History taking, Mental state examination, and making a diagnosis
What body language and behavior used are most suitable while taking psychiatric history?
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
- Developmental problems
- Head injuries
- Endocrine abnormalities
- Liver damage
- Esophageal varices
- Peptic ulcers (can show if alcohol problems)
- Vascular risk factors
What to ask about alcohol/illicit drug use?
- Regular or intermittent
- Amount (know the units)
- Pattern Dependence/withdrawal
- Impact on work, relationships, money, police
- Screening questionnaires e.g. CAGE
What to ask in a forensic history
- Offenses including sentences
- Recidivism
- 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...
- Appearance Behavior
- Mood Affect
- Speech
- Thoughts
- Beliefs
- Perceptions
- Suicide/homicide
- Cognitive function
- Insight
What is looked at when assessing appearance?
- Height/build
- Clothing (appropriate, kempt, bizarre)
- Personal hygiene
- Makeup
- Use of Jewelry
What is looked at when assessing behavior?
- Greetings
- Non-verbal cues
- Gesturing
- Abnormal movements (tremor, posturing, etc)
- Response to unseen stimuli
- Cooperative, rapport
- Evidence of intoxication, or
- medication side effects
What is looked at to assess mood?
- Self-rating scale
- Eye contact
- Affect
- Psychomotor function (retarded, agitation)
What is looked at when assessing speech?
- Spontaneity
- Volume (loud, quiet, poverty)
- Rate (pressured, slowed)
- Rhythm (rhyming and punning)
- Tone (monotonous, lilting)
- Dysarthria
- 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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