The Psychiatric History and Mental state Examination

Question 1

Why can circumstances be a barrier to engaging with a patient?

Answer 1

• if in custody patient may be less engaged

Question 2

Why can personality be a barrier to engaging with a patient?

Answer 2

• if anti-social, speaking to a doctor may be scary

Question 3

Why can lack of trust be a barrier to engaging with a patient?

Answer 3

• patients may feel withhold important information if they do not trust the doctor

Question 4

Why can resentment be a barrier to engaging with a patient?

Answer 4

• patients may have negative views on psychiatry

Question 5

Why can mental state be a barrier to engaging with a patient?

Answer 5

• if drunk cannot engage effectively

- fear or cognitive impairment may impact upon patients engagement

Question 6

When preparing to see a patient, what is important in relation to space?

Answer 6

• private space
• chair organisations (sit diagonally not opposite)
• safety (alarms, sit between door and patient)

Question 7

In any medical history, including a psychiatric examination, what is important at the very beginning?

Answer 7

• warm and friendly introduction

- ask what patient prefers to be called

Question 8

In any medical history, including a psychiatric examination, it is important at the very beginning to introduce yourself in a warm and friendly manner and ask the patient what they prefer to be called. What is the next important part?

Answer 8

• explain what the interview is about

- what you hope to get out of the interview

Question 9

Once introductions are complete, what is the next thing to do?

Answer 9

• discuss nature of the problem, why the patient is there
• discuss onset of the problem
• discuss precipitating/ameliorating factors
• ask if the patient has seen anyone else

Question 10

When thinking about a patients past psychiatric history, what are the 5 main things we need to ask?

Answer 10

1 - dates of past psychiatric illness and symptoms
2 - any diagnoses (do they agree with these?)
3 - on any treatments (pharmacological, psychological, ECT, social interventions
4 - hospital admissions (informal or under Mental Health Act section (e.g. section 2 or 3?)
5 - history of past deliberate self-harm or suicide attempts

Question 11

Once we have determined if there is any past psychiatric history, what is the next part of the psychiatric assessment?

Answer 11

• past medical history

Question 12

Following medical history, what is the next factor that we need to consider?

Answer 12

• currently on any medications
• allergies and sensitivities
• prescribed as required medications
• over the counter prescribed

Question 13

Once we have asked the patient about their current and previous medications, what should we ask the patient about in a psychiatric assessment?

Answer 13

• family history (medical and psychiatric)

Question 14

Once we have discussed the patients family history, we will then ask the patient about what?

Answer 14

• personal history

- ask patients about everything from delivery through to now

Question 15

Once we have discussed the patients personal history, we will then ask the patient about what?

Answer 15

• social circumstances
• patients are driven by their social environments
  (work, friends, family, driving, daily activities)

Question 16

Once we have discussed the patients social circumstances, we will then ask the patient about what?

Answer 16

• premorbid personalities

- ask how friends and family would describe you prior to the current condition

Question 17

What are the 2 final things to discuss in a patients psychiatric assessment?

Answer 17

• alcohol use

- forensic history (arrests, charges, convictions, imprisonment, violence, weapons)

Question 18

When we are discussing risk with regards to a patient, why is it not sufficient to just say patient is a risk or is at risk?

Answer 18

• we need to know the context of the risk

- why they are or at risk

Question 19

Following the psychiatric history and risk assessment, what is the next thing we must do?

Answer 19

• mental state examination

Question 20

When performing a mental state examination we need to describe a patients appearance. When describing a patient, what should we be aiming for?

Answer 20

• description should allow someone to pick out patient in a waiting room based on your description

Question 21

When performing a mental state examination we need to describe a patients behaviour. When describing a patients behaviour, what should we be aiming for?

Answer 21

• eye contact
• manner towards interviewer
• rapport
• facial expressions
• excessive/decreased movements

Question 22

When performing a mental state examination we need to describe a patients speech. When describing a patients speech, is the most important thing to remember what they are saying?

Answer 22

• no

- how they speak (rate, volume)

Question 23

When performing a mental state examination we need to describe a patients mood and affect. When describing a patients mood and affect, what should we be aiming for?

Answer 23

• mood is similar to the climate for the year
• affect is comparable with weather on a specific day
• relate mood to longer lasting impression
• how the patients describes their mood and our impression of their mood

Question 24

When performing a mental state examination we need to describe a patients mood and affect. When describing a patients mood and affect, what should we be aiming for?

Answer 24

• affect is similar to weather (short term)

- temporary states

Question 25

When performing a mental state examination we need to describe a patients thoughts. When describing a patients thoughts, what 2 things do we need to consider?

Answer 25

1 - form

2 - content

Question 26

When performing a mental state examination we need to describe a patients thoughts. When describing a patients thoughts, we need to consider form and content. What does form relate to?

Answer 26

• how is someone thinking
• lots of or no thoughts
• loosening of associations
• circumstantiality and tangentiality
• word salad, loss of grammatical structure

Question 27

When performing a mental state examination we need to describe a patients thoughts. When describing a patients thoughts, we need to consider form and content. What does content relate to?

Answer 27

• are they delusional (out of social content, unshakable belief that it is true)
• common in psychosis

Question 28

When performing a mental state examination we need to describe a patients perceptions. When describing a patients perceptions, we talk about illusions and hallucinations. What are illusions?

Answer 28

• illusions (perception of an external object and the mental image to produce a false perception)
• we have all had some illusions at some point (magic)
• commonly associated with drugs, delirium and intoxication

Question 29

When performing a mental state examination we need to describe a patients perceptions. When describing a patients perceptions, we talk about illusions and hallucinations. What are hallucinations?

Answer 29

• a perception in the absence of a stimulus
• able to happen without any sensory modalities
• patients can hear voices for example, but no auditory stimulus

Question 30

When performing a mental state examination we need to describe a patients cognition. When describing a patients cognition, we must consider what?

Answer 30

• attention
• concentration
• orientation (time, place, person)
• memory (short and long term)
• cognitive test where appropriate

Question 31

When performing a mental state examination we need to describe a patients insight. When describing a patients insight, we must consider what?

Answer 31

• how the patients perceive their own mental health

- how do they feel about treatment, diagnosis etc..