Methods of diagnosis Flashcards
What are fundamental components of psychiatric assessment?
-history
-mental state examination
-risk assessment
(the above 3 are the key ones)
-physical exam/investigations
-formulation
-diagnosis
-management plan
example of when physical exam would be needed in psychiatry?
- if somebody was self-harming/suicidal
- indications of self-neglect (not eating/drinking)
- to exclude any organic causes of psychosis (so do brain CT)
- diagnosis of dementia (vascular/non-vascular can be judged by a CT scan)
how to take psychiatric history
- presenting complaint
- history of PC
- check if they take drugs or alcohol
- medical/medication/forensic/family/personal/social history
why is it important to take medical history for a psychiatric assessment?
- any medications they are taking could cause psychosis
- any underlying conditions (hyperthyroidism can cause palpitations so this would not be psychiatry related)
what is included in the mental state examination?
- appearance (eye contact/ hygiene)
- behavior (agitated/om-edge/sluggish/drowsy)
- speech (not engaging in convo/tone/volume/speed- in mania people speak fast)
- mood (feeling low-depression/ constantly changing-bipolar?)
- affect (what we can see in the patient- do their words match the way they carry themselves)
- thought (thought disorders? wondering away from the main point of their speech)
- perception (may perceive things differently/hallucinations auditory or visual/delusions)
- cognition (if they are orientated and can process surroundings)
- insight (are they aware that what they are experiencing may not be real- hallucination or delusions)
why is it important to assess whether the patient has insight>
If patient has insight then more likely to comply with treatment and take medications and CBT. Without insight they will refuse these as they believe nothing is wrong.
why is a risk assessment necessary?
to look for self-neglect/whether patient is a risk to themselves or others. Thus we can decide how urgent their case is.
why is it important to make the correct diagnosis?
- to ensure the correct treatment/management plan is implemented
- some patients appreciate having a label for what is happening, as they feel more understood
- having a diagnosis allows patients to have access to resources (like PIP, benefits or student facilities) from the government
- enables further research into that illness
what are potential social benefits those with mental health disorders can get?
- education and healthcare plan (EHCP)
- social care package
- access to community services
- DLA/PIP
- freedom pass (free travel pass)
- free prescription
- housing aid
- help with CV/job-seeking
what are Pros and Cons of “labelling” someone with an illness?
Pros
- a relief to know exactly what is wrong with someone
- social benefits
Cons
- social stigmas
- generalization of some psychiatric diagnosis
- diagnosis can change (is not always consistent eg. initially diagnosed with psychosis and over years changed to schizo-effective disorder)
what is formulation
- not used by many other medical specialties to reach diagnosis
- using a biopsychosocial model
take notes on 3 factors:
PREDISPOSING- what factors make that individual more likely to get that mental health issue (some genetic ones- bipolar/ADHD) (Some social ones- abuse/finance issues)
PRECIPITATING- what are the current factors which caused the problem now (war/bullying/accident/bereavment)
PERPETUATING- any factors causing the issue to continue/escalate (substance use.family dynamic)
(4th one and 5th one unofficial):
PROTECTIVE- social networks they have/family support/anybody that depends on them (they won’t hurt themselves due to these factors)
PREDICTIVE FACTOR -
what is one of the first systematic classifications of psychiatric disorders?
Emil Kraeplin back in 18-1900s created a classification system. Noticed clustering symptoms that led to a standalone mental illness (with no physical underlying cause).
Proposed 2 groups of severe mental disease:
1. dementia praecox (early term for schizophrenia)
it was thought chemical imbalance causes this)
- manic-depressive psychosis (early term for bipolar disorder)
was thought that an irregularity in metabolism caused this
As time went on, what became the 3 subgroups of mental illness before the current system?
THE NEUROSES
- depression/anxiety/mania/compulsions
- patient usually retains insight and orientation
- patient may have deep distress and commit suicide
THE PSYCHOSES
- schizophrenia/puerperal psychosis
- -patient is disorientated/deluded/lacks insight
THE DEMENTIAS
- progressive deterioration
- loss of recent memory and personality
- can be primary or secondary to another condition (alcohol/stroke)
what is the current psychiatric disorder hierarchy?
- organic disorders (delirium/disorders of alcohol or drug abuse)
- psychotic disorders (includes schizophrenia/psychosis not related to drugs)
- mood disorders (depression/bipolar affective disorder, psychotic depression)
- anxiety disorders (phobia, panic, anxiety, OCD, PTSD, adjustment disorders)
- personality disorders (emotional dependent disorder, dependent personality disorder, antisocial personality disorder)
what are examples of developmental disorders?
- autism (quite common one)
- ADHD
