Psychiatric Assessment Flashcards

Question

Approach to risk assessment and what areas to assess

Answer 1

-Risk assessment is a vital part of any psychiatric assessment and should always be performed =No patient questionnaire or suicide risk-scoring system alone has been shown to be superior to thorough clinical assessment -Key areas to assess are: =Risk to self e.g. self-harm, suicide, self-neglect or exploitation by others =Risk to others e.g. violent or sexual crime, stalking and harassment =Risk to children e.g. physical, sexual or emotional abuse, neglect or deprivation =Other risk (e.g. to property)

Answer 2

1. Presence of suicide risk factors =Epidemiological factors, Psychiatric disorder, Debilitating physical illness, Recent adverse life-events 2. Is there suicidal intent? How intensely did they wish to end their life? =Advanced planning of attempt, writing a note or will =Dangerous method (hanging, firearm, jump from height) =Plans to avoid discovery/rescue or avoiding help after an attempt =Route of presentation (how were they discovered? Who called for help?) 3. Mental state examination =Current suicidality, Current mood, Other psychiatric illness, Evidence of future planning 4. Current social supports / protective factors =Family, children/other dependents, friends, enjoyable job

Answer 3

-Welfare =Untreated psychiatric illness is of itself a source of distress and functional impairment -Self-neglect =May arise in many psychiatric disorders =Consider weight loss, personal hygiene, treatment of physical illnesses =Specialised guidelines for assessment of physical risk in anorexia nervosa -Exploitation =Most likely to arise in impaired cognition (e.g. intellectual disability, dementia)Consider sexual exploitation, financial exploitation

Answer 4

-Ask the patient whether they feel or are worried they might harm someone else =Why do they feel this way? (What “evidence” do they have?) -Structured clinical judgement is the most effective way of assessing risk of violence and involves using the HCR-20 risk scale and clinical judgement -The HCR-20 assesses =History of problems with violence, antisocial behaviour, relationships, employment =Recent problems clinically with insight, psychiatric symptoms, violent ideation, instability =Future problems with risk management such as housing, support systems, health services/crisis planning and stress -A history of violent behaviour is the best predictor of future violent behaviour

Answer 5

-Patients posing serious risk of violence should be discussed with a multidisciplinary team including social workers and forensic mental health specialists -Compulsory hospitalisation may be required in some cases =This may require use of the mental health act if the patient refuses admission -Important to note: clinicians have a duty to break confidentiality to warn potential victims of serious threats that have been made (in consultation with the police)

Answer 6

-Does the patient express or admit any thoughts/wishes to harm their own or other children? -Have they placed a child in their care at risk? For example, by taking an overdose or substances while caring for child? -Consider physical, sexual, emotional mistreatment or neglect/ deprivation -Risk factors: =Parent: abused, substance abuse, mental illness, step-parent, young, immaturity, criminality, low socioeconomic status, overcrowding =Child: low birth weight/ prematurity, early maternal separation, unwanted child, intellectual or physical disability, challenging behaviour, excessive crying

Answer 7

-If suspected =Refer child protection guidelines =Ask for child’s full name and DOB =Tell senior. Involve police, social workers, duty paediatrician as per protocol =Keep comprehensive notes -Important to determine if the child may be in imminent danger =Immediate steps should be taken to remove them from harm (contacting the police)

Answer 8

-Description of patient =Case summary of identifying information, main features of presenting complaint, relevant background details, positive findings in MSE and physical examination =Ascertain if conditions are independent or related -Differential diagnosis (for and against, order of decreasing probability) -Aetiology (9 grid: predisposing, precipitating, perpetuating/ biological, psychological, social) -Management (immediate to short-term, medium to longer term/ biological, psychological, social) -Prognosis (natural course of condition, individual patient factors)

Answer 9

-How has your mood been lately? (depth, objective vs subjective) -Does your mood vary throughout the day? (does anything account for this) -What is your appetite like at the moment? (loss of interest in food/ loss of motivation to prepare food/ swallowing/ recent weight loss/ fitting clothes) -How is your concentration? (ability to perform standard tasks read newspaper TV show, work performance) -What is your memory like at the moment? -How is the sexual side of your relationship? (loss of libido) -Do you have any worries on your mind at the moment?(guilty?)

Answer 10

-How do you fee about the future? -Have you ever thought that life was not worth living? -Have you ever wished that you could go to bed and not wake up in the morning? -Have you had thoughts of ending your life? (frequency, fleeting, rapidly dismissed, prolonged) -Have you had thoughts about how you would do it? (methods) -Have you made any preparations? (how far plans have progressed from ideas to action, place, bought pills, suicide note) -Have you tried to take your own life? -Self-harm: in what circumstances do they harm themselves? What do they feel and think before harming themselves, how do they feel afterwards)

Answer 11

-How has your mood been lately? -Do you find your mood is changeable at the moment? (mania lability: tearful and irritable and elation) -What is your thinking like at the moment (increase in speed and ease of thinking) -Do you have any special gifts or talents? -How are you sleeping (length and quality) -What is your appetite like at the moment? -How is your concentration? -How is the sexual side of your relationship?

Answer 12

-Would you say you were an anxious person? -Recently, have you been feeling particularly anxious or on edge? -Do any particular situations make you more anxious than others? -Have you ever had a panic attack? -Do any thoughts or worries keep coming back to your mind even though you try to push them away? -Do you ever fund yourself spending a lot of time doing the same thing over and over like checking things or cleaning- even though you've already done it well enough

Answer 13

-Now I want to ask you about some experiences which sometimes people have but find difficult to talk about. These are questions I ask everyone. -Have you ever had the sensation that you were unreal or that the world had become unreal? -Have you ever had the experience of hearing noises or voices when there was no one about to explain it? (when, awake, how often, where did the sound appear from, what did it say, recognise the voice, more than one, how did they refer to the patient, examples) -Have you seen any visions (when, how often, circumstances, was the vision seen with the minds eye or perceived as being in external space, distinct from surroundings or seen as part of wallpaper or curtain pattern) -Do you ever notice smells or tastes that other people aren't bothered by?

Answer 14

-Do you have any particular worries preying on your mind at the moment? -Do you ever feel that people are watching you or paying attention to what you are doing? -When you watch television or read the newspapers do you ever feel that the stories refer to you directly or to things that you have been doing? -Do you ever feel that people are trying to harm you in any way? -Do you fee that you are to blame for anything, that you are responsible for anything going wrong? -Do you worry that there is anything wrong with your body or that you have a serious illness?

Answer 15

-Do you ever hear voices commenting on what you are doing? Or discussing you between themselves? Or repeating your own thoughts back to you? (him her not you) -Do you ever get the feeling that someone is interfering with you thoughts- that they are putting thoughts into your head or taking them away? Or that your thoughts can be transmitted to others in some way? -Do you ever get the feeling that you are being controlled? That your thoughts or moods or actions are being forced on you by someone else?

Psychiatric Assessment Flashcards

(39 cards)