History taking, Mental state examination and making a diagnosis Flashcards
(44 cards)
Setting for a psychiatric interview
Importance of privacy Avoid interruptions (phones etc) Informal setting Avoid barriers Respect personal space Easy exit
What is talked about when orientating the patient in the intro of the history?
The purpose of the history
Likely duration of interview
Let them know you are taking notes but it is definitely confidential
Body language and behaviour used in the history
Eye contact - raport Relaxed non-threatning posture and appear unhurried Use facilitated noises (I see, okay etc) Pick up on non verbal cues Acknowledge what they are saying Show willingness to understand Do not offer opinion/advice too early Control over talkativeness with polite authority at right time
Definition of Open question
A question in which there is not a closed yes/no answer
Advantages of open question
Allows patient to start talking about themselves and puts them at ease as they have the floor
Allows you time to think and plan areas of questioning as you assess their style and content of response
Allows a period of non-verbal response from interviewer; listening and facilitating
What question could you ask to the patient after they have stopped volunteering their symptoms?
“What other changes have your partner/family/friends noticed in you?”
Definition of Command hallucinations
A voice or person telling them do things
PMH relevant to ask about in a psychiatric history
Developmental problems Head injuries Endocrine abnormalities Liver damage, Oesophageal varices, Peptic ulcers (can indicate if alcohol problems) Vascular risk factors
What to ask about alcohol/illicit drug use
Regular or intermittent Amount (know the units) Pattern Dependence/withdrawal Impact on work, relationships, money, police Screening questionnaires e.g. CAGE
What to ask in a forensic history
Offences including sentences
Recidivism
Particular attention to violent or sexual crimes
Recidivism meaning
Tendency to reoffend
Mental state examination involves….
Appearance Behaviour Mood Affect Speech Thoughts Beliefs Percepts Suicide/homicide Cognitive function Insight
What is looked at when assessing appearance?
Height/build
Clothing (appropriate, kempt, bizarre)
Personal hygiene
Make up, jewellery
What is looked at when assessing behaviour?
Greetings
Non-verbal cues
Gesturing
Abnormal movements (tremor, posturing etc)
Response to unseen stimuli
Cooperative, raport
Evidence of intoxication, or medication side effects
What is looked at to assess mood?
Self rating scale
Eye contact
Affect
Psychomotor function (retarded, agitation)
What is looked at when assessing speech?
Spontaneity Volume (loud, quiet, poverty) Rate (pressured, slowed) Rhythm (rhyming and punning) Tone (monotonous, lilting) Dysarthria Dysphagia (expressive, receptive)
What is an illusion?
When the stimulus is there, but you may interpret something different
What is a hallucination?
There is no stimuli, but they see something these
What domains can abnormal percepts be experienced?
Auditory Visual Somatic/tactile Olfactory Gustatory
What should be asked about suicidal thoughts?
Ideation
Intent
Plans (vague, detailed, specific, already in motion)
Also homicidal risk
What is used to assess cognitive function?
Orientation
Attention/concentration
Short term memory (3 objects, name and address)
Long term memory (personal history)
If any concerns perform objective tests e.g. MSQ, MMSE, executive function tests)
Most key symptom of depression
Low mood
What indicates more likely to kill yourself?
The more effort you make to kill yourself
What does tolerance mean in respect to drinking?
You need to drink more to have the same effect.
