Comprehensive Psychiatric Assessment
- age, sex, source, reliability, marital status (single/common-in-law/married), ethnicity, culture/religion (optional), children, employment status, living situations)
Mode of Presentation (ie brought in by EHS? by police?)
HPI: pt’s current concerns – often require collateral info – family, friends, neighbors, police
- Onset, duration, frequency, Character, Intensity, associated events, provocative/palliative factors
Psychiatric symptom Screen
- Normalize symptoms before asking, eg. “some people tell me that when you watch TV, they get special message from God. Have you ever experienced something like that?”
Depression – M SIGE CAPS
- Interest – lost of interest (anhedonia)
- Energy – decreased
- Concentrate – unable to
- Appetite – loss of appetite
- Psychomotor retardation (“do you feel as if you are slowed down?”)
- Suicidal Ideation
Mania – DIG FAST
- Distractibility and easy frustration
- Impulsivity – Irresponsibility and erratic uninhibited behavior
- Grandiosity – esteem inflation
- Flight of ideas – racing thoughts
- Activity increased with weight loss and increased libido
- Sleep is decreased – insomnia
- Talkativeness – Pressured Speech
- “Do you ever see things or hear things that other people don’t see or hear?”
- “Do you ever feel as if something is crawling or creeping on your skin?”
- “Do you ever feel as if people are talking about you of laughing at you behind your back?”
- “Do you feel as if anyone or anything is out to get you?”
- “Do you ever get special messages while watching TV or reading newspaper that are intended especially for you?”
- “Do you ever get the sense that other people can read your thought or that thoughts are being inserted into your mind against your will?”
- Negative symptoms: flat affect, alogia, avolition
- disorganized speech
- Panic attacks
- “Are you ever bothered by persistent thoughts that you cannot get out of your mind?”
- “Do you ever feel the ned to repeat certain activities over and over again even though you don’t want to?”
- PTSD – recent traumatic event
Substance abuse / dependence: Tobacco? Alcohol? Drug use?
- What age did you start taking drugs?
- What was the first drug you tried?
- What is your drug of choice now? How much?
- Previous attempts to quit (ie. Detox)
EtOH: “tell me about your drinking?” CAGE
- Cut down: “Have you ever tried to cut down on your drinking?”
- Annoyed by criticism: “Are you annoyed by criticism about your drinking?”
- Guilty about drinking: “Do you ever feel guilty about drinking?”
- Eye-opener: “Do you ever need to drink first thing in the morning?”
Past psychiatric history:
- dx & Tx, age at onset, Current psychiatrist?
- past psychiatric admissions (#), most recent admission,
- past suicide attempts, ECT/LAI tx?
Family Hx: psychiatric illnesses, medical illnesses – pedigree
Social Hx: see psychosocial Hx
Born in: ___________(Where were you born and raised?)
- Were there any problems that you know of with your mother’s pregnancy or delivery?
- Did you reach developmental milestones on time?
Childhood?Include Family structure ( ie. Parents divorced/separated? # of siblings?)
- Whom did you feel close to while you were growing up?
- What was your family like?
- Was there any violence in your home?
- Did you encounter any abuse (verbal, physical, sexual)?
Schooling Years include grade completed? hx of bullying?
- When did you start school? Did you like school? Did you have any trouble in school?
- What were you like as a child? As a teenager?
Current living situation? Marital status? Kids? Relationship Hx? Sexual Hx?
- Do you have any children of you own? How would you describe your relationship with your children?
- How would you describe your relationship with your family now?
- Do you have any close relationship right now? Tell me about that.
- Are you or have you been married? How would you describe your marriage?
- Where do you live now? What is your home like?
Employment Hx and current status?
- Are you working right now? Tell me about your job or your trade?
- What kinds of jobs have you had in the past?
- What kinds of things do you do for fun?
- How satisfied are you with your life right now?
- Previous jail sentences? Criminal Record? Outstanding Charges?
Mental Status Exam – ASEPTIC
Appearance and Behaviour:
- Actual vs apparent age
- Attire, hygiene, makeup, jewelry, clothing, body habitus, distinctive physical features – physical abnormalities, tattoos/piercings etc
- Noting body language (elaborate hand gestures), mannerisms (lip smacking), attentiveness, psychomotor retardation / agitation, responding to cues in the room (VH/AH)
- Agitation, hyperactivity, akathisia, compulsions, tics, tremor
- rate and volume (loud, soft), how pt answers questions, tone – accent?
- Flow- pressured vs increased latency?
- Cooperation: eye contact, attentiveness to interview?, attitude/demeanour, secondary gain
- Mood – elicit the pt’s description of his mood – dysphoric, euphoric, anxious, angry
- Affect – range & stability, intensity (flat vs blunted, labile, full/wide range, inflated)
Perception – hallucination and illusion
Thought content and process
- Thought process/form – inferred from the pt’s speech – coherent? logical progressions? – linear, tangential, circumstantial, loose association, perseveration, flight of ideas, thought blocking, word salad, echolalia
- Thought content – delusions (erotomanic, grandiose, paranoid) vs overvalued ideas, obsessions, phobias, SI/HI
Insight & judgement
- Insight – document whether the pt has any insight into his illness
- does the pt recognized that something is wrong?
- Do they accept the problem is due to illness?
- Are they willing to accept medical advice regarding management?
- Judgement – ask pt to respond to some questions. Eg. “What would you do if you woke up in your home and found it to be on fire?”
- LOC, Oriented to person, place, time.
- MMSE, attention/concentration (spell WORLD backwards), calculations (serial 7’s), abstraction (proverb interpretation)
- OSCE and Clinical Skills Handbook – second edition
- The Edmonton Manual of Common Clinical Scenarios