Wednesday, 5 January 2005

History taking, Mental state examination, and making a diagnosis

History taking, Mental state examination, and making a diagnosis

What body language and behavior used are most suitable while taking psychiatric history?

What is an open-ended question?

What question could you ask the patient after they have stopped volunteering their symptoms?

"What other changes have your partner/family/friends noticed in you?"

What is the definition of Command hallucinations?

A voice or person telling them to do things

PMH relevant to ask about in a psychiatric history

  1. Developmental problems 
  2. Head injuries 
  3. Endocrine abnormalities 
  4. Liver damage
  5. Esophageal varices 
  6. Peptic ulcers (can show if alcohol problems) 
  7. Vascular risk factors

What to ask about alcohol/illicit drug use?

  1. Regular or intermittent
  2. Amount (know the units)
  3. Pattern Dependence/withdrawal 
  4. Impact on work, relationships, money, police 
  5. Screening questionnaires e.g. CAGE

What to ask in a forensic history

  1. Offenses including sentences
  2. Recidivism 
  3. Particular attention to violent or sexual crimes

Recidivism meaning

Tendency to re-offend

History taking, Mental state examination, and making a diagnosis

Mental state examination involves...

  1. Appearance Behavior
  2. Mood Affect
  3. Speech 
  4. Thoughts 
  5. Beliefs 
  6. Perceptions 
  7. Suicide/homicide 
  8. Cognitive function 
  9. Insight

What is looked at when assessing appearance?

  1. Height/build
  2. Clothing (appropriate, kempt, bizarre) 
  3. Personal hygiene 
  4. Makeup 
  5. Use of Jewelry

What is looked at when assessing behavior?

  1. Greetings 
  2. Non-verbal cues 
  3. Gesturing 
  4. Abnormal movements (tremor, posturing, etc)
  5. Response to unseen stimuli 
  6. Cooperative, rapport 
  7. Evidence of intoxication, or 
  8. medication side effects

What is looked at to assess mood?

  1. Self-rating scale
  2. Eye contact
  3. Affect 
  4. Psychomotor function (retarded, agitation)

What is looked at when assessing speech?

  1. Spontaneity
  2. Volume (loud, quiet, poverty)
  3. Rate (pressured, slowed)
  4. Rhythm (rhyming and punning)
  5. Tone (monotonous, lilting)
  6. Dysarthria 
  7. Dysphagia (expressive, receptive)

What is an illusion?

When the stimulus is there, but you may interpret something different

What is a hallucination?

There are no stimuli, but they see something these

What domains can abnormal percepts be experienced?

Auditory-Visual Somatic/tactile Olfactory Gustatory

What should be asked about suicidal thoughts?

Ideation Intent Plans (vague, detailed, specific, already in motion) Also the homicidal risk


What is used to assess cognitive function?

Orientation Attention/concentration Short term memory (3 objects, name, and address) Long term memory (personal history) If any concerns perform objective tests e.g. MSQ, MMSE, executive function tests)

History taking, Mental state examination, and making a diagnosis

The most key symptom of depressive disorder

Low mood

History taking, Mental state examination, and making a diagnosis

What indicates more likely to kill yourself?

The more effort you make to kill yourself

History taking, Mental state examination, and making a diagnosis

What does tolerance mean with respect to drinking?

You need to drink more to have the same effect.

History taking, Mental state examination, and making a diagnosis

How long roughly does citalopram take to work? (anti-depressant)

About 2 weeks

History taking, Mental state examination, and making a diagnosis

Hypothyroid is related to what psychiatric disorder?

Depression


Hyperthyroid is related to what psychiatric disorder?

Anxiety

What does the premorbid personality look at?

Are they different now from what they were normally like before?

History taking, Mental state examination, and making a diagnosis

Definition of psychopathology

Concerned with abnormal experience, cognition, and behavior

Definition of Descriptive psychopathology

Describes and categories the abnormal experience as described by the patient

Definition of phenomenology

Refers to the observation and understanding of the psychological event or phenomenon so that the observer can as far as possible know what the patient's experience feels like

Mood definition

Generally held to be the patient's subjective report on their current mood state in terms of how they rate themselves from depressed through euthymic (neutral) to elated

How do you define Affect? 

Affect held to be the emotions conveyed and observed objectively during an interview in terms of- types of affect observed - range and reactivity of affect - Congruity of affect

Low mood and psychotic symptoms together mean what?

Severely depressed

Definition of Delusion

An unshakable idea or belief which is out of keeping with the person's social and cultural background

Broadly 3 classes of perceptual disturbance

Hallucinations Pseudo hallucinations Illusions

Features of hallucinations

Have the full force and clarity of true perception Located in external space No external stimulus Not willed or controlled

What should insight be conceptualized as?

A spectrum - rarely 100% absent or present

3 Questions for the continuum of insight

Do you think you are ill? If you are ill, is it a mental illness? If you are ill and it is a mental illness, do you agree broadly with the current treatment plan?

Symptoms of a depressive episode

Persistent sadness or low mood Loss of interests and pleasure Fatigue or low energy At least one of these, most days, most of the time for at least two weeks (above)disturbed sleep poor concentration or indecisiveness low self-confidence Poor or increased appetite suicidal thoughts or acts agitation or slowing of movements guilt or self-blame

How many symptoms are classed as a mild depressive disorder?

4

How many symptoms are classed as moderate depressive disorder?

5-6 symptoms

How many symptoms are classed as a severe depressive disorder?

seven or more symptoms, with or without psychotic symptoms

What is the SSRI choice in children and adolescents?

Fluoxetine

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