Template - further assessment Flashcards
Opening spiel for further assessment
I would like more information from patient
Information from corroborant
Aid diagnosis
Influence risk assessment and management plan
Subheadings for missing details from patient (8)
- HOPC + symptoms
- Screening tools
- Clarify/rule out conditions
- Clarify sequence of events
- DSH and Suicide
- BGH
- Co-morbid conditions screening
- MSE
HOPC + symptoms missing from patient (6)
Onset Potential triggering life events Duration Timing and progression Exacerbating and alleviating factors Severity and impact on life
Details on DSH and suicide (12)
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
Further information about past psych history (3)
History of DSH/suicide
Past treatment/hospital
Other untreated psych symptoms
Further information about drug history (6)
Doses Adherence Side effects Efficacy New medications Allergies
Further information in social history (3)
Living situation
Support network
Dependents/safe-guarding
Further information in substance history (7)
Quantity How long has this been a problem Pattern of use Evidence of dependence Impact on life Screening tools Method of use (illicit drugs)
Further information in forensic history (4)
Violence and aggression
Details of offences
Relation to psych illness
Relation to substance misuse
Further information in personal history (3)
Education + age left school
Childhood - happy, relationship with parents
Major life events
Spiel for co-morbid conditions
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
MSE spiel
I would also like to assess further aspects of his/her MSE formally including…
Further information in thoughts (2)
Nature/content/danger of thoughts
Probe fixity of beliefs
Further information in perceptions (2)
Content/dangerous
Feeling threatened
Further information in cognition (2)
Particularly if over 60, alcohol problems, suspected cognitive impairment
Use screening tool - MoCA or MSE
Spiel for missing details from corroborant
It would be very useful/essential to obtain a corroborative history from relatives/friends/carer/employer, their GP and looks at their previous carenotes
Subheadings for missing information from corroborant (4)
Presenting complaint
Pre-morbid personality
Relevant background history
Delusions and beliefs
Further information in presenting complaint from corroborant (3)
Additional symptoms
Behavioural changes
If interview is representative of full spectrum of symptoms typically present on a daily basis
Further information in background history from corroborant (10)
Past psychiatric history Past medical history Family history Suicide/DSH Aggressive/violent Accidents Confusion Wandering Coping at home Cognition and memory
Further information in delusions and beliefs from corroborant (2)
Falsity/truth of delusions
Cultural background
What should be included in the functional enquiry? (3)
Impact of illness on daily activities and relationships
Coping at home
Mobility
Physical examination (6)
Neurological signs Endocrine system Signs of self-neglect Signs of DSH Weight and height Basic observations (including blood pressure, heart rate, temperature)
Basic investigations (12)
Bloods Urine dip UDS ECG Neuro-imaging LP EEG MoCA Smoking status Alcohol/substance intake QRISK score VTE assessment
What should be included in routine bloods (13)
FBC and haematinincs U&Es Calcium TFTs LFTs PTH, phosphate Cortisol and ACTH Lipid profile Glucose Auto-antibodies Prolactin Bone profile HIV
Which auto-antibodies would you screen for? (2)
NMDA, VGCC
Investigations for co-morbid drinking (7)
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)
When should you consider CT/MRI of head? (5)
Dementia Parkinson's Cerebrovascular disease/stroke Multiple sclerosis SoL
