Tutorial 1- Mood disorders Flashcards
A psychiatric history id atypical from other histories as it involves extra sections. List the process of taking a psychiatric history.
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
What are some key points to the history of presenting complaint
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
What are some key points of the past psychiatric history?
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?
What are some key points of the past medical history
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
What are some key point of the drugs and allergies history?
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
What are some key points to asking about alcohol, smoking and illicit drugs?
Also forensic history in here
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
What are the key points of the family history?
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
What are the key points of asking about personal history?
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
What is important to know about social history?
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
What is important to ask in about their premorbid personality?
How would your friends/family describe you lately
How would you desrbibe yourself lately
How would you describe yourself before the episode
What is important in ICE?
Listen to the patient
Let them speak
Keep asking as their may be more than one concern
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
Appearance Behavious Mood Thoguhts Perceptions Suicide and homicide Cognitive function Insight
What sort of ways can appearance be assessed?
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
How would you describe in the notes a patients appearance?
Appropriately dressed?
Good level or personal hygiene?
Be very detailed in describing patient, should be able t pick them out of a line up
What sort of things are assessed in behaviour
Body lanuage
Speech- rate, tone, volume,
