Psychiatric history and MSE Flashcards
4 aims of psychiatric assessment?
Gathers sufficient info to make a diagnosis + establish care plan
Communicate w other health prof. + Create safe environment to interview patient in
Communicate with patient + informants
Systematically record info + feedback to patient & their families
Outline the psychiatric history which is UNIQUE
unique to Psychiatric History:
Personal History- inc forensic history
Past Psychiatric History
Pre Morbid Personality
5 things asked during history of presenting complaint?
“When did you last feel completely well?” - define the current episode in terms of time (Chronological order)
Onset, duration & changes over time
Predisposing & relieving factors
Life events, drug misuse or non-compliance with prescriptions
Suicidal thoughts + actions must be asked in every patient assessed!
What is asked in Personal History? What must you pay attention to?
try to get Chronological picture of patient’s life - pay attention to the events that may’ve affected their:
- Psychological development
- Capacity to form + maintain relationships
- Their view of themselves + world
Eg- early trauma, relationships, education, sexual etc
3 things explored during past psych history?
Admissions with understanding of context, incl. use of mental health act
Previous Treatments & compliance to them
Episodes of self-harm
What would you explore during alcohol + drug use history if the patient is using?
For each drug - ask physical health + social consequences (relationships, finances, police),
Method of administration, risks
Ask prev treatments for addiction, inc detox
Periods of abstinence
Motivation to reduce or stop use?
What is meant by pre morbid personality?
Collateral history
Patient’s/loved ones view of what they were like before current problem
What does the mental state examination entail?
AbSMTPCI
Appearance and behaviour
Speech- how loud, fast, tone, spontaneity
Mood
Thought – content and form
Perceptions
Cognition
Insight
Expand on mood in the mental state examination using subjective and objective
Subjective is the patient’s own view of his current mood
Objective is how he appears to the assessing clinician
What is meant by non-psychotic thought content?
What are delusions?
Non-psychotic thought content: phobias, ruminations, obsessions with understanding of compulsions
Delusions: fixed false beliefs that cannot be changed by opposing evidence + are not in line w cultural backgrounds
What is meant by abnormal thought content?
Abnormal thought content involves:
thought withdrawal/broadcast/insertion
somatic passivity, delusional misinterpretations
Thought withdrawal = delusional belief that thoughts have been ‘taken out’ of the patient’s mind, and the patient has no power over this.
Thought encompasses content and form. What is meant by thought form?
checking for presence of thought disorder based on patients form & content of speech
3 things classified as abnormal experiences?
Auditory, visual, olfactory, gustatory, sensory or tactile hallucinations
derealisation or deja vu
Depersonalisation, awareness of disturbance in thinking or actions!
Explain insight + 3 ways to examine insight
An assessment of the extent of agreement between patient + Dr.
ways to break up insight:
Does the patient believe they have a problem?
Does the patient understand their problem?
Are they willing to accept treatment?
What type of questions should you ask when trying to gauge risk assessment?
How serious is risk?
Is risk specific or general?
Is risk immediate or volatile?
What specific treatment & management plan can best reduce the risk?
