1
Q
Alcohol Use
A
- Could you please talk me through how much you’re drinking per day? (Ideally work out the units per week)
- Any more on the weekend?
- How long have you been drinking this much?
Dependency
- Difficult to control the amount you drink after you have started?
- Craving drinks in between sessions?
- Needing to drink more over time to get the same effects?
- Get sweats and shakes if you miss a drink or first thing in the morning?
- Does it worry you that Alcohol may be causing you some harm?
- Is alcohol taking increasing priority over other things in your life like leisure activities/friends etc.?
Impact
- Who is at home with you? Does it affect your relationship with your wife/children? (DV)
- Does it affect work?
- How are finances?
- Trouble with police?
- Driving?
- Physical health consequences?
2
Q
Anxiety (GAD/Phobias) - (detailed)
A
- Have you been feeling particularly anxious recently?
- Would you describe yourself as an anxious person?
- Any clear precipitating event/cause?
- Do you worry about things you should not worry about?
- How long have you been feeling like this? (>6 months for GAD)
- Do specific situations or thoughts trigger anxiety?
- Social - centre of attention? doing something embarassing? fear of public speaking?
- Agoraphobia - not being able to escape from a situation? Crowds? Specific environments?
- Specific phobias?
- Are there situations you avoid due to anxiety?
- Do you feel anxious all the time or does it vary?
- What symptoms do you have when you are anxious? How does it feel?
- Do you feel jittery/irritable/on edge?
- Do you have panic attacks (sudden onset, 30-60mins, impending doom and +++ physical symptsoms)
- Do you use alcohol or drugs to manage your anxiety?
- What impact is it having on your life?
- What is your sleep like?
- Do you have difficulty concentrating?
- Screen for depression/suicidal thoughts/trauma/OCD
3
Q
Anxiety - OCD
A
Obsessions
- Do you have thoughts or worries that keep bothering you?
- Do they keep coming into your mind even if you try not to think about them?
- How much of your time is occupied with obsessive thoughts?
- How do they make you feel? Do they distress you?
- How much control do you have over them? Can you resist them or distract yourself?
- Where do these thoughts come from?
- Are they true?
- What do you do to manage the anxiety they cause?
- How much does this interfere with your ability to get on with your life?
- Do you avoid any situations because of them?
Compulsions
- Do you every spend time doing the same thing over and over again?
- Do you have any mental rituals to neutralise bad thoughts?
- How frequently and for how much time?
- What purpose does it serve? Does it make you feel less anxious? Is it linked to a specific thought?
- Do you try to resist doing these rituals? Can you control doing them?
- What happens if you do not do them?
- How much do these interfere with your ability to get on with your life?
- Would you say you have always been an obsessive person?
- Are you a superstitious person?
- Hoarding? Lucky numbers?
- Screen for substance use/depression/suicidality
4
Q
Anxiety - PTSD
A
Intrusion symptoms:
- Could you describe the event? (ask first if this is okay or too difficult)
- How often do you think about it?
- Do thoughts about it come into your mind intrusively when you don’t want to be thinking about it?
- Do you have nightmares about the event?
- Do you have flashbacks of the event?
- Do you ever relive the event?
- Do you have difficulties remembering the event?
Avoidance:
- Do you find yourself avoiding places/people/activities associated with that memory?
- Have you been back to the place where the event took place?
- How hard is it to talk about the event?
Alterations in arousal:
- Since the event do you feel more on edge much of the time?
- Are you easily startled?
- Have you been feeling irritable?
- How is your sleep?
- How is your concentration?
Cognition and mood:
- How has this affected your life?
- How does it affect how you feel? Do you ever feel numb?
- How have your relationships been effects?
- How do you see the future?
- Do you feel guilty for what happened?
- Has your interest in activities been affected?
5
Q
History Following Self-Harm Attempt
A
- Can you tell me what happened?
Before
- How long have you been planning this?
- What preparations did you make? Did you buy things for the act? Did you put your affairs in order?
- Did you tell anyone about these thoughts?
- Were you alone at the time? Did you do anything to make sure you wouldn’t be interrupted?
During
- What did you do?
- If tablets - how many? of what? everything they had?
- Did you take any alcohol or drugs before or during the event?
- What did you think would happen? Did you expect to die?
- Did any part of you want to live
- How were you discovered? Did you seek help youself?
Now/Future
- How do you feel about what happened?
- Do you regret anything?
- Has anything changed for you between now and then?
- How do you see the future?
- Do you plan on doing something like this again?
- If not what will happen if x trigger occurs again?
Risk
- Have you ever tried to harm or kill yourself before?
- Have you ever been seen for a mental health problem by a professional?
- History of depression?
- Do you have anyone who you can talk to about your worries? Who is at home with you?
- Is there anything going on in your life that is causing you a lot of stress/worry? Relationships/finances/work/health?
- Screen for depression/substance misuse
6
Q
Behavioural and Psychological Symptoms in Dementia - Assessment
A
- Start with open questions
- Existing diagnosis? History?
- Onset and progression?
- Trigger/link with anything>
- ABC of behaviours
Differentials
- Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers?
- Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself?
- Medication - any recent changes to medication?
- Environmental - any changes to staff, routine, activities, visitors?
7
Q
Wandering History - Dementia (Carer)
A
- When did this begin?
- How many episodes?
- Getting more frequent?
- Daytime/ night-time?
- Does she go for a walk every day?
- Where does she go? Same place? Doing what?
- Drinking/spending lots of money?
- Who has been bringing her back and at what time?
- Medical history?
- Medications?
- Risks:
- To self - Crossing roads/falls
- To others - Agression to others/disinhibition
- From others - Exploitation by others including carers
- Neglect - not taking medications? Eating and drinking? Exposure?
8
Q
Dementia - History Taking
A
- Onset of problem, any trigger, progression - gradual or stepwise?
- 5As - memory, skills, disorientation, speech, personality
- Memory
- Misplaces things?
- Forgets appointments?
- What about the past?
- Disorientation:
- Muddled up with day and dates?
- Gets confused at times?
- Difficulty recognising people?
- Speech:
- Difficulties word finding?
- Able to follow conversations?
- Memory
- Differential:
- Low in mood before the onset of problems? (pseudementia due to depression)
- Visual hallucinations? Movement difficulties? Falls? Fluctuating? (suggests LBD)
- Cardiac risk factors - HTN, diabetes, hypercholesterolaemia, CVD? (suggests vascular)
- Increased apathy? Impulsivity? Irritability? Insight? - (suggests frontal lobe)
- Impact on functioning?
- What is he having difficulties with?
- Dressing, washing/toilet, walking, shopping, cooking, transport, finances?
- What is he having difficulties with?
- Risk
- Are there concerns about his behaviour?
- Risk to self:
- Episodes of wandering
- Falls
- Accidents due to fire/flooding at home?
- Risk to others:
- Episodes of aggression?
- Risk from others:
- Risk of exploitation/abuse by caregivers
- Physical health
- Past psych history
- Medications
- Drugs/ETOH
9
Q
Mini Mental State Examination (MMSE)
A
- Orientation:
- Year, season, month, date, time
- Country, town, district, hospital, ward
- Registration:
- I would like you to remember three objects and repeat them to me immediately, then again in 5 minutes:
- Apple, table, penny
- I would like you to remember three objects and repeat them to me immediately, then again in 5 minutes:
- Attention and Calculation:
- Can you spell the word WORLD for me?
- Could you spell it backwards?
- Recall:
- Please repeat the three words I told you earlier back to me
- Language:
- Please name the objects I point at (pen, watch)
- Please repeat the phrase: ‘no ifs, ands or buts’
- Please follow my instructions (three stage command):
- Place the index finger of your right hand on your nose, on your forehead then on your ear
- Can you please read this sentence and do what it says: write ‘close your eyes’ on a piece of paper.
- Could you give me a sentence with a subject and a verb
- Copying:
- Draw two intersecting pentagons and then ask patient to copy
Scoring:
24-30 = no cognitive impariment
18-23 = mild cognitive impairment
0-17 = severe cognitive impairment
10
Q
Delerium - Assessment
A
- Clarify presenting complaint
- Onset and duration?
- Fluctuating with time of day?
- Aware of surroundings?
- More alert or subdued?
- Possible causes:
- Any underlying medical conditions?
- Seen recently by GP
- Any new medications
- Elimination
- Complaints of constipation?
- Difficulties PU? New odour, pain or increased frequency?
- Comorbid psychiatric symptoms
- Mood over the past 2 weeks?
- Decreased interest in doing things recently?
- Changes in appetite or sleep?
- Responding to things that aren’t there?
