Psychiatry History & MSE Guide for Interns Rotation at the

Department of Mental Health & Behavioral Sciences

AFP Health Service Command - V Luna Medical Center 2020mjl

Check your lighting, proximity to camera and angle (face occupying approx. 1/3rd of screen)
Kindly remind the facilitator of the activity that the screen of the laptop used by the patient can
be adjusted approximately at eye level of the patient, similar to a “face to face” encounter
Greet –“Sarge Surname”, with a clear, polite voice, establishing good eye contact*
Introduce yourself with confidence, as rehearsed from practice and simulation
Explain further that this activity allows the department staff to review the circumstances of their
admission and check up on the patient, this is also one of your tasks & rotation responsibilities
Ask if you may call the patient by his /her name, aside from just “Sarge” *

I. GENERAL DATA
name*:_______________________________________ nickname_______ age: ___ sex:* ____ cs*:________
date of birth: ________ religion: ____________ highest educational level: ______________ yrs in service: ___
position/ job description*:________________________________ unit assignment _______________________
address: _________________________________________________________________________________
reliability ( remember to score this at the end your interview)

II. CHIEF COMPLAINT (patient’s own words):

PRE-MORBID STATE: (known to friends as - general attitude, reputation, social activities, interests, before HPI)

III. HISTORY OF PRESENT ILLNESS

(maximize 10-15 minutes just with the HPI more points designated here and for your MSE)
Guide Q’: Sgt, Puede mo ba ikuwento yung mga nangyari, kaya kayo naadmit sa V Luna?
Simulan nyo po ang kuwento dun sa palagay nyo
- try to look for a stressor that the patient may have encountered just before he/she noticed the start of symptoms
- when a symptom is mentioned, like hearing voices, having anxiety/panic attacks, being irritable
ask to describe the symptom in detail, follow PQRST, Precipitating (is there a pattern of occurrence),
Quality (description), Radiation (to any body part, manifest with any/any other bodily sensation, if auditory is
it perceived as external or internal), Severity (level of disturbance tolerable, moderately to severely disturbing,
Temporal (duration & frequency), Relieving (does the symptom go away spontaneously, lasting for a
few seconds or minutes? Or lasts for hours, or more? ask for his THOUGHTS about this, ask how he
FELT, what does he /she DO about it? (confide, pray, engage in drinking, smoking, ignore)
- if consult was done, meds taken, ask for the dose, how long the meds were taken, what was this substance
for according to patient, ask if he thought it had any effect?
- ask for socio-occupational impairment is he still able to concentrate and perform – work, are important
relationships -family affected? when in the history did you notice that work /relationships seem to be affected?
Are symptoms worsening or more or less the same during the rest of the History
- ask for what he knew what friends or family were saying about patient’s behavior,
- explain what happens between intervals of your HPI, persistence, worsening, waxing & waning, on and off
Symptom clustering guide also used for pertinent negatives
 delusions  anxiety  depressed  mood is elevated
 hallucinations  restlessness  sleep disturbance ( )*  distractibility
 disorganized speech  tense muscles  interest lacking  irresponsible behavior
(incoherence, derailment) (anhedonia) (buying sprees, hypersexual)
 disorganized behavior  irritability  guilt feelings  grandiosity
 negative symptoms  fatigue  energy decreased  flight of ideas
(anhedonia or blunted affect)
 worrying (xcs & gen)  concentration decreased  activity ( in goal directed)
 traumatic experience  panic attacks  appetite change (wt  )  sleep ( need for sleep)
 re-experiencing / int thoughts  palpitations  psychomotor changes  talkativeness
 avoidance  chest pain  suicide “manic episode”
 unable to function (ISOF)  DOB/SOB  violence - tendency to Insomnia
 month duration  nausea/abd distress to hurt others Initial – onset delayed
 arousability/reactivity- hv, esr  sweating  homicide Middle – intermittent, broken
 negative alteration in  shaking/ tremors Terminal – waking up too
“depressive episode”
cognition & mood) early & cannot sleep
 depersonalization  fear of going crazy Non-restorative sleep
 derealization  fear of dying/heart - subjective experience sleep
attack Other negative symptoms is not restorative
Delusions: paranoid, Avolition
Persecutory, reference,  obsessions Asociality
Grandiose, erotomanic  compulsions Alogia

