The Psychiatric History and Mental state Examination Flashcards
Why can circumstances be a barrier to engaging with a patient?
- if in custody patient may be less engaged
Why can personality be a barrier to engaging with a patient?
- if anti-social, speaking to a doctor may be scary
Why can lack of trust be a barrier to engaging with a patient?
- patients may feel withhold important information if they do not trust the doctor
Why can resentment be a barrier to engaging with a patient?
- patients may have negative views on psychiatry
Why can mental state be a barrier to engaging with a patient?
- if drunk cannot engage effectively
- fear or cognitive impairment may impact upon patients engagement
When preparing to see a patient, what is important in relation to space?
- private space
- chair organisations (sit diagonally not opposite)
- safety (alarms, sit between door and patient)
In any medical history, including a psychiatric examination, what is important at the very beginning?
- warm and friendly introduction
- ask what patient prefers to be called
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?
- explain what the interview is about
- what you hope to get out of the interview
Once introductions are complete, what is the next thing to do?
- 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
When thinking about a patients past psychiatric history, what are the 5 main things we need to ask?
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
Once we have determined if there is any past psychiatric history, what is the next part of the psychiatric assessment?
- past medical history
Following medical history, what is the next factor that we need to consider?
- currently on any medications
- allergies and sensitivities
- prescribed as required medications
- over the counter prescribed
Once we have asked the patient about their current and previous medications, what should we ask the patient about in a psychiatric assessment?
- family history (medical and psychiatric)
Once we have discussed the patients family history, we will then ask the patient about what?
- personal history
- ask patients about everything from delivery through to now
Once we have discussed the patients personal history, we will then ask the patient about what?
- social circumstances
- patients are driven by their social environments
(work, friends, family, driving, daily activities)
Once we have discussed the patients social circumstances, we will then ask the patient about what?
- premorbid personalities
- ask how friends and family would describe you prior to the current condition
What are the 2 final things to discuss in a patients psychiatric assessment?
- alcohol use
- forensic history (arrests, charges, convictions, imprisonment, violence, weapons)
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?
- we need to know the context of the risk
- why they are or at risk
Following the psychiatric history and risk assessment, what is the next thing we must do?
- mental state examination
When performing a mental state examination we need to describe a patients appearance. When describing a patient, what should we be aiming for?
- description should allow someone to pick out patient in a waiting room based on your description
When performing a mental state examination we need to describe a patients behaviour. When describing a patients behaviour, what should we be aiming for?
- eye contact
- manner towards interviewer
- rapport
- facial expressions
- excessive/decreased movements
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?
- no
- how they speak (rate, volume)
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?
- 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
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?
- affect is similar to weather (short term)
- temporary states
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?
1 - form
2 - content
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?
- how is someone thinking
- lots of or no thoughts
- loosening of associations
- circumstantiality and tangentiality
- word salad, loss of grammatical structure
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?
- are they delusional (out of social content, unshakable belief that it is true)
- common in psychosis
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?
- 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
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?
- 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
When performing a mental state examination we need to describe a patients cognition. When describing a patients cognition, we must consider what?
- attention
- concentration
- orientation (time, place, person)
- memory (short and long term)
- cognitive test where appropriate
When performing a mental state examination we need to describe a patients insight. When describing a patients insight, we must consider what?
- how the patients perceive their own mental health
- how do they feel about treatment, diagnosis etc..
