Psychiatry at a Glance

Cornelius L. E. Katona, Claudia Cooper, Mary Robertson

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781119129684
• Edition: 6
• Topic: Medicine
• Subtopic: Psychiatry & Mental Health

Psychiatry at a Glance is an up-to-date, accessible introductory and study text for all students of psychiatry. It presents 'need-to-know' information on the basic science, treatment, and management of the major disorders, and helps you develop your skills in history taking and performing the Mental State Examination (MSE). This new edition features:
•Thoroughly updated content to reflect new research, the DSM 5 classification and NICE guidelines
•All the information required, including practice questions, for the written Psychiatry exams
•Extensive self-assessment material, including Extending Matching Questions, Single Best Answer questions, and sample OSCE stations, to reinforce knowledge learnt
•A companion website at ataglanceseries.com/psychiatry featuring interactive case studies and downloadable illustrations Psychiatry at a Glance will appeal to medical students, junior doctors and psychiatry trainees, as well as nursing students and other health professionals and is the ideal companion for anyone about to start a psychiatric attachment or module.

Part 1
Assessment and Management

Chapters

1. 1 Psychiatric History
2. 2 The Mental State Examination
3. 3 Diagnosis and Classification in Psychiatry
4. 4 Risk Assessment and Management in Psychiatry
5. 5 Suicide and Deliberate Self-harm

1
Psychiatric History

---

An example psychiatric history

Introduction and presenting complaint: Mr John Smith is a 36-year-old Caucasian man, a mechanic, admitted to Florence Ward three days ago after police detained him on Section 136 for acting bizarrely in the street. He is now on Section 2. He thinks his neighbours are plotting to kill him.

History of presenting complaint: Mr Smith last felt free from worry four months ago. Since witnessing his neighbour staring at him, he has believed this neighbour and his wife are intercepting his mail, using a machine so no one can tell that the letters have been opened. He sees red cars outside, which he thinks the neighbours use to monitor his movements. After an altercation on the street three days ago in which he accused these neighbours of pumping gas into his flat, he has believed that they want to kill him or force him to move out so that they can purchase the property. He denies low mood. He cannot rule out the possibility he might defend himself against the neighbours but denies specific plans to retaliate. He denies hearing the neighbours or others talking about him or feeling that they can control him or his thoughts. He has been sleeping poorly. His appetite is reasonable.

Collateral history: Mrs Smith confirmed that her husband had been very preoccupied for the past month with worries about the neighbours intercepting mail and pumping gas into the flat. She witnessed the recent altercation in which her husband was verbally but not physically aggressive to the neighbours. The neighbours are a retired couple who are polite and considerate. Mr Smith has become withdrawn, staying mostly in the kitchen, the only room he believes is ‘safe'. He has been hostile to his wife at times this week, which is unusual. This occurred when she questioned his beliefs. He has never threatened her or their daughter.

Past psychiatric history: Mr Smith has seen a psychiatrist once before, aged 8, when he was diagnosed with ‘emotional problems'. His GP diagnosed depression when he was 24 and prescribed fluoxetine, which he never took. He believes he was depressed for a couple of years in his mid-20s but denies mental health problems since then. No previous psychiatric admissions. He has never taken medication for mental illness.

Past medical/surgical history: Mild asthma. Nil else of note.

Drug history and allergies: No current medication. No known allergies.

Family history: When Mr Smith was 28, his father died from lung cancer aged 60. His mother and brother, who is eight years younger, live nearby. Both are well, in regular contact and supportive. No known family psychiatric history.

Personal history – early life and development: Normal vaginal delivery, no known complications, no developmental delay. Mr Smith lived in the same house in Doncaster throughout his childhood. His father was a shopkeeper, and his mother a housewife. His parents were happily married, and there were no financial problems at home. No childhood abuse.

Educational history: Mr Smith left school at 16 with five GCEs. He had good friends from school. He was often in trouble with his teachers; he was suspended once for cheating in an exam but was never expelled.

Occupational history: On leaving school Mr Smith worked in the family plumbing business for a few years, then trained and worked as a mechanic. He has never been sacked and has been in his current job for three years. He has been on sick leave for the last two weeks because of ‘stress'.

Relationship history: Happily married for 10 years. He has one daughter, aged 5, who is well.

Substance use: Mr Smith drinks 30 units of alcohol a week, mainly wine in the evenings. There is no history of alcohol dependence. He has used cannabis regularly in the past (aged 16–28) but no illicit drug use since this time.

Forensic history: Conviction and fine for driving without due care aged 21. No other arrests or convictions.

Social history: Mr Smith owns his three-bedroom detached house. He usually sees his mother, brother and work friends regularly, but not in the past month. No current financial difficulties.

Premorbid personality: Mr Smith described himself as a sociable, calm person who thought the best of people and didn't tend to get into disputes with others until his current difficulties. He is a keen cyclist and member of a local cycling club.

---

The psychiatric history and mental state assessment (discussed in Chapter 2) are undertaken together in the psychiatric interview. This is a critical time for establishing rapport as well as systematically obtaining this information. In this chapter and the next, we present a format for written documentation; greater flexibility is clearly required during the actual interview. Y...