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 1
 IV. PAST PSYCHIATRIC (description of past psychiatric symptoms that lead to consult, dx, OPD treatment &/or hospitalization)
& PAST MEDICAL/SURGICAL HISTORY (previous hospital admissions, surgical operations, history of head trauma,
loss of consciousness, seizure, allergies, medications taken)
eg. ” 2008 Gouty Arthritis on celecoxib 200 mg PRN
2010 S/P Appendectomy UE
No previous history of psychiatric illness,
No known allergies to food, substances such as dust, pollen, antibiotics

V. FAMILY HISTORY (HPN, DM, CAD, Asthma, GERD/PUD, Colon CA, CA, thyroid, seizure,
mental illness* developmental disorder , substance abuse)
Guide Q’s: … dun sa magulang mo, mga kapatid (o ibang mga kamaganak), mayroon ba ..HPN, DM..mental illness
Eh yun kayang na depress, o may gumugulo sa isipan .. yun nagkaroon din ng kundisyon sa mental health?
Ah e yun naman nalulong kaya sa bisyo, labis na paginum ng alak o gumamit ng panglibangan (trip) na gamot?

VI. SUBSTANCE USE / ABUSE - if not significant may reflect sa report only underlined parts
Smoking
Age started smoking. How many cigarette sticks or packs per day, in a week? On stressful days?
your thoughts on that? Do you think you can cut down or stop, or you are ok with that?
Alcohol
Age started drinking.. beer, gin, bottles per day, times per week, do you drink with friends, alone,
maximum consumption? effects of intoxication, … naaksidente, napaaway minsan..
do you do things but the following day believe you cannot remember some things that you did?

“CAGE questions”, Have you felt the need, attempted to Cut down on your intake,
felt Annoyed of criticisms about your drinking ,
had Guilt feelings, had an Eye opener – experiencing “tremors”

Prohibited Drugs (marijuana, metamphetamine, cocaine, ecstacy, others)

Guide Q: Minsan ba Sarge, noong nagaaral ka ba, o bago pumasok sa serbisyo, nabarkada o nacurious, ay
nakatikim / gamit ka ba ng MJ o shabu o iba pang mga recreational (pinagbabawal) na gamot (candid face)

- note Duration, Route of admin, Amount, Pattern of use, Effects

D: How long been using , just 1-2x , months, years? R: Oral, inhalation, injection, mix? preferred, why?
A: How many consumed per session? P: Use mostly with friends, alone, mostly with friends or alone
E: High, tripping, gutom, hangover, naapektuhan concentration,

VII. HISTORY OF PSYCHOLOGICAL TRAUMA

(previous physical, psychological, sexual abuse, near death experiences, vehicular accident,
near drowning experience, etc., may include witnessing of traumatic experience of others)

VIII. FAMILY PROFILE

(indicate relationship & “nick name”.. e.g. Father “Pa” , for siblings start with the eldest then end with
youngest, insert patient’s name, accdg to birth order in the table. Under last column indicate patient’s
closeness to members, but do not accept answers like” close ako sa lahat.” (closest among siblings with whom?)
Ask patient to describe “living conditions” then with family of origin.
If with spouse & children insert after the youngest sibling.) Put an astrerisk (*) in the 1st column, names of those who
are staying in the patient’s current home

Relationship to Age/ indicate closeness to patient, reason, description

occupation (closeness to patient among parents, among siblings),
patient & nickname Sex briefly ask why patient thinks this is so
Primary family (family of origin)
Closer to Father, compared to mother
Father “Papa” Farmer
“kasama uminum, maraming similarities”
Mother “ Ma” housewife Dislikes patient’s wife, “maasikaso”
Less close to eldest brother
Eldest “ Kuya Jo” CPL PA
“di masyado naguusap”
Patient (2nd of 3 ) - -
Closest to sister among siblings.
* Sister “Nene” teacher
“mas naiintindihan nya ako”
Nuclear family
* Wife – “babe” tindera “Ok naman kame ni hon”, Masipag sa tindahan at bahay
* Son –“bunsoy” Grade 1 Only child, “mabait”

