Psychiatric History
Often an OSCE station. The below is a guide of a full
psychiatric history, but there is unlikely to be enough time in a 10
minutes to complete it. The best OSCE strategy is to ask questions to
get a feeling of the diagnoses, then to ask questions relating to this
diagnosis (the symptoms of the major psychiatric consitions are given
below) including the social impact. Once you have done that, keep
asking any of the below questions until you run out of time!
The Routine
Introduce
Be empathic
PC/HPC
-
-
Onset, duration, effect on life, events coinciding, solutions
tried
-
Depression
-
Suicidal thoughts, plans or actions
-
Psychosis: persecutory, delusions, hallucinations
-
Mania, obsessions/compulsions, anxiety, eating disorders
Present circumstances
Housing, finance, work, marriage, friends, religion
FH
Physical/mental health, relationship to family, personalities in family
Birth, growth, development
-
-
Stresses, hobbies, education
-
Jobs, Pychosexual: marriage, sex, orientation
-
Make friends easily? Stress?
PMH
Including psychiatric diseases
Psychoative substances
Forensic
I.e. criminal activities
Premorbid personality
Attitudes to self and others, moral/religious beliefs, predominant
mood ("how would other people describe you"), etc.
Mental state
-
General appearance & behaviour
-
Mode of speech
-
Mood
-
Beliefs
-
Unusual experiences or hallucinations
-
Orientation
-
Short-term memory
-
Long-term memory
-
Concentration
-
Insight
-
Rapport
Common Diseases
Depression
Divided in to core symptoms and "biological" symptoms.
-
↓Mood, anhedonia (lack of enjoyment), worthlessness/self-denigration, guilt, fatigue,
concentration
-
Biological: early morning waking, ↓apetite/weight,
↓sex, psychomotor retardation), suicidal intent.
Schizophrenia
-
Auditory hallucinations
, esp thought echo or 3rd
person commentary.
-
Thought withdrawal, insertion or
interruption
(delusions about external control of thought).
-
Thought broadcasting
(the delusion that others can
hear ones thoughts).
-
Delusional perceptions
(abnormal significance of a normal event ('the lights changed & I
realised I was the son of god')).
-
External control of
emotions
.
-
Somatic passivity
(thoughts,
sensations & actions are under external control).
-
Chronic
sx
: Activity, motivation, social withdrawal, emotional
flattening.
Anxiety
-
Restlessness, Fatigue, ↓concentration, Irritability, Muscle
tension (eg. trembling), Disturbed sleep.
-
Types: Panic disorder agoraphobia Post traumatic stress disorder,
OCD, Phobia, Social phobia, Acute stress disorder.
