GS - Art of observation Flashcards
What must we ask in the History of Presenting Complaint in a psychiatric consultation?
Symptoms (SIGCAPS);
- Sleep
- appetite
- energy
- concentration
- suicidal idealisation,
- auditory or visual hallucinations)
Social;
- support system
- impact of work or social life
What sections are covered in a Mental status exam?
- Appearance and behaviour
- Speech
- Mood
- Affect
- Mobility
- Thought process and thought content
- Cognitive
- Insight
Risk assessment ?
What is covered in the Appearance and behaviour section?
- dress
- hygiene
- motor movements
- eye contact
- co-operative
- agitated ?
What is covered in the Speech section?
Rate and volume of speech
What is covered in the Mood section?
how are you feeling ? (internal)
What is covered in the Affect section?
How does patient appear (external), euthymic, irritable, intensity (how much emotion do they show? - flat, blunted, consistent, full)
Does this match the mood? (e.g laughing when sad)
What is covered in the Mobility section?
Does affect change or go up and down levels during consultation?
What is covered in the Thought process and thought content section?
Thought process and thought content;
- Hallucinations (content)
- Delusions (content)
- Flight of ideas
- Racing thoughts
- Loose associations
- Phobias
- Obsessions
What is covered in the Cognitive section?
Cognitive;
- Orientation - what time is it, where are we?
- Memory - repeat 3 words right away and few mins later (immediate and short term memory)
- Language - read, write, repeat or name
- Abstract or visuospatial; do they understand a quote that requires you to be more bastratc, can a patient replicate a shape?
What is covered in the Insight section?
Insight;
- Aware of illness (no, partial or full insight)
- Judgement - does patient understand consequences of their actions
Why might a risk assessment be necessary ?
Some patients may have weapons to protect themselves if they believe someone is trying to harm them and may act upon this
What should you ask in the PMH?
Any psychiatry history ?
What should you ask in the SH ?
Any substance abuse?
What should you ask in the FH?
Family Psychiatry History ?
What should you ask about in the DH?
Any substance abuse?
Medication adherence (if applicable)