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 2
 IX. DEVELOPMENTAL & SOCIAL History

1. Prenatal & peri-natal hx:

planned or unplanned, wanted pregnancy:
age of mother during pregnancy delivered born full term/premature , via NSVD / CS, by hilot, midwife at home,
lying in , hospital, with or with no feto-maternal complications,

mother had (regular/irregular/no) prenatal check ups, (regular/irregular/no) intake of meds MV,
maternal illness recalled (UTI, trangkaso) during pregnancy, Is your mother a smoker alcoholic drinker?
Is it possible that she may have taken these substances during her pregnancy ?
(did your mom have problems conceiving a child before with your siblings? If then GPTPAL)

2. Early childhood (0-3)

primary caregiver is the mother / maternal deprivation?
breast-fed or bottle-fed, weaning with “am” or rice porridge (~6mos),
language and motor development if at par with age as compared to others of his/her age then
no problems in eating or sleeping then

3. Middle childhood (3-11years old):

toilet trained: should be ok by 4 y/o, attitude of parents, feelings about it,
ask for memorable preschool & grade school experiences, patterns of play, with classmates and neighbors
problems in adjustment to going to first days of school or just had few days of anxiety:
id school (gradeschool) & personality then: shy, withdrawn, active, restless, friendly, patterns of play
primarily from whom do you think you patterned conscience (right from wrong from)? Priorities as a child?

Who is the main disciplinarian, what method (verbal, palo, stick, belt, slippers) mostly used then?
What would you say are some of the worst you have experienced (locked in cabinet, sack, binugbog etc..)
What did you do then, why was this done to you?
How about parents acknowledging your talents /accomplishments? Need to p

<this section can be in middle childhood and /or adolescence, cut n paste if needed>
Age of masturbation, beliefs & feelings about it, attraction to opposite and same sex, orientation
Acquiring sexual knowledge, witnessing coitus in household, actual sexual abuse

No head bumping/ banging, rocking, night terrors, temper tantrums. Bed-wetting/soiling (~5) up to what age?

4. Prepuberty through adolescence (12-18 years old)

What school did you go to (high school)? Main activities / experiences you recall during high school?
Describe yourself as a student, average, top of the class, delinquent? Often a leader or a follower?
Who did you look up to then (can be two or more)? Why so?
Other experiences of special interest? (barkada, ML, fraternities, gangs, church group, activist group)
Copying assignments, copying during quizzes, other forms of cheating, running away, cutting classes,
Religious /spiritual beliefs, influences? (can be included in young adulthood esp if there is change in adulthood)

Relationships and sexual background (How many girlfriends, how short/long relationship, beliefs about
relationships in adolescence, why did the relationship not last work out, who ended the relationship, why
1st kiss, 1st coitus if not yet then ask in young adulthood), what were his/her beliefs about relationships then
adolescent emotional /physical problems: nightmares, recurring distressing dreams, phobias, bed-wetting,

5. Young adulthood (late teens or 20’s to 30’s) - Middle adulthood and old age (40’s to 60’s) / “Adulthoood”
Occupational History
- jobs prior to joining the military, and duration, relationship with others and with superiors
- like or dislike about previous work
Marital & Relationship History
- age of marriage, pregnancy before marriage, considered abortion, common law marriage,
attitude in raising children, planning & contraception,
housing difficulties, sexual adjustment, extramarital affairs
areas of agreement & disagreement, management of finances, role of in laws
Military History
- previous assignments & positions/job descriptions through the years,
experiences - with colleagues and superiors, likes and dislikes about work
1st battle encounter, succeeding encounters, injuries sustained,
casualties: experience of first kill, being almost killed, loss of a friend
Note if there is hesitancy avoidance while asking these questions

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 3
 Social Activity
- participation in family social gatherings/ reunions, social drinking, office activities
Any specific / general thoughts and feelings about these activities

Religion
- current beliefs and practices, according to his /her religion

Current Living Situation

- describe the house, condo, unit. owned or rented. Material. Area /subdivision.
How many rooms how many occupants.

