Psychiatric history taking, mental state examination and making a diagnosis (symposium 1) Flashcards
1
Q
Setting of history taking
A
- Emphasis on privacy
- Avoid interruptions → phones and pagers
- Informal setting, avoid barriers, repeat personal space
- Easy exit → interviewer must have immediate access
2
Q
Suggested structure of a psychiatric history
A
- Presenting complaint(s)
- History of Presenting Complaint(s)
- Past Psychiatric History
- Past Medical History
- Current and Recent Medication
- Social history → alcohol, smoking and drugs
- Family History
- Forensic History
- Personal history
- Developmental milestones
- Schooling/ education
- Occupational history
- Relationships
- Pre-morbid personality
3
Q
Important tips
A
- Eye contact (but don’t stare into their soul)
- Relaxed non-threatening posture
- Open language gestures
- Non-verbal cues
- Polite authority over talkativeness
- Avoid advice and opinions too early
- Clarification and summary → allows for misperceptions to be rectified
4
Q
Presenting complaint
A
- Normal structure: what has brought them her
5
Q
History of presenting complaint
A
- Find detail into each complaint
- Onset, precipitant, duration, severity
- Associated symptoms
- Worst of better
- Response to treatment
- An absence of any particular symptoms
- SOCRATES
6
Q
Systematic enquiry
A
- Mood → depressed, euthymic, elated
- Anxiety/ panic symptoms
- Memory problems/ confusion
- Abnormal thought content → odd ideas, paranoia, obsessions, hypochondriacal concerns
- Perceptual abnormalities/ hallucinations
- Risk to self/ others
- Insight into illness → need for medication, treatment or hospital admission
7
Q
Exploring psychotic symptoms
A
- Seen or heard things that other people aren’t aware of
- Hear people taking when no one is around
- Insight into what is causing symptoms
- Beware commands
8
Q
Past psychiatric history
A
- Past episodes/ dx/ contacts
- Past treatments
- Inter-episodic functioning
- Previous hospital admissions
- Attempted suicide/ deliberate self harm
- Detention under mental health act
9
Q
Past medical history
A
- Developmental problems
- Head injuries
- Endocrine problems
- Liver damage, oesophageal varies, peptic ulcers
- Vascular risk factors
10
Q
Current/ recent medications
A
- Tablets/ injections
- Recent medications
- Discontinued drugs (within 6 months)
- Length and dosage of medication
- Adverse reactions and allergies
11
Q
Family history
A
- Major mental illness in distant relatives
- Genogram is helpful
12
Q
Social history
A
- Occupation
- Current financial situation/ stressors
- Smoking/ alcohol/ illicit drug use
- Current relationships/ stressors
- Children - contact
13
Q
Alcohol/ illicit drug history
A
- Regular/ intermittent
- Amount (units)
- Pattern
- Dependance/ withdrawal
- Impact on work, relationships, money, police
- Screening questions → CAGE
14
Q
Forensic history
A
- Contact with police
- Offences/ reoffends
- Violence and sexual crimes
15
Q
Personal history
A
- Developmental milestones
- Early life
- Schooling
- Occupation
- Relationships
- Financial
- Friendships, hobbies, interests
