Week 2: Psychiatric history Flashcards
What are the 4 components of a psychiatric assessment?
1) Psychiatric history
2) mental state examination
3) physical examination
4) risk assessment
What is involved in diagnostic formualtion of a psychiatric patient?
1) Description of the patient
2) Differential diagnoses
3) Aetiology
4) Management
5) prognosis
What is the purpose of the psychiatric history?
1) Gather information on psychological and physical symptoms
2) Understand the impact of symptoms on the patient’s life
3) Understand the context of the patient’s problems from a psychological and social point of view
4) contributes to risk assessment
5) contributes to formulation
6) provides therapeutic intervention
In what ways is the psychiatric history different to a standard history?
Psychiatric history is longer in length and time to complete with a number of sections.
You may not be able to gather all info in one sitting and may need to fill gaps from other sources e.g. collateral and notes
What should you consider when taking a psychiatric history?
1) Setting, quite and private
2) Build a rapport and be flexible
3) Time constraints
4) Safety –> alarms, patient not between you and the door, inform colleagues where you are, who you are seeing
What is building a rapport about?
Building a rapport is about building trust and a therapeutic relationship
What should you consider when trying to build a rapport?
What are key skills to use here?
Treat patients with respect, empathy and sensitivity.
Think about your 1) body language 2) eye contact 3) phrases and language used.
Key skills:
Active listening (e.g. nodding, acknowledgement (yes, okay, reflections, summarising).
Encouragement : tell me more about that
Validation : I appreciate this must be really difficult to talk about
Appropriate use of silence
Why is building a rapport important especially with the psychiatric patient?
- It may be the first time they’ve built the courage to talk to someone
- They may need reassurance, and have unrealistic beliefs/ unhelpful beliefs of what may happen to them
- They may have experienced stigma when talking about MH in the past
- They may feel isolated (the only one to exp. these sx)
- They are talking about personal and painful feelings/ experiences
- May be concerned about the impact of discussing sx on work/ relationships
What are the components of an introduction in a psychiatric hx?
- Introduce yourself and explain purpose of the interview
- Explain how long the assessment is likely to take
- Explain need to take notes
- explain any cofidentiality issues
- Gain the patient’s consent to speak to informants
Describe the structure of the psychiatric history
- Personal details
- Referral details
- Hx of presenting complaint
- past psychiatrix hx
- past medical and surgical hx
- drug hx and allergies
- family hx
- social hx
- personal hx
- substance and alcohol hx
- forensic hx
- premorbid personality
What are the key personal details you need in a psychiatric hx?
- Name
- Age
- address, type of accomodation
- occupation
- marital status
What are key details of referral hx you need in psych hx?
- Record place and time pt seen
- Voluntary or detained under MHA?
- source of referral
- reason for referral
- informants name and relationship to the patient
What are key details of the presenting complaint?
- Patients own words
- may be appropriate to record problems as described by the informant
- Brief description
Key factors in the hx of presenting complaint?
- Can use similar structure to physical sx (SQITARPS/SOCRATES)
- Site/ Quality –> nature of symptoms
- Intensity –> impact
- Timing –> onset, development, duration, frequency, course
- Precipitating or exacerbating factors
- Relieving factors
- Associated sx
- Explore relationship between psychiatric symptoms, physical symptoms and social problems
- Current treatment and effect
- Previous episodes
- Previous treatment and effect
How would you explore the presenting complaint of a patient hearing voices?
- Onset –> When did they start? Are they there all the time or only certain times? Have they changed since they first began?
- Site –> are the voices in your head or do you hear them through your ears?
- Quality/ intensity –>
- How many voices are there?
- Are the voices male or female?
- do you recognise the voice?
- Do they speak directly to you, about you or give a running commentary?
- What do they say?
- do they tell you to do anything? (command hallucinations)
- do they stop you from doing anything
- Associated symptoms –> tactile or visual hallucinations, delusions, thought insertion/ withdrawal/ broadcast, feelings or reference, low mood?
- Relieving factors?
