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The Psychiatric History:

1. Identifying information:
- Socio-demographic summary
- Name
- Age
- Marital status
- Living arrangements
- Occupation or how do they support themself?
- Voluntary or involuntary patient
2. History of Presenting Complaint:
- Symptoms
- Onset
- Duration/course
- Precipitants
- Exaggerating/alleviating factors
- Impact of illness of patients social, occupational, financial functioning
- Note current and previous treatment (dose and duration)
3. Psychiatric review of systems:
- Depression:
o Mood
o Energy or psychomotor disturbance
o Interest or enjoyment
o Motivation
o Appetite/weight change
o Sleep disturbance
o Hopeless/helpless themes and guilt
o Indecisiveness or poor concentration
o Suicidal ideation
- Mania: (now or in the past)
o Particularly happy or elevated
o Decreased need for sleep
o Grandiosity
o Pressured speech, flight of ideas or racing thoughts
o Distractibility
o Increase in goal-directed activity or psychomotor agitation
o Excessive involvement in pleasurable activity with high potential
for painful consequences
- Psychosis:
o Ideas of reference: t.v. or radio talking specifically about you?
o Hallucinations: hear voices when no-one is around?
o Paranoia:
Feel like people are taking particular notice of you?
Feel that someone might want to hurt you?
Difficulty concentrating
o Negative symptoms: lack of motivation, low mood etc
- Anxiety:
o Feel worried or nervous about everyday things or going out in
public places?
o Heart racing, shortness of breath, sweaty etc
o Particularly concerned about a particular thing or things (OCD)
4. Medical History

- Current and past medical conditions


- Current and past treatment
5. Personal history of psychiatric disorders and treatment:
- Details of previous episodes of illness
- Previous psychiatric admissions/treatment
- Outpatient/community treatment
- Suicide attempts/drug and alcohol abuse
- Interval function (what is the patient like between episodes when
well)
6. Family history of psychiatric disorders and treatment
7. Personal history:
- Prenatal/birth history
- Childhood
- Adolescence
- Adulthood:
o Educational
o Occupational
o Interpersonal/social
o Sexual
o Drug and alcohol use
o Marital history
o Children
o Leisure
o Forensic history

The Mental State Examination:


1. General appearance and behaviour:
2. Speech:
3. Affect and mood:
a. Quality
b. Range
c. Appropriateness
d. Assessment of suicidality
4. Thought:
a. Stream
b. Form
c. Content (obsessions/delusions)
5. Perception
a. Hallucinations/illusions
b. Depersonalisation
c. Derealisation
6. Cognition
a. Level of consciousness
b. Orientation
c. Concentration
d. Memory
e. Intelligence
Note: can just say not formerly assessed
7. Judgement
8. Insight
9. Rapport

OSCE Stations:
1.

You are a registrar working at a general psychiatric ward assessing a new


patient in the clinic. He is a 21 year old man who has a 2 month history of
social withdrawal, problems with sleep and concentration and a decline in
his academic functioning. There is also a history of personal decline. You
have taken a history and have reached the point in the mental state
examination where you need to elicit perceptual abnormalities.

2. Mr Da Silva, a 19 year old man with a 3 month history of social withdrawal


has been referred to you by his GP. His parents have noticed that there
has been a gradual decline in him socialising and he is more or less
confined to his room. They have noticed that he is paranoid at times.
You have taken a brief history and have reached the stage in the mental
state examination where you need to elicit any abnormalities in his
thinking.