Psychiatric Assessment

 

Emergency

 

Hx

Ex

Ix

Mx

 

Index

 

 

  

 

Psychiatric History

 

HPI

PMH

 

Social

 

Family

 

 

  

Psychiatric History of Presenting Illness (HPI)

 

-  Anhedonia: depression

-  Panic attacks/Anxiety

-  Psychosis: schizophrenia

-  Delusions

-  Hallucinations

-  Mania/Hypomania: bipolar

-  Suicidal, homicidal: depression, psychosis, BPD

-  Involuntary admission

-  Sleep/appetite disturbance

-  Trauma: PTSD, depression, anxiety, substance abuse

-  Impaired functioning

-  Social, occupational, relatationship

-  Current Mx

-  Antidepressants, anitpsychotics, mood stabilisers

 

Premorbid Personality

-  Self-concept

-  Precption of how others see them

   

 

 

  

Psychiatric Past Medical History (PMH)

 

Past Psych Hx

-  Previous episodes of HPI

-  Past admissions

-  Out-pt or community Mx

-  Suicide attempts, self harm, homicide

-  Arrests, convictions

 

Co-morbidities

-  Other psychiatric illness

-  Substance abuse

-  Medical

-  Somatisation

-  Chronic or terminal illness: depression, anxiety, suicidality..

-  Neurological disease: head injury, PD, Dementia (AD..)

-  Endocrine disease

-  Cushings syndrome (anger, aggression)

-  Hypothyroidism (depression)

-  Medications, psychotherapy, hospitalizations

-  HIV/AIDS: dementia

          

 

 

  

Psychiatric Social & Personal History

 

-  Birth & early development

-  Pregnancy complications, planned pregnancy, premature, feeding problems, temperament, milestones

-  Childhood

-  Personality traits, behavioural traits, social relationships, phobias, bed wetting, play

-  Family: relationships, stability, violence

-  Abuse: physical, sexual, neglect

-  School

-  Adjustment, performance, disciplinary problems

-  Adolescence

-  Adjustment, sexual behaviour, delinquency, relationships, drug use

-  Education

-  Highest level, difficulties, social problems

-  Occupation

-  Job changes, satisfaction, time jobs held for, best job attained, relations at work (boss, workers), compare job w ambition, family expectations

-  Military history: PTSD

-  Menstrual Hx

-  Sexual Hx

-  Orientation, experiences, past partners, psychosocial problems, deviant behaviour, feelings about sex, impotence, libido

-  Marriage

-  Age, # times, behaviour patterns

-  Children

-  Number, attitude towards, health/issues, relationship

-  Social

-  Supports, group activities

-  Important people

-  Relationships: maintained, loner, follower, leader

-  Current social situation

-  Living situation, income, social environment, stability & happiness (marital, family)

-  Psychological stressors

-  Interpersonal disputes, role changes, disruption/lack of support

-  Forensic Hx

-  Convictions, imprisonments, anti-social behaviours

-  Drug & EtOH Hx

-  Substance use, misuse/abuse, dependance

 

 

 

 

  

Psychiatric Family History

 

-  At home: who, relationship

-  Role in family

-  Hx: suicide, depression, bipolar, schizophrenia

-  Substance abuse

 

 

 

 

 

Psychiatric Examination

 

 

Mental State Exam

Mini-Mental State Exam (MMSE)

 

 

 

 

Mental State Exam (MSE)

 

-  Appearance

-  Age, height, build

-  Grooming, hygiene, facial hair, body odour

-  Clothes: age/environ appropriate, casual, formal

-  Behaviour

-  Reacton to situation

-  Friendly, guarded, un-coperative, hostile, uncommunicative

-  Social manner

-  Eye contact, disinhibitions, over-familiar, withdrawn, guarded

-  Motor behaviour

-  Restless/akithisia (inability to stay sill due to inner need to move): antipsychotics

-  Tardive dyskinesia: antipsychotics

-  Mannerisms (odd, idiosyncratic method of performing a task, serving no particular function): schizophrenia

-  Stereotypy (repetitive or ritualistic movement, posture, or utterance): schizophrenia

-  Gesticulations, distractions

-  Tremor: PD

-  Psychomotor retardation: depression

-  Non-verbal communication

-  Speech

-  Dysarthria, dysphasia

-  Rate

-  Slow, latent, mute

-  Rapid: mania (bipolar)

-  Pressured: schizophrenia

-  Volume

-  Loud, whispered

-  Slurred: intoxication

-  Quantity & Quality

-  Tone: monotonous

-  Flight of ideas: mania (bipolar)

-  Poverty of speech: schizophrenia

-  Mood & Affect

-  Mood (pts description)

-  Euthymic (normal), elevated, depressed

-  Affect (Drs description)

-  Appropriate, inappropriate, flat

-  Restricted: depression

-  Blunted: schizophrenia

-  Incongrous: schizophrenia

-  Labile (excessive +/- mood incongruent): delerium, dementia, mania (bipolar)

-  Quality of communication

-  Depersonalisation (feel unreal, detached, numb)

-  Derealisation (external world is unreal, distorted or disfigured)

-  Thought

-  Stream

-  Declined: depression

-  Pressured: mania (bipolar)

-  Form

-  Quantity & Rate

-  Poverty of ideas: schizophrenia

-  Slowed: psychomotor retardation (depression)

-  Vague

-  Concrete (no abstraction, literal): schizophrenia

-  Logical order

-  Flight of ideas: mania (bipolar)

-  Derailment, knights move, loose association: schizophrenia

-  Circumstantiality (eventually gets to the point)

-  Thought blocking

-  Punning, word salad (incoherent), clanging, neologisms (creating words): schizophrenia

-  Content

-  Major topics

-  Delusions (fixed, false beliefs inconsistent w subculture): psychosis

-  Reference, control, persecutory, erotomanic, passivity, somatic passivity: schizophrenia

-  Grandiosity: bipolar, mania

-  Nihilistic: depression

-  Over-valued ideas

-  Obsessions, compulsions, preoccupations

-  Phobias

-  Suicidal or homicidal ideation

-  Perception

-  Hallucinations (false perception wo external stimulus): psychosis

-  Auditory: psychosis (schizophrenia), frontotemporal

-  Visual: delerium, frontotemporal dementia

-  Meds: ketamine

-  Illusions (distorted perception of real stimulus): DT

-  Cognition

-  General knowledge: Prime Minister..

-  MMSE: dementia

-  Memory

-  Concentration (serial 7s, WORLD..)

-  Orientation (person, place, time [MMSE])

-  Abstraction

-  Similarities

-  Apples v oranges

-  Bus v plane

-  Poem v sculpture

-  Proverbs

-  A rolling stone..

-  Too many chiefs

-  Glass houses

-  Clock face

-  Neuropsychiatric testing

-  Judgement

-  Rational, logical, impaired

-  Insight

-  Poor, excellent, limited 

 

 

 

 

Psychiatric Investigations

 

Path

Imaging

Proc

Micro

 

 

 

 

Psychiatric Management

 

General

Meds

Surgery

Proc

 

Acute Behavioural

Management