Hx Psyhiatry

Question 1

what is the ESSENTIAL/MUST DO component of every psychiatric Hx?

Answer 1

Risk assessment

Question 2

What (4) things to ask for in ‘depression’?

Answer 2

• core: mood, anhedonia
• biological: sleep, energy, appetite
• future: hopelessness, suicidal thoughts/plans for suicide
• other: a history of mania/hypomania

RISK assessment

Question 3

What questions to ask for in HPC of anxiety? (in general, just subheadings)

Answer 3

• Time (onset, duration, frequency, triggers, the effect on life)
• Somatic symptoms
• associated psychological symptoms
• psychiatric differentials
• organic differentials
• RISK assessment

Question 4

HPC of anxiety. What to explore in somatic symptoms?

Answer 4

palpitations, breathlessness, chest tightness, sweating, dizziness

Question 5

HPC of anxiety. What to explore in associated psychological symptoms?

Answer 5

• depression screen
• worry
• stress
• avoidance

Question 6

What are psychiatric differentials for anxiety?

Answer 6

obsessions

compulsions

post-traumatic stress disorder

Question 7

Symptoms of post-traumatic stress disorder

Answer 7

• psychological trauma
• flashback
• nightmares
• hyperarousal

Question 8

What are organic differentials (2) in anxiety?

Answer 8

• hyperthyroidism
• ACS

*ask about symptoms

Question 9

What further questions to ask about auditory hallucinations? (5)

Answer 9

• voice detail: famale/mae, familiar/unfamiliar, always same?
• Pseudo/real: inside/outside head
• 2nd or 3rd person: talk to you/about you/comment
• what do they say: (include commands)
• risk to self/others

Question 10

Psychiatric system review (4)

Answer 10

• Psychosis screen (1st Rank symptoms): 3rd person auditory hallucinations, commentary, delusions of thought, control, perception
• Depression screen: core (mood, anhedonia), biological (sleep, energy), future (hopelessness, suicidal thoughts)
• Other: memory, anxiety, insight
• Risk: self/suicide/self-harm

Question 11

What (3) things to ask for in someone presenting with delusions?

Answer 11

• expand and challenge the delusion
• risk to self/others
• associated psychiatric symptoms (psychosis, depression, memory, anxiety, risk)

Question 12

Someone presenting with memory loss. What further questions to ask for? (5)

Answer 12

• Try to obtain a collateral Hx
• Insight and concerns
• Functional levels (washing, dressing etc.)
• Perform cognitive assessment (mini-mental state)
• Risk assessment

Question 13

History of the Eating disorder. What questions to ask? (6)

Answer 13

• BMI: weight, height
• Symptoms (another flashcard)
• food diary (what they eat each day)
• results: menstrual cycle disturbances, poor dental hygiene
• screen for depression
• risks

Question 14

What are the symptoms of an eating disorder? (5)

Answer 14

• avoidance of weight gain
• need to lose weight
• preoccupation with appearance
• efforts to purge (vomiting, laxatives, exercise)
• any binge eating/ fasting