The Psychiatric History and Mental state Examination Flashcards

1
Q

Why can circumstances be a barrier to engaging with a patient?

A
  • if in custody patient may be less engaged
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2
Q

Why can personality be a barrier to engaging with a patient?

A
  • if anti-social, speaking to a doctor may be scary
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3
Q

Why can lack of trust be a barrier to engaging with a patient?

A
  • patients may feel withhold important information if they do not trust the doctor
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4
Q

Why can resentment be a barrier to engaging with a patient?

A
  • patients may have negative views on psychiatry
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5
Q

Why can mental state be a barrier to engaging with a patient?

A
  • if drunk cannot engage effectively
  • fear or cognitive impairment may impact upon patients engagement
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6
Q

When preparing to see a patient, what is important in relation to space?

A
  • private space
  • chair organisations (sit diagonally not opposite)
  • safety (alarms, sit between door and patient)
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7
Q

In any medical history, including a psychiatric examination, what is important at the very beginning?

A
  • warm and friendly introduction
  • ask what patient prefers to be called
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8
Q

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?

A
  • explain what the interview is about
  • what you hope to get out of the interview
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9
Q

Once introductions are complete, what is the next thing to do?

A
  • 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
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10
Q

When thinking about a patients past psychiatric history, what are the 5 main things we need to ask?

A

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

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11
Q

Once we have determined if there is any past psychiatric history, what is the next part of the psychiatric assessment?

A
  • past medical history
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12
Q

Following medical history, what is the next factor that we need to consider?

A
  • currently on any medications
  • allergies and sensitivities
  • prescribed as required medications
  • over the counter prescribed
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13
Q

Once we have asked the patient about their current and previous medications, what should we ask the patient about in a psychiatric assessment?

A
  • family history (medical and psychiatric)
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14
Q

Once we have discussed the patients family history, we will then ask the patient about what?

A
  • personal history
  • ask patients about everything from delivery through to now
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15
Q

Once we have discussed the patients personal history, we will then ask the patient about what?

A
  • social circumstances
  • patients are driven by their social environments
    (work, friends, family, driving, daily activities)
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16
Q

Once we have discussed the patients social circumstances, we will then ask the patient about what?

A
  • premorbid personalities
  • ask how friends and family would describe you prior to the current condition
17
Q

What are the 2 final things to discuss in a patients psychiatric assessment?

A
  • alcohol use
  • forensic history (arrests, charges, convictions, imprisonment, violence, weapons)
18
Q

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?

A
  • we need to know the context of the risk
  • why they are or at risk
19
Q

Following the psychiatric history and risk assessment, what is the next thing we must do?

A
  • mental state examination
20
Q

When performing a mental state examination we need to describe a patients appearance. When describing a patient, what should we be aiming for?

A
  • description should allow someone to pick out patient in a waiting room based on your description
21
Q

When performing a mental state examination we need to describe a patients behaviour. When describing a patients behaviour, what should we be aiming for?

A
  • eye contact
  • manner towards interviewer
  • rapport
  • facial expressions
  • excessive/decreased movements
22
Q

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?

A
  • no
  • how they speak (rate, volume)
23
Q

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?

A
  • 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
24
Q

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?

A
  • affect is similar to weather (short term)
  • temporary states
25
Q

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?

A

1 - form
2 - content

26
Q

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?

A
  • how is someone thinking
  • lots of or no thoughts
  • loosening of associations
  • circumstantiality and tangentiality
  • word salad, loss of grammatical structure
27
Q

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?

A
  • are they delusional (out of social content, unshakable belief that it is true)
  • common in psychosis
28
Q

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?

A
  • 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
29
Q

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
  • 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
30
Q

When performing a mental state examination we need to describe a patients cognition. When describing a patients cognition, we must consider what?

A
  • attention
  • concentration
  • orientation (time, place, person)
  • memory (short and long term)
  • cognitive test where appropriate
31
Q

When performing a mental state examination we need to describe a patients insight. When describing a patients insight, we must consider what?

A
  • how the patients perceive their own mental health
  • how do they feel about treatment, diagnosis etc..