular disease/stroke
Multiple sclerosis
SoL

Psychiatry (9 decks)

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