Legal
- claims to have not been charged nor convicted of any crime, or for any misdemeanor,
please include traffic violations, jay walking, and other violation/s of city ordinances

X. REVIEW OF SYSTEMS - (cut n paste from your own standard medical ROS template
but do not forget to review from HPI – minus points here if cut n paste & “overlooked”)

Headaches, dizziness, blurring of vision, impaired hearing, tinnitus, dysphagia, palpitations, chest pain,
abdominal pain, nausea/ vomiting, numbness, sexual problem/impotency, polydipsia/ polyuria

XI. PHYSICAL EXAMINATION & NEUROLOGIC EXAMINATION

(include in “ PE and Neuro Examination” section in your written and powerpoint case report
but indicate as “not done/ performed” - online)

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 4
XII. MENTAL STATUS EXAMINATION
Penumonics for specific MSE components used “ABCES.M & MA Think3 Perceptions & Cognition lead to Insight & Judgment”
A. Appearance (nontechnical description as a novelist* may write it)
Young, middle aged, adult, adolescent, elderly, /man/woman, looks appropriate / older / younger for stated age
medium built, chubby, lean, thin, obese, muscular, weak looking wearing/clad in ____(attire),
neatly, fairly, poorly kempt & groomed, fashionably, inappropriately dressed, seated upright, w/ stooped posture
note if with disfigurement, other distinguishing features such as tatoos, scars or fresh/ recent wounds

B. Behavior /Attitude: polite, formal, poised, pleasant, guarded, demanding, agitated, troubled, furious, effeminate,
masculine, signs of anxiety - perspiring forehead, moist hands, restlessness, tense posture, …inaccessible
Cooperation - cooperative, fairly cooperative, uncooperative
Eye Contact - good, fair, poor, no eye contact or avoids, w/ sideways glances, darting eyes, “crazy eyes”
extended blinking, peering out of the corner of eyes
Speech* - fluent in native language, spontaneous, monotonous, slow, rapid, emotional, angry, childlike
w/ occasional pauses, hesitancy (if fluent - no slurring stuttering, stammering)
if rapid indicate if interruptible, or difficult to interrupt, indicate soft, moderate or loud tone of voice
Mannerisms & Motor movement - no mannerisms nor no tics noted / no noted abnormal movements
motor spectrum: catatonic, psychomotor retardation/ hypoactive/sluggish, normal, restless/ hyperactive, agitated
tremors, restlessness, fidgeting (playing with one’s finger, hair or personal object), gait (limping), shaking of legs

C. Mood and Affect* best conveyed when quoting exact words that highlight patients’ emotions, but also
indicate if: depressed, anxious, irritable, euthymic, elated, euphoric, expansive, labile
Affect range: full & reactive, restricted, constricted, blunt, flat, or mood incongruent, or inappropriate
D. Thought process, content, disturbance (process -> content -> disturbance )
Process: Linear, logical, goal directed, or circumstantial, tangential, responses blocking, derailment
Flight of ideas, looseness of association, clang, neologism, word salad, perSeveration, verbigeration
Content: preoccupations / current concerns of the patient in quotation
Suicide, homicide (ideation, intent, plan, attempt) p.136 Othmer,
Assess suicide Risk -“FAIL”-, Lethality, Intent, Attempts & Post Suicidal Attitude, Family support
obsessions, compulsions, phobias ________________
Disturbances: contents of any delusional system ( p 144 of Othmer) ;
Types of delusions: persecutory, reference, grandiose, control, erotomanic, somatic (clip)
Guide Q’s: Naiisip ba ng ibang tao na mayroong kang naiiba paniniwala? Palagay mo anung nangyayari
at manyayari pa? Ano ang pde mong gawin tungkol dito?
Overvalued ideas, Phobias, Obsessions, Conversion, Dissociation, Paroxysmal Attacks ** (Othmer)
Thought control –thought insertion, thought withdrawal, thought broadcasting* - “mga naiisip, ideya”
E. Perception Hallucinations – auditory, visual, other senses; hypnogogic, hypnopompic vs pseudohallucination*

