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Psychiatry > Psychiatric history taking > Flashcards

Psychiatric history taking Flashcards

1
Q

What to ask for presenting complaint?

A

Name, age, gender

Brief account of initial complaint

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2
Q

History of presenting complaint, what to ask?

A

OPEN Qs

  • history of this particular instance
  • how did they arrive into hospital/clinic? (detained under MHA, via police, via GP?)
  • patient history
  • collateral history if possible
  • history from notes
  • onset and progression
  • severity
  • any biological cause? (delirium from infections/hormones e.g. thyroid, testosterone, oestrogen)
  • stress - bereavement, moving house, relationship issues
  • latch onto specifics - ask pertinent questions specific to presenting complaint
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3
Q

what questions to ask for HPCx for depression?

A

Screen - over the last two weeks:

  • had little interest in doing things?
  • felt down, depressed or hopeless?
  • had trouble sleeping or sleeping too much?
  • felt a reduction in energy?
  • poor appetite or over-eating?
  • feeling like you’ve let someone down?
  • trouble concentrating
  • feeling fidgety? or speaking and moving slowly?
  • thoughts about suicide or self-harm
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4
Q

What questions to ask in HPCx for anxiety?

A
  • Panic attacks- triggers? severity? fear of death or imminent danger? hands tingling? tremors? sweating? palpitations?
  • phobias
  • screening, over last two weeks have you: (felt nervous, anxious, on edge? mnot able to stop worrying? worrying about different things had trouble relaxing? being so restless you can’t sit still?becoming easily annoyed or irritable? feeling afraid of something awful happening?)
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5
Q

What questions to ask in HPCx for suicidal thinking?

A
  • just ideas or ever acted on them?
  • if just ideas - what is stopping you? any protective factors?
  • if acted - where, when, planned/impulsive/note or will/expect to be found etc. are they glad/regretful that it’s not worked?
  • have they any plans to kill themselves now or hurt themselves?
  • have they ever self-harmed?
  • have they done anything in the past- details?
  • can they describe this in MSE?
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6
Q

What questions to ask in HPCx for mania?

A
  • what did they do?
    think of Sx for mania - sexual/social disinhibition, reckless/impulsive behaviour/poor sleep/poor self car including eating/overspending/not completing tasks and so on…
  • are you special/chosen in anyway?
  • any unusual ideas or hallucinations?
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7
Q

What questions to ask in HPCx for Schizophrenia?

A
  • what does that diagnosis mean to you? how do you experience it?
  • triggers for relapses? - substances, stress, changes in personal life, financial stresses, family illness, non-compliance with medication?
  • first rank Sx -> auditory hallucinations (3rd person, running commentary, do they have to do what the voices are saying?), delusions of passivity (eellike external force is in control of a part of their body), somatic hallucinations (patient feeling something that isn’t there), thought interference (thought withdrawal, thought broadcast, thought insertion), other delusions? (grandiose, persecutory, hypochondriac, coward/nihilistic, Othello etc.)
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8
Q

What questions to ask in HPCx for bipolar?

A

ask the mania and depressive questions

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9
Q

What questions to ask in HPCx for personality disorder?

A
  • establish any childhood trauma

- forensic history

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10
Q

questions in past psychiatric history?

A
  • any previous detentions under MHA?
  • known psychiatric diagnoses? rough dates of acute episodes and duration?
  • previous treatments? - medication, ECT, psychotherapy
  • visits to GP re mental health?
  • previous contact with psychiatric services incl as a child?
  • history of self-harm
  • history of depression
  • past medical history
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11
Q

Drug history?

A
  • psychiatric medication -> Compliance, any side effects?
  • other meds and allergies
  • past psychiatric medications
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12
Q

Personal history?

A
  • from birth to now
  • how was birth? - type, injury, SCUBU?
  • developmental milestones?
  • childhood illness?
  • interactions from a young age? any aggression?
  • primary - secondary school - friends/academics
  • victim of bullying?/was a bully? Truancy?
  • Relationships with family members? support?
  • abuse? neglect? - ask with caution
  • college?university?jobs/unemployment?
  • premorbid personality?
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13
Q

Drug and alcohol history Qs?

A
  • Hx of alcohol use?
  • Hx of drug use?
  • present use?
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14
Q

Social Hx Qs?

A

home circumstances
support networks
current occupation

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15
Q

forensic Hx Qs?

A

encounters with police?
ever broken the law? caught or not? prison?
any cautions?/convictions?/reprimands?

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16
Q

psychosexual Hx Qs?

A 
- puberty - normal development?
relationships/sexual encounters/orientation?
- significant relationships/marriage?
- children?
- sexual function/dysfunction?
- abuse if not mentioned earlier?
17
Q

What are the sections of the mental state examination (MSE)?

A 
Appearance
Behaviour
Mood
Affect
Speech
Thought
Perception
Cognition
Insight
Risk
18
Q

What do you do for appearance of MSE?

A

comment on general appearance, clothes and how well kept they are

19
Q

What do you do for behaviour of MSE?

A
  • eye contact
  • agitated/settled
  • rapport easy or difficult to establish?
  • abnormal movements?
20
Q

What do you do for mood of MSE?

A
  • subjectively
  • objectively - use biological information here to form objective impression - eating, sleeping, energy, concentration, libido, attention
  • feelings of guilt, hopelessness and/or worthlessness
21
Q

What to do for affect of MSE?

A

Related to reactivity of mood - flat, blunt, incongruous?

22
Q

What to do for speech of MSE?

A
  • Form - rate, rhythm and volume, Pressure?

- content

23
Q

What to do for thought of MSE?

A
  • form - anything odd e.g. thought blocking, perseveration, knights move thinking?
  • content - delusions, depressive ideas, obsessions
24
Q

What to do for cognition of MSE?

A
  • orientated to time/place and person?

- MMSE if appropriate

25
Q

What to do for insight of MSE?

A

Do they realise they have a mental health difficulty? what is their explanation for their difficulties?

26
Q

What do you do for risk of MSE?

A

include risk to self, others. property and self-neglect.

willing to stay on ward/comply with treatment?/vulnerable to exploitation?

27
Q

What is the abbreviation/mnemonic of the MSE topics?

A

ASEPTIC

Psychiatry (40 decks)

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