Psychiatric History Taking, Mental State Examination and Making a Diagnosis Flashcards
(57 cards)
What are the 2 fundamental components in psychiatric interviewing?
1 - Collection of clinical data
2 - Understanding of the patient as an individual
What are key components of being able to understand the patient as an individual?
1 - Empathy
2 - Descriptive psychopathology
What is involved in collecting clinical data from a psychiatric patient?
1 - Taking a clinical history
2 - Examining mental state
What are the additional areas that need to be explored in a psychiatric history taking on top of the normal history taking components?
1 - Past psychiatric history
2 - Recent medication (in addition to current medications)
3 - Family Psychiatric history:
4 - Forensic history
5 - Personal history:
- Developmental milestones
- Schooling/education
- Occupational history
- Relationships
- Pre-morbid personality
6 - MSE
How should psychiatric histories begin?
1 - Start with open questions (“can you tell me in your own words why you are here?”)
2- Record each presenting complaint in the patients own words
3 - Clarify each complaint in turn (use appropriate parts of SOCRATES)
What are the systematic symptoms to enquire about during a psychiatric history?
1) Mood - depressed, elated
2) Anxiety/panic
3) Memory problems/confusion
4) Abnormal thought content (obsessions, paranoia)
5) Hallucinations
6) Risk of harm to self or others
7) Insight
What questions should be asked when exploring perceptual disturbances in psychiatric patients?
1 - “Have you seen or heard anything that other people have not been aware of?”
2 - “Have you heard any people talking when there was nobody around?”
What questions should be asked when exploring a psychiatric patients beliefs/thoughts?
1 - Has anything particular been playing on your mind?
2 - Do you know why this is happening?
3 - Have you noticed any change in your thoughts?
4 - Has anyone interfered with your thoughts?
5 - Does anyone else have access to your thoughts?
What are the components of the mental state examination?
1 - Appearance
2 - Behaviour
3 - Mood
4 - Speech
5 - Thoughts
6 - Beliefs
7 - Percepts
8 - Suicide/homicide
9 - Cognitive function
10 - Insight
What points should be considered when reviewing a patients appearance?
- Height & build
- Clothing - is it appropriate or not, are they kempt or bizarre looking
- How is their personal hygiene - clean/unshaven/malodorous
- Are they wearing make-up, jewellery or accessories
What should be considered when reviewing a patients behaviour?
1 - Their initial greeting
2 - Their non-verbal cues
3 - Gestures (normal, expansive, bizarre)
4 - Abnormal movements (tremor, choreiothetoid movements, posturing)
5 - Are they cooperative and can build a rapport
What should be considered when assessing a patients mood?
1 - Eye contact
2 - Rating of mood subjectively and objectively (score out of 10)
3 - Psychomotor function (retarded or agitated)
What should be considered when assessing a patients speech?
1 - Spontaneity (are they speaking without being asked questions)
2 - Volume (loud, quiet, poverty)
3 - Rate - pressured or slowed
4 - Rhythm - rhyming and punning
5 - Tone - monotonous, lifting
6 - Dysarthria (unclear articulation)
7 - Dysphasia - expressive or receptive (unable to generate or understand speech)
What should be considered when assessing a patient for abnormal thoughts?
1 - Close relationship of thoughts to speech
2 - Phobias
3 - Obsessions
4 - Flight of ideas
5 - Thought disorders (broadcast, echo, block, withdrawal)
What should be considered when assessing a patient for abnormal beliefs?
1 - Preoccupations
2 - Over valued ideas
3 - Delusional beliefs (fixed, false belief out of cultural context, extraordinary comviction)
What is the difference between illusions and hallucinations?
Illusions - A stimulii is present
Hallucinations - No stimulii is present
What should be considered when assessing a patients perception?
1 - Illusions
2 - Hallucinations
3 - Which domain is their perceptual disturbance? Auditory, visual, somatic/tactile, olfactory, gustatory
What should be considered when assesing a patient for suicide/homicide?
1 - Must always ask about suicidal thoughts
2 - Ideation (having ideas or thoughts about suicide or homicide)
3 - Intention
4 - Plans (vague, detailed, specific, already in motion)
5 - Homicidal risk
What should be considered as part of assesing a patients cognitive function?
1 - Orientation (time, place, person)
2 - Attention/concentration
3 - Short-term memory (3 objects; name and address)
4 - Long-term memory (personal history)
What tests are available for more advanced assesment of cognitive function if concerns arise from basic assesment?
1 - Mental Status Questionaire (MSQ)
2 - Mini-mental state examination (MMSE)
3 - Montreal Cognitive Assesment (MOCA)
What questions should a patient be asked when assesing their insight?
Ask the patient the following questions to check their understanding of their condition and ability to label their abnormal behaviours as part of their illness:
1 - Are their symptoms due to illness?
2 - Is this a mental illness?
3 - Do they agree with treatment and management plan?
What are important aspects of the family history when taking a psychiatric history?
1 - Family structure (divorce etc.)
2 - Family psychiatric history
What are important events to consider in the PMH of a psychiatric patient?
1 - Head injuries
2 - Neurological disease
3 - Developmental disorders
4 - Psychosomatic disorders
What endocrine disorder can mimic the symptoms of depression?
Hypothyroidism