Guide Q’s: Are you bothered by hearing voices? / Have you ever been so sick that you heard voices?
Do you ever hear noises or voices when there is nobody else there? Do they tell you to do things? (Do you obey?)
Are the voices like you hear mine right now? Do they tend to comment on what you are doing/thinking?
Can you hear them in your ears, or are they in your mind? Are they present all the time?
How many voices are there? Does anything make them better/worse?
Do you recognize the voices? Do you ever find yourself having a conversation with them?
What do they say? Do you smell or see anything at the same time that you hear these
voices? (Guide Q’s from OSCE )
F. Cognition (use your references on how to test specifically for cognition)
Orientation: time, place, person & situation,
Memory: short & long term memory intacte, immediate retention & recall intact
Concentration & Calculation: can spell “MUNDO” backwards, subtract 3 from 20 , 5 consecutive times,
Fund of knowledge: questions relevant to the educational & cultural background
Abstract thinking: explain similarities & differences (apples & oranges)

G. Insight to illness - described as poor, fair or good, and as explained

Guide Q’s “Ano yung pagkakaintindi mo sa pinagdadaanan / kondisyon mo ngayon?”, “ bakit kaya nagkakaganon?”
“ Ano pa kaya ang mga ibang dahilan (factors) kaya nagkakaganito? Ano kaya yung mga kailangan gawin/iwasan?
“ Sa tingin mo meron ka kayang mga nagawa o hindi nagawa, paguugali na kailanging pa iadjust o baguhin?”
“Ano ano ang mga gamut na pinapainum sayo? Para saan kaya ang mga ito?

H. Judgment 1. Social judgment: Does the patient understand the effect of his behavior to others; efforts to adjust?
2. Test judgment: Patient's prediction of what he or she would do in imaginary situations (e.g., what
patient would do with a stamped addressed letter found in the street, or smell smoke inside your house?)

To end your interview: Explain that this is the end of the interview and you are thanking him/her for cooperation
And wish him speedy recovery. Ask if there is anything the patient may want to express to the you or the staff?

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 5
IV. FURTHER DIAGNOSTIC STUDIES
-include tests that you think should be done during admission & other tests you may want to request now

V. SALIENT FEATURES/ SUMMARY OF FINDINGS

- aside from info from HPI should include contributing factors taken from Family History- mental illness, Hx of psychological trauma
Anamnesis

VI. DIAGNOSIS & PROGNOSIS -include your differentials, rule in & rule out, cut n paste DSM 5 full criteria of your diagnosis

WRITTEN REPORTS ENDS HERE – YOU HAVE UNTIL TOMORROW

TO SUBMIT YOUR WRITTEN REPORT

AFTER SUBMISSION OF YOUR WRITTEN REPORT

CONGRATULATE AND TREAT YOURSELF FOR A JOB WELL DONE

WHEN READY YOU MAY PROCEED WITH PREPARING SLIDES FOR YOUR CASE PRESENTATION
YOU MAY CHANGE INFORMATION AS NECESSARY, EVEN YOUR DIAGNOSIS AND DIFFERENTIALS
THE CASE PRESENTATION WILL NOW INCLUDE A BRIEF TREATMENT PLAN

VII. TREATMENT PLAN

- one slide for pharmacotherapy, include those disclosed by patients during your interview, medicines if not known
discuss only common ones used according to literature
- one slide for psychotherapy: must be able to discuss at least two types of psychotherapy can be used

MAKE YOUR POWER POINT SLIDES SIMPLE

WITH NO ANIMATION AND TO SAVE AS PDF FILE PRIOR TO SUBMISSION

VII. PSYCHODYNAMIC FORMULATION / BIOPSYCHOSOCIAL FORMULATION

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 6
 VLMC DMHBS 1 page quick guide to common DSM 5 disorders
SIGE CAPS (5/9) Psychosis PSYCHOTIC DISORDERS
[ ] depressed mood* Criteria A (Schiz) 2/5 x 1 month
[ ] sleepd [ ] delusions* Schizophrenia -Crit A; sx > 6mo, ISOF
[ ] interest () or anhedonia* [ ] hallucinations* Schizophreniform- Crit A; 1 mo to 6 mos Schizoaffective
[ ] guilt (excess)/ worthlessness) [ ] disorganized speech * Brief Psychotic - 1day <1 mo (d.h.ds.bh) - Schiz crit A + MDE or manic epi
[ ] energy (loss of)/ fatigued (incoherence/word salad/derailment) - must have >2 wks delusions
[ ] concentration (diminished)d [ ] disorganized behavior Delusional - > 1delusion, > 1 mo /hallucinations in the ABSENCE
[ ] appetite ()d ~daily, >5% weight/mo [ ] negative symptoms (“5A’s”)* - if w/ hallucination consistent w/ theme* of mood episode (1x in lifetime)*
[ ] psychomotor activity () - affect (flattening) -not obviously bizarre behavior, -mood episode sx= majority illness

V LUNA
[ ] suicidal ideation - alogia (poverty of speech) -not marked ISOF,
[ ] hopelessnessd - avolition (motivation goals) -If MDE/manic episodes = brief
[ ] helplessness - anhedonia
[ ] low self esteemd - asociality PERSONALITY D/O deviant behavior, pervasive, inflexible, adolescence/early adulthd
Ff are affected (cognition, affect, IPR, impulse)2
DI2GFAST (3 or 4) TRAUMA -N
2 2

[ ] distractibility [ ] traumatic event Cluster A - onset early adulthood Cluster A- “MAD”

[ ] insomnia / impulsive [ ] re-experiencing/reliving [ ] distrust & suspiciousness– Paranoid pd Paranoid, Schizotypal
[ ] grandiosity / self esteem [ ] avoidance [ ] odd/magical thinking – Schizotypal pd Schizoid
[ ] flight of ideas /racing thoughts [ ] unable to function (socio-occ) odd behavior & IPR/social deficits “Pa.type.ng Schiz”
[ ] activity ( goal directed) [ ] month duration [ ] no desire companionship- Schizoid pd
[ ] speech (pressured) [ ] arousability /hypervigilance* seem cold, detached, flattened affect Cluster B: BAD
[ ] thoughtlessness, in risky exaggerated startle response Histrionic, Borderline

MEDICAL
activities (such as buying sprees) [ ] negative alteration-cognition * Cluster B Antisocial, Narcisisstic
(inability to recall, persistent negative [ ] attention seeking- “Hi”(strionic) pd goons
belief- blame self/others, negative seductive, excessive emotional “Hi-BANg”
mood episodes emotional state)
[ ] major dep (sigecaps 5/9; 2 wks) [ ] w/ or w/o dissociative symptoms Impulsive >5 : Borderline pd Cluster C: sAD -anxious
[ ] manic (m.mood, hyper + >3sx, 1wk)* - depersonalization [ ] impulsive (spending, sex, subs, eat, drive)2 Avoidant, Dependent
[ ] hypomanic (m.mood, hyper >3sx, 4d)* - derealization [ ] moody (episodic dysphoria, anxiety, irritable) Obsessive Compulsive
“ m.mood “ = persistently elevated, [ ] paranoid under stress “Avoid De OC”
expansive or irritable mood(>3→4)* PTSD - TRAUMA2-N2 sx > 1mo [ ] unstable self-image
ASD - trauma occurred < 1 mo ago [ ] labile relationships * (IPR) Cluster C
Mood disorders TRAUMA2-N2 sx < 1mo, [ ] suicidal (gestures, threats, self-mutilation) Avoidant pd
[ ] MDD = 1 MDE, ≠ manic/hypoman ep [ ] inappropriate Anger (constant/intense) [ ] avoid occuptn others -A4void
[ ] Dysthymia = >2 criteria (d*), for 2 yrs, Anxiety [ ] vulnerable to Abandonment*(efforts to avoid) [ ] fear of rejection/criticized

CENTER
& never asymptomatic > 2 mos Criteria C : GAD [ ] emptiness [ ] reserved (shy) until sure ~liked
Or chronic MDD > 2 yrs [ ] worry & anxiety (excessive) [ ] inadequacy (socially inept/inf)
Accompanied >3 