Psychiatric History Taking and MSE PDF

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Summary

Summary of Psychiatric History Taking and MSE, required for the Psychiatry OSCE and Viva...

Description

Psychiatric History Taking PC 

____ year old man/woman with a history of ____ presenting with ____

HPC 

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PMHx

Onset: o When was patient last well? o Sudden/gradual development? o Reason for presenting now? o Any precipitating factors e.g. bereavement, marriage breakup, trauma Severity: o Periodicity/frequency o Improving/deteriorating? Exacerbating/relieving factors Impact on patient’s life Treatment history: o Medications o CBT, psychotherapy o ECT Symptoms to ask about: o Low/high mood o Anxiety o Confusion o Psychosis (ask “have you ever seen something that isn’t really there? Do you ever hear voices that aren’t really there? ASK TUTOR HOW TO ASK) o Difficulty remembering things o Suicide risk:  Sometimes when people are feeling down, they can start to think about hurting themselves – have you ever had any feelings like this?  Have you ever purposefully hurt yourself?  Again, sometimes people can think about going as far as killing themselves – have you ever had any thoughts like this?  Have you ever seriously considered it? Put any plans in place? Actually attempted to take your own life?

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Physical and psychiatric

DHx 

Ask about ECT treatments if relevant

FHx  

Physical and psychiatric illness RELATIONSHIPS

SHx     

Who are you living with right now? Support network? What sort of housing? Coping? Occupation Developmental Hx? Smoking, alcohol, illicit drugs (best way to ask?)

Mental State Exam 

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Appearance and behaviour: o Appearance:  Age  Build  Self care  Specifics e.g. needle marks, tobacco stains o Behaviour:  Facial expression  Posture and body language  Eye contact  Motor activity Speech Mood and affect (mood = climate, affect = weather): o Subjective mood:  What has your mood been like recently o Objective mood:  Level (elated, euthymic, depressed)  Changeability (labile, reactive, flat) o Somatic symptoms:  Sleep disturbance  Change in appetite  Change in libido

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o Suicidality:  Any suicidal thoughts? How frequent, powerful, passive/active?  Any suicidal plans?  Any suicidal acts? Preparatory or definitive, what stopped them? Thought: o Form:  Circumstantial thinking (lots of detours, common in dementia)  Flight of ideas (mania)  Loosening of associations (little/no logical connection, schizophrenia)  OR “No formal thought disorder” o Content:  Delusion:  Paranoid  Persecutory  Grandiose  Of reference (think everything relates to them)  Nihilistic  Obsession (patient recognises as their own, tries to resist)  Over-valued idea (anorexia, hypochondriasis) o Possession (insertion/withdrawal in schizophrenia) Perception: o Illusions o Hallucinations (perception without an object) o Enhanced/dulled perceptions Cognition: o MMSE/Addenbrooke’s Insight: o Patient’s understanding of what is going on

MMSE    

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Orientation to time: o Year? Season? Date? Day? Month? Orientation to place: o Where are we now? County? Town/city? Hospital? Floor? Registration: o Name 3 unrelated objects, instruct patient to name all 3 Attention and calculation: o Count back from 100 by sevens o OR spell WORLD backwards Recall:

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o Earlier I told you the names of 3 things. Can you tell me what they were? Language: o Show patient 2 simple objects e.g. watch and pencil, ask patient to name them Repetition: o Repeat the phrase ‘No ifs, ands or buts’ Complex commands...