Appearance and behaviour

  • How does the patient enter the room?
    • quickly? slowly?
  • What is the patient’s attitude to the interview?
    • aggressive? reluctant? Can you build a rapport with them?
    • can you engage them?
  • Eye contact?
    • Do they make any? Is there too much? None at all?
  • Clothes
    • Eccentric? Clean? Mismatch – (inability to co-ordinate thoughts)
  • Facial
    • Tattoos (on the face high indication to mental illness, sign of past imprisonment, gang involvement) Scars
    • Facial expression
  • Psychomotor
    • unusual movements
    • agitation / retardation
  • General
    • tearful
    • anxious
    • overactive
    • underactive

Mood

  • Description
    • Elated (overly happy)
    • Dysphoric (very low)
    • Euthymic (normal)
    • Labile (constantly fluctuating)
    • Subjective – patient’s opinion of their mood and state
    • Objective – our opinion of their mood and state

Speech

  • Rate / Rhythm / Tone
  • Accent
  • Language
  • Form
  • Spontaneous?
  • Do they answer questions

 

Thoughts

Ask the patient to describe any preoccupations or worries:

  • Content
    • Can they form construct thoughts? Do they make sense?
    • Are there any thoughts they seem to be preoccupied with?
    • e.g persecution, health, weight
    • Interference: Insertion, withdrawal, broadcasting
    • Passivity phenomenon feels as if they’re being taken over.
  • Nature
    • Delusions : A false belief, which is firmly held despite contrary evidence and is out of keeping with the patient’s cultural or religious background.
    • Obsessions: A recurrent thought, impulse or image that enters the subject’s mind despite resistance.
    • The patient may realise that it’s not necessarily true but can’t resist thinking about it.
    • May be compulsive in nature
    • An overvalued idea: A belief not held quite as strongly as a delusion, and is typically more understandable.
  • Flow
    • The content may be normal but the flow (form) may not be : Formal thought disorder
    • flight of ideas, connections e.g. rhyming, do the ideas join together?
    • Suicide / self harm / harm to others
    • Future plans

 

Perceptions

Have you ever heard anything that other people couldn’t? Do things / people seem diffirent from normal.

  • Hallucinations: A perception experienced as real in the absence of a stimulus
    • Auditory (psychotic) – 2nd person (talking to them), 3rd person (talking about them)
    • Visual (acute confusional state)
    • Tactile
  • Illusions: A misperception e.g. seeing someone in the shadows when there is no-one there
  • Depersonlization: A feeling of detachment from the normal sense of self “ As if i’m acting”

Cognitive function

  • Mini mental state
  • Orientation – time, place, person
  • Show patient 3 items and ensure they have registered them – test recall after 2mins

Insight

  • Spectrum – fluctuates according to mental state
  • Are they aware of their behaviour
  • Do they believe they need treatment
  • Do they believe they have a mental disorder
  • Capacity

Formulation

Biological Social Psychological
Predisposing
Precipitation
Maintaining

 

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