Psychiatric history- Presenting complaint
- History of presenting complaint
- Reason for referral
- What is the main problem / Which problems are the worst?
- How has it affected you?
- Precipitants?
- When did you last feel well?
- Past psychiatric history
- Hospitalisations?
- Sections?
- Current treatment / care
- PMH
- Medications
- Social history
- Accommodation
- Finances
- Employment
- Support
- Drugs + alcohol
- Forensic history
- Family history (incl. psychiatric)
- Still alive / How did they die?
- Well?
- Occupations?
- Relationship with brothers + sisters
- Personal history
- Delivery + early development
- Schooling
- Teenage years
- Relationships with family
- Psychosexual
- Employments
- Premorbid personality
- Describe themselves before they got ill
Mental state assessment - Appearance and behaviour
- Describe to someone who's never seen them before
- Mannerisms, EPSEs, Posturing, Eye contact, Preentation
- Speech
- Form
- Quantity, Rate, Volume, Rhythm
- Content (quote if possible)
- Words, Meanings, Appropriateness
- Mood and affect
- Subjective vs Objective
- Mood (climate) vs Affect (weather)
- Sleep, Appetite, Libido, Psychomotor, Anxiety, Restlessness, Aggitation, Appropriateness, Congruence
- Thoughts
- Form
- Abnormal flow
- Flight, Crowding, Retardation, Circumstantiality
- Interrupted flow
- Passivity
- Withdrawal, Insertion, Broadcasting
- Content
- Delusions (Fixed, Unshakeable)
- Persecution, Grandeur, Religious, Control
- Judgement
- Paranoia
- Ideas + beliefs
- Reality
- Perceptions
- Sensory systems (all)
- Distortions (Still identified correctly)
- False perceptions
- Illusions (Mis-interpreted stimuli)
- Hallucinations (Absence of stimuli)
- Pseudohallucinations (Perceive thoughts or memories as voices)
- Cognition
- Level of consciousness
- Qualitative (vs Quantitative
- Twilight state, Perseverence, Confabulation, Fugue, Deja vu
- Insight
- Not absolute
- Treatment ideas
- Cultural factors
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