Tutorial 1- Mood disorders Flashcards

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1
Q

A psychiatric history id atypical from other histories as it involves extra sections. List the process of taking a psychiatric history.

A
History of presenting complaint
Past psychiatric history
Past medical history
Drugs and allergies
Alcohol, Smoking and illicit drugs
Family history
Personal history 
Social history 
Pre-morbid history
ICE
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2
Q

What are some key points to the history of presenting complaint

A

Nice open questions, kind attitude
Don’t let the patient ramble but conversely let them say their story
They may not volunteer their true problem so try and find out the associated symptoms and use clinical reasoning to deduct true problem

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3
Q

What are some key points of the past psychiatric history?

A

Any previous instances of this episode?
Any problems with your mood in the past?
Have you ever had to be sectioned under the mental health act?

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4
Q

What are some key points of the past medical history

A

Have you ever been in hospital before
Have you ever had surgery
Do you see your GP regularly
JAM THREADS- particular interest in head injuries, bitrh trauma and epilepsy

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5
Q

What are some key point of the drugs and allergies history?

A

Do you take any regular medications-dose,freq
How are you at taking these medications
Are there any medications you are prescribed medications that you don’t take
Do you take any over the counter medications?
Any herbal medications or OCP/HRT

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6
Q

What are some key points to asking about alcohol, smoking and illicit drugs?

Also forensic history in here

A

Some people who suffer problems with their mood take alcohol and drugs, do you ever take alcohol or drugs
OR
I’d like to move on now and ask how much you would drink in a typical week- quantify units
Do you smoke
Have you ever smoked/when did you stop
Do you take any recreational drugs- quantify
Has this ever lead to problems with withdrawl/dependence
Have you ever had any expericneswith the police

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7
Q

What are the key points of the family history?

A

Are your parents still with us?
OR
How is your parents health?
Brothers/sisters
Siblings
Have they ever suffered from similar episodes/ mood disorders
Are there any conditions that run in the family

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8
Q

What are the key points of asking about personal history?

A

If i could just ask now a bit about your life, could you tell me about your childhood (relationships when young)
Were there any traumatic episodes you can remember from your childhood
As far as you know were there any problems with pregnancy
Decipher educational attainment e.g.
Ask about work and then did they need degree or just go straight from school
Decipher occupational history
Ask about relationships and home life

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9
Q

What is important to know about social history?

A

Currently what is you living situation
Where abouts do you live
(Already asked about work)
Could i ask how are you doing financially
How often do you spend time with other outside the house
Do you have any hobbies

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10
Q

What is important to ask in about their premorbid personality?

A

How would your friends/family describe you lately
How would you desrbibe yourself lately
How would you describe yourself before the episode

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11
Q

What is important in ICE?

A

Listen to the patient
Let them speak
Keep asking as their may be more than one concern

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12
Q

In psychiatry the Mental state examination is used as oppose to any physical examinations. What sorts of things are involved in this? Physical examinations can still be undertaken if indicated

A
Appearance
Behavious
Mood Thoguhts
Perceptions
Suicide and homicide
Cognitive function 
Insight
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13
Q

What sort of ways can appearance be assessed?

A

Looking at the clothes the patient wears
Looking at the patients personal hygiene
Looking at the patients defining characteristics e.g. tattoos, hair colour etc

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14
Q

How would you describe in the notes a patients appearance?

A

Appropriately dressed?
Good level or personal hygiene?
Be very detailed in describing patient, should be able t pick them out of a line up

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15
Q

What sort of things are assessed in behaviour

A

Body lanuage

Speech- rate, tone, volume,

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16
Q

What sort of questions can be asked to assess mood?

A

How have you been felling lately?
How would you describe your mood?
How would your friends/loved ones describe you mood

17
Q

What is the key thing you are looking to determine about mood

A
Subjective mood (what you experience)
Objective mood (what the patient describes)

euthymic= steady mood/ appropriate mood

18
Q

What do you ask about in thought?

A

Do you have any phobias?
Do you have any obsessions or compulsions?
Do you have any delusions or overvalued ideas?
OR
Do you have any ideas or beliefs that your family might consider to be strange.

19
Q

What sort of thoughts may present

A

Negative/nihilistic thoughts, often talk about god and death

Flat affect- not reacting to stimulus, monotone voice
Reactive affect- over reacting to questions and stimulus

Knight’s move speech- thoughts are constantly going off on tangents, difficult to follow ideas

20
Q

What sort of questions can be asked to assess the patients perceptions?

A

Do you ever hear or see things that others do not see or may be hard to explain
Have you ever felt distant or not real?
have you ever thought that things around you are unreal?

21
Q

What different perceptions may people have?

A

Auditory hallucinations- most common
Visual hallucinations-more common in drug use/pathology
Olfactory hallucinations- see below
Gustatory hallucinations- see below
Tactile hallucinations- all most common in pathology e.g. temporal lobe epilepsy

Have you ever felt distant or not real?- depersonalisation
have you ever thought that things around you are unreal?- derealisation

22
Q

How do you assess Suicidal and homicidal idiations?

A

Some people who suffer with low mood have thoughts of taking their life. Have you ever had these thoughts?
Have you ever felt like life’s not worth living
Have you ever self harmed?
Have you ever had thoughts of harming others

23
Q

What sort of comments are to be made about suicidal and homicidal idiations?

A

Suicidal thoughts? How serious, how likely
Homicidal thoughts? how serious, how likely
Self harm? how serious

24
Q

How do you assess cognitive function?

A

Usually assessed on the first session but can be done using a mini mental state questionnaire or something similar

Can ask the person if they know the date and time roughly

25
Q

How do you assess insight?

A

Are your symptoms due to an illness?
Do you think you have a mental illness?
Do you agree with the treatment plan?

26
Q

What is it important to ask about in hypomania

A

Sleep and energy levels- less sleep more irritable

27
Q

What is it important to know

A

Drug doses- 20mg of fluoxetine is the lowest dose