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Y5 PACERS > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the components of a psychiatric history?

A
  • PC
  • HPC
  • Past Psychiatric Hx
  • PMHx
  • DHx - Substance misuse is key
  • FHx
  • Personal Life
  • Premorbid personality
  • SHx
  • Forensic Hx
  • Collateral Hx
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2
Q

What questions should you ask for suspected postpartum mental disorders?

A
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3
Q

What questions should you ask for suspected mania/if you are suspecting BPAD?

A
  • You seem so happy, is this usual for you?
  • You seem to have a lot of energy, is this usual for you?
  • How much sleep are you actually getting?
  • Do you feel special/better than others?
  • Can you do things that other people can’t? Do you have special powers?
  • How are you getting on with people these days?
  • Sounds like you’ve been incredibly busy recently, do you have time to eat or sleep?
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4
Q

In a psych history, what do you need to find out about the history of PC?

A
  • Begin with patient’s own narrative and explore
  • Clarify terms - e.g. patient says she is “depressed”
  • Timing - onset, triggers, progression
  • Severity, frequency, duration
  • Screen for other possible associated symptoms
  • Has treatments been initiated
  • Changes and effects
  • Impact of illness
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5
Q

In a psych history, what must be assessed surrounding PPH?

A
  • Nature
  • Duration of illness
  • Previous treatments – Did it work?
  • Admissions/MHA – dates/lengths of admissions
  • Suicide attempts or self harm/other risks
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6
Q

In a psych history, what must be assessed surrounding PMH?

A
  • Breif full medical history including medications
    • Endocrine
    • Neurological
    • Head injury
    • Infections
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7
Q

In a psych history, what must be assessed surrounding FH?

A
  • Ages
  • Occupations
  • Physical health
  • Psychiatric history
  • Relationship with patient
  • Divorces/separations/conflicts
  • Genogram
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8
Q

In a psych history, what must be assessed surrounding the patients personal history?

A
  • Pregnancy and birth details
  • Early childhood development
  • Childhood health
  • Early emotional stresses (separation/abuse)
  • Education
  • Occupational history
  • Key relationships and psychosexual history
  • Realtionship
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9
Q

In a psych history, what must be assessed surrounding the patients premorbid personality?

A
  • Relationships – how relate to others
  • Predominant mood
  • Moral/religious beliefs
  • Activities and interests
  • Reaction to stressors
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10
Q

In a psych history, what must be assessed surrounding SH?

A
  • Current occupation
  • Finances
  • Residence - Who are you currently living with
  • Social contacts
  • Interests and hobbies
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11
Q

In a psych history, what must be assessed surrounding Forensic history?

A
  • Arrests
  • Cautions/charges
  • Convictions/sentences
  • Crimes of violence
  • Associated factors
  • Have incidences been linkec with episodes of psychiatric illness
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12
Q

What are the components of a Mental state exam?

A
  • Appearance and behaviour
  • Speech
  • Emotion/mood
  • Perception
  • Thoughts
  • Insight
  • Cognitive function
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13
Q

In a Mental state exam, what should be assessed under Appearance and behaviour?

A
  • Describe a ‘picture of patient’
    • Assess self-care/clothing
    • Eye contact
    • Posture and movements
      • Psychomotor agitation/retardation/EPSE:akathisia/TD
    • Level of activity
    • Appropriateness of behaviour
    • Responsiveness - distractibility
    • Rapport/Guarded
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14
Q

In a Mental state exam, what should be assessed under Speech?

A
  • Rate (fast/slow)
  • Tone (emotional quality – sarcastic/angry)
  • Flow (spontaneous/prompted/hesitant/long pauses/uninterruptible)
  • Volume (loud/soft)
  • Link to thoughts:
    • Pressure of speech – pressure of thought
    • Poverty of speech – poverty of thought
    • Sudden stop – thought block
    • Organic: Dysarthria, Dysphasia, Perseveration
    • Unusual Content: neologisms, clang associations(rhyming), punning
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15
Q

In a Mental state exam, what should be assessed under Emotion?

A
  • Subjective assessment
    • Rating scale
      • How much are you able to enjoy things that you used to like?
      • Do you feel happier than usual?
    • Record verbatim
  • Objective/Affect assessment
    • Restricted, blunted, flattened
    • Depression
    • Elation
    • Anxiety
  • Guilt/worthlessness
  • Suicidal ideation/Risk to others
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16
Q

What questions would you ask to assess emotions in suspected mania?

A
  • You seem so happy, how are you feeling, is this usual for you?
  • You seem to have a lot of energy today, is this usual for you?
  • Sounds like you’ve been incredibly busy recently, do you have time to eat/sleep?
  • How much sleep are you actually getting?
  • Do you feel special? Better than other people? Can you do things that other people can’t do? Do you have special powers?
  • How are you getting on with other people these days?
17
Q

What is the difference between Affect and Mood?

A
  • Affect = objective, short lived
  • Mood = subjective and objective, more pervasive
  • Affect = Weather
  • Mood = Climate
18
Q

What questions should you ask about suicide?

A
  • ‘Have you ever had thoughts of harming yourself /ending it all?’
    • If a patient has had specific thoughts, ask:
      • ‘What particular thoughts went through your mind?’
      • ‘Have you made any plans?’
      • ‘How close have you come?’
      • ‘What has stopped you doing anything?’
      • ‘Have you actually tried to harm yourself?’
        • If yes, ask:
          • ‘What happened exactly?
19
Q

What two things are essential to assess following an episode of DSH?

A
  • Intent
  • How did they feel afterwards
20
Q

In a Mental state exam, what should be assessed under Thoughts?

A
  • Thought Form - Formal Thought Disorder
    • Circumstantial speech – over-inclusive thinking (but you get to the goal)
    • Flight of ideas (don’t get to the goal)
    • Derailment – change topic, no logical connection (don’t get to the goal)
    • Loosening of associations (also derailment, knights move thinking)
    • Word salad
  • Thought Content
    • Preoccupations – worries and concerns
    • Overvalued ideas
      • Body image, belief they have a serious illness
    • Obsessional thoughts and Compulsions
    • Delusions
    • Interference
21
Q

What questions would you ask to assess emotions in a suspected anxiety disorder?

A
  • Can you tell me what else you worry about?
  • Is there anything specific that you are very scared of? Any particular situations?
  • How do you feel in your body when you are worrying?
  • Do you feel your heart racing? Do your palms gets sweaty? Do you sometimes find it hard to breathe?
  • Do you avoid particular things/situations because of these unpleasant feelings?
  • How do you cope in these situations?
22
Q

What questions would you ask to assess emotions for suspected obsessions?

A
  • Do you have any unpleasant thoughts that don’t go away however hard to try to ignore them?
  • Do you worry about cleanliness, not having checked something, bad religious thoughts, doing something bad to someone, etc
  • Where do these thoughts come from?
  • Do you believe them?
  • How do they make you feel?
  • How do you manage these feelings?
23
Q

What is the difference between delusional mood and delusional perception?

A
  • Mood = ‘When you go somewhere, everything seems already set up for you like in a theatre – it’s really eerie, and you get terribly frightened’
  • Perception = Objects/events gain a new meaning
24
Q

What questions would you ask to assess emotions for suspected psychosis?

A
  • Do you ever feel something strange is going on?
    • ‘Do you ever feel that people are trying to harm you or hurt you?’
    • ‘Do you ever feel that you are being watched or followed?
  • Have you had any unusual experiences?
    • Ideas of Reference - ‘Have you ever felt as if you were receiving messages from television, radio, newspapers?’
  • Have you felt suspicious about things recently?
25
Q

What questions would you ask to assess emotions for suspected thought interference?

A
  • Thought Interference
    • ‘Do you ever feel that your thoughts are being interfered with?’
  • Thought Broadcasting
    • ‘Do you ever feel that people can read your mind or that your thoughts are available to others?’
  • ‘Thought Withdrawal
    • Have you ever felt as if thoughts are being taken out of your head?’
  • Thought Insertion
    • ‘Do you feel that people are putting thoughts into your head?’
26
Q

In a Mental state exam, what should be assessed under Perception?

A
  • Illusions
  • Depersonalisation/derealisation
  • Hallucinations
    • Auditory
    • Visual
    • Tactile
    • Olfactory
    • Gustatory
27
Q

What questions would you ask to assess emotions for suspected hallucinations?

A
  • ‘Do you ever hear someone talking when there seems to be no one around?’
  • ‘Could you tell me more about what you hear?’
  • Auditory
    • ‘What do they say?’
    • ‘Is there one person/voice or more than one person/voice?’
    • ‘Do you recognize them?’
    • ‘Do they seem to talk to you, like I’m talking to you or about you, as if you’re not there?’ – second or third person
    • ‘Where do they seem to be coming from?’
    • ‘Do they seem to come from inside or outside your head?’ – pseudo hallucinations versus hallucinations
    • ‘Are they real or do you feel they are part of you?’ – hallucinations versus pseudo hallucinations
    • ‘How much of the time are they there?’
    • ‘Do you hear them in certain situations?’
    • ‘How do they affect you?’
    • ‘Do you ever hear your own thoughts spoken aloud?’ – thought echo
    • ‘Do the voices ever tell you to do things?’ – commanding voice
      • ‘What do they instruct you to do?’
      • Do they ever tell you to do bad things, for example hurt yourself or others?’
      • ‘Do you feel you have to act on them?’
28
Q

What questions should you ask to determine whether a patients thoughts are a fixed delusion or overvalued idea?

A
  • ‘Are you absolutely sure that that there is a plot against you, or is it possible that you might be mistaken?’
  • ‘If somebody else said that to you, what would you make of it?’
  • ‘Is there any chance you mind could be playing tricks on you?’
29
Q

In a Mental state exam, what should be assessed under Cognition?

A
  • Ideally a MMSE or MOCA
  • Can do a short assessment of orientation, attention, concentration, memory for consult
30
Q

In a Mental state exam, what should be assessed under Insight?

A
  • Do others/you think you might be unwell?
  • What do you think the problem is?
  • Do you think you might need treatment?
  • What do you think will help/has helped?
31
Q

How might you counsel a patient with Bulimia nervosa?

A
  • Explain the diagnosis (characterised by episodes of excessive eating followed by guilt and purging)
  • Explain the complications (low self-esteem, depression, problems with relationships, dehydration, tooth and gum disease, heart problems)
  • Explain the psychological management (guided self-help for 4 weeks to CBT-ED or just FT-BN)
  • Consider medical (high-dose fluoxetine)

Y5 PACERS (3 decks)

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