History taking and mental state examination Flashcards
How can we collect data in a psychiatry patient?
Taking a clinical history
Examining the mental state
What must be taken into account about the setting of a psychiatric interview?
Importance of privacy Avoiding interruptions ie phones, pagers Create an informal setting Respect personal space Interviewer should have easy access to an exit
What is important to find out in the history?
Presenting complaint and history of presenting complaint
Past medical/psychiatric history
Current and recent medication
Social history - alcohol/drugs, smoking, social circumstances, occupation
Family history
Personal history - school/education, occupational history, relationships
How should you carry out an introduction in a psychiatric interview?
Greet verbally and introduce yourself
Observe non-verbal cues
Orientate the patient and check they know the purpose of the interview and the likely duration of the interview
What are your main objectives in a psychiatric interview?
Form rapport and gather information
Explore symptoms in context of personality and circumstances
Explore possible biological and social factors related to the symptoms
Inform and motivate patient
Mental state exam
How can you ask a patient about their related symptoms?
Ask about changes acquaintances have noticed
Systematic enquiry for other symptoms eg depression, obsessions, anxiety, psychosis
How can you ask about psychotic symptoms?
‘Have you ever seen or heard anything that other people haven’t been aware of?’
‘Have you heard people talking when nobody was around?’
‘Has anything been playing on your mind?’
‘Has anyone interfered with your thoughts?’
What questions should be asked about past psychiatric history?
Past episodes/diagnoses/contacts
Previous treatments
Inter-episode functioning
Previous admissions to hospital
Attempted suicide/repeated direct self harm
Previous detentions under mental health legislation
What is important to find out in the past medical history?
Developmental problems Head injuries Endocrine abnormalities Liver damage, oesophageal varices, peptic ulcers Vascular risk factors
What should you ask about in alcohol and drug history?
Regular or intermittent use Amount - units Pattern Dependence/withdrawal symptoms Impact on work, relationships, money, police Screening questionnaires
What should be asked about in forensic history?
Have they ever been charged with a crime
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes
What is looked into in mental state examination?
Appearance Behaviour Mood Speech Thoughts Beliefs Percepts Suicide/homicide Cognitive function Insight
What should be examined about the patient’s appearance?
Height/build
Clothing - appropriate or inappropriate, well kempt? bizarre
Personal hygiene - clean, unshaven, malodorous
Make up, jewellery, accessories
How is behaviour examined?
How they greet you Non verbal cues Gesturing - normal, expansive, bizarre Abnormal movements Cooperative Rapport
How is mood examined?
Eye contact
Mood rating out of 10
Psychomotor function
