13.04.15 Assessment

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

      • Don't say "normal"

    • 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

        • Derailment, Blocking

      • 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