Appearance
Observe the patient’s general appearance:
- Personal hygiene: are there any signs of self-neglect?
- Clothing: are they dressed appropriately for the weather/circumstances? Are clothes put on correctly?
- Physical signs of underlying difficulties: any self-harm scars or signs of intravenous drug use?
- Stigmata of disease: note any stigmata of disease (e.g. Jaundice).
- Weight: note if they appear significantly underweight or overweight.
- Objects: look around to see if the patient has brought any objects with them and note what they are.
Behaviour
Note if the patient appears engaged in the consultation and if you can develop a rapport with them.
- If they appear distracted or appear to be responding to hallucinations
- do the patients make eye contact?
- facial expression & if that’s appropriate for the topic of conversation
- Any abnormal movements/tics/restlessness
Speech
- Flow, tone and volume - rate and quantity
- Is it spontaneous?
- Comprehensive answers?
- Any tangential or circumstantial speech
- Mania is generally loud and all over the place, Depression quiet and
Mood
Subjective - how does person think about themselves
- “How are you feeling?”
- “What’s your current mood?”
Objective - how do you view the person?
- Whats their apparent emotion (affect)
- Fixed affect: the patient’s affect remains the same throughout the interview, regardless of the topic.
- Restricted affect: the patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.
- Labile affect: characterised by exaggerated changes in emotion which may or may not relate to external triggers. Patients typically feel like they have no control over their emotions.
- How intense is this affect?
- Does this agree with their thoughts
Affect - expression of emotions on face
Thoughts
Form - how do the thoughts connect together
- Tangental thinking?
- Go around the question rather than answering
- Flight of ideas - how quick do the thoughts change?
Content - what’s in the thoughts
- Is there a logical trail of thought
- Any obsessions/delusions/overvalued ideas?
- Suicidal thoughts?
Perception
Hallucinations - sensory experience without sensory input Illusion - misperceives a real sensory stimulus
Cognition
4-AT
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Do you know how old you are?
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What’s your date of birth?
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What’s the current year?
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Do you know where we are at the moment?
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Can you remember who I am?
Insight & Judgement
One of the most complex areas of psychiatry
- Does the person understand that they’re ill
- And if they understand this, do they believe that is related to a mental disorder
- And if they do do they think there’s ways to recover
Social history
Alcohol and drugs
- As if/how much they drink, how often, what they drink, with anyone?
- Do they take any recreational drugs
Social
- Who do they live with?
- Do they have a group of friends/support network
- Do they have any family nearby?
Risk
- “When things are difficult people can have thoughts about harming themselves and of suicide. Have you had these thoughts?”
- Any risk of Self Harm/harm to others/suicidal ideas or plans
- Protective factors - family, friends, pet
- Domestic violence and abuse?
- SAFEGUARDING