This section only contains some brief notes that may help you take a psychiatric history. To develop your history taking skills beyond competency will require further self- directed learning, practice and supervision. This assessment will look at your ability to gather relevant information from a patient presenting with a common psychiatric disorder. You will not be expected to demonstrate a sophisticated clinical interview but be able to sensibly collect information on the relevant areas to allow for an accurate clinical picture of the patient’s presentation.
CHECKLIST FOR MSE 1. Appearance and Behaviour Appearance e.g. grooming, hygiene, clothing, physical health. Eye contact and facial expression. Attitude to situation and examiner e.g. hostile, withdrawn, seductive. Motor behaviour e.g. slowed down, restless, tremors, posture Any bizarre behaviour e.g. appearing to respond to hallucinations Assess the patient’s level of self- care (note any self neglect which may be associated with depression and dementia). Note any weight loss or signs of physical illness e.
PERFORM A COGNITIVE SCREENING ASSESSMENT You need to perform a brief but comprehensive cognitive screening test such as the Mini-Mental State Examination (MMSE) or Standardised Mini- Mental State Examination (SMMSE) either to be demonstrated in role-play with your supervisor or in interview with a real patient. There are two parts to the assessment: Firstly, you must demonstrate the verbal communication skills to complete task. This means you should be able to make all instructions readily understandable to the patient.
Risk assessment is an essential component of every psychiatric assessment. It is imperative that you ask specifically about each of the key domains of risk listed in the box below. Your trust is likely to have both a risk assessment protocol and mandatory forms that need to be completed on each client. Please take some time to familiarise yourself with both. In this section, we will only briefly cover the key domains of risk that you need to enquire about and then look a little more closely at assessing self harm as this is a common clinical presentation.