Week 1- history taking tutorials/lectures Flashcards
What are the things you assess for in a mental state examination?
Appearance/behaviour Speech Mood- affect and mood Thoughts- form and content Hallucinations and dellusions Perception Cognitive function
Give examples of things you are looking for under the category of appearance/behaviour?
Appearance- age, sex, unkempt, clothing/grooming, weight, posture, smell. Specificallu- gait, tremor, evidence of self harm etc.
Behaviour- eye contact, agitation, looking around, rapport, mannerisms
Give examples of things you are looking out for under the category speech?
Rate, rhythm, volume
Pressured speech- almost like the words are bursting out of their mouth- different to quick speech.
Tone
Poverty of speech- can’t think of the words.
How would you assess someones mood?
Rate your mood from 1-10. 1 being the worst mood you’ve ever felt and 10 being uncontrollably happy.
How are you feeling?
What is the difference between mood and affect?
Mood- the overall feeling over a longer period of time
Affect- the way they react to what you’re saying e.g. they say they are feeling suicidal but their affect is them cracking jokes at the same time? doesn’t really add up.
What is important to check when assessing mood?
Have you ever thought about harming yourself. If so- any plans?
Have you ever thought about committing suicide?
What are the two things you are assessing in thought?
Thought form-the way the information comes out. Is the information relevant? is it goal driven (e.g. you ask a question and they are able to recognise and answer it)
Thought content- the things they are thinking about. Are they obsessing over something?
What are delusions?
Dellusions are fixed beliefs that cannot be shaken despite logical argument, innapropriate to the patients socio-cultural background.
What are illusions?
Misidentification/misinterpretation of a stimulus.
The nurses are trying to poison me
Or the table is a knife.
What are hallucinations?
Perception in the absence of stimulus.
E.g. there is someone behind you watching me (no one is there).
What sort of hallucinations are the most common?
Auditory hallucinations e.g. voices speaking to you.
What important questions should you ask a patient with auditory hallucinations (voices)?
How many voices?
What are they saying?
Do you listen to them?
How would you assess cognitive function?
Ask them where they are?
What day it is?
Who is the prime minister etc?
What should the opening statement in a consultation (not mental state examination) be for a psychiatric patient?
During this consultation I am going to be asking you some personal questions, they all do serve a purpose but please let me know if they make you feel uncomfortable.
Past psychiatric history questions?
Have you ever been treated for a psychiatric illness?
What are the important areas to cover in a drug history?
Prescription drugs Over the counter meds Illicit drugs Alcohol use Smoking Compliance.
Key questions to ask in personal/social history?
Home arrangements- whats it like at home?
Relationships- have you got any family? Do you see your family? Are you in a relationship? How is that going?
Occupation- do you have a job? If they are steady enough to hold down a job then they are immediately at less risk.
Childhood- what was your childhood like?-really important for patients with personality disorders.
Hobbies- what do you do for fun?
Financial situation
Sexual history and psychosexual history
Children/marital status- are there people relying on this person?
Have you ever been involved with the police? Has any of your family ever been involved with the police?
Why is family history important?
Psychiatric illnesses tend to run in families. Ask about their birth- any substance misuse while their mum was pregnant? Prematurity? Consanguineous relationships- inbreeding