- More suspicious than usual?
- Risk:
- More agitated than usual?
- Done anything to risk harming himself or others?
- Wandering?
- Underlying memory issues:
- Prior to onset of confusion how was memory?
- Issues with short term memory? Long term?
- Word finding difficulties?
- Not orientated to time?
- Not recognising people?
- Prior to onset of confusion how was memory?
- Functioning and ADLs?
- Grooming, dressing and finances?
11
Q
Behavioural and Psychological Symptoms in Dementia - Assessment
A
- Start with open questions
- Existing diagnosis? History?
- Onset and progression?
- Trigger/link with anything>
- ABC of behaviours
Differentials
- Organic causes - intake and elimination, pain, new complaints/unwell, recent falls, fevers?
- Psychiatric - changes in mood? irritability? emotional lability? anhedonia? actively responding or talking to himself?
- Medication - any recent changes to medication?
- Environmental - any changes to staff, routine, activities, visitors?
12
Q
A
13
Q
ADHD - History Background
A
- Age?
- Current education?
- Onset of problems? How long for? (ADHD >6 months and onset before age of 7)
- Birth/developmental issues?
14
Q
Tics - Assessment
A
- Age?
- Known to CAMHs?
For both motor and vocal
- Description
- Motor where? simple or complex?
- Vocal what? simple (sounds) or complex (words/phrases)
- Onset? Any indentifiable event linked?
- Frequency and severity
- Duration? Periods free and for how long for?
- Triggers/exacerbators?
- Obscene gestures of words (copropraxia/lalia)
- Any funny feelings before tics?
- Able to consciously suppress?
15
Q
Autism Assessment - Core Symptoms - Abnormal Reciprocal Social Interactions
A
- Do they make eye contact when being spoken to?
- Reciprocates when hugged?
- Does he come to you when hurt?
- Able to make friends with other children?
- Can he play games and share toys with other children?
16
Q
Autism Assessment - Core Symptoms - Communication Problems
A
- Any difficulties using language?
- Able to sustain a conversation?
- Delay in speech/first words?
- Tends to repeat things?
17
Q
Autism Assessment - Core Symptoms - Restricted, stereotyped or repetitive behaviour
A
- Any unusual interests?
- Any unusual interactions with toys?
- Able to have imaginative play?
- Does he do anything repeatedly?
- Any rituals?
- Repetitive movements? e.g. hand flapping
- How does he react to changes in his environment/routine?
- Sensitivity to certain stimuli?
18
Q
Autism Assessment - Developmental History
A
- How was the pregnancy? Any complications before/during/after?
- Did he meet developmental milestones?
- When did he first smile, turn over, crawl, sit and walk?
- Any skills he used to have he has now lost?
- Any unusual physical characteristics?
- Past medical history? Any history of seizures or head injury?
- Has he had his hearing and vision checked?
19
Q
Autism Assessment - Comorbidities
A
- How has mood been recently? Any loss of interest in things he used to enjoy?
- Any things he is specifically afraid of?
- How has sleep and appetite been?
- Any agressive behaviour to others? Any self-harming behaviour?
20
Q
Conduct Disorder - Assessment D
A
Defiance
- Frequently argumentative?
- Violated set rules by adults?
- Staying out after dark? Running away? Truanting?
- Evidence of stealing?
- Involvement in any crimes?
- Relationship with peers?
21
Q
Conduct Disorder - Assessment Core AVD
A
Aggression/violence
- Getting into fights?
- Physically agressive to others?
- Sexually coercive?
- Cruel to others/animals?
Destruction of property
- Any incidents of deliberately destroying things?
22
Q
Conduct Disorder - Assessment Risk Factors
A
- Family history of mental health problems?
- Crimes/substance use in family?
- Financial situation at home?
- Severe physical/verbal punishments when growing up?
23
Q
Conduct Disorder - Differentials/Comorbidities
A
- How has mood been recently? Any loss of interest in normal things they used to enjoy?
- Any evidence of increased anxiety?
- Can they focus on things? Are they always on the go? Do they interrupt a lot?
- Problems during infancy/growing up?
- What was previous academic perfomance like? Always struggling? Paricular areas?
- Any possibility using alcohol or drugs at the moment?
24
Q
Conduct Disorder - Follow-Up Qs
A
- Impact - at home, at school, socially, bullying?
- Past psych history
- Past medical history
- Medication
CASC 3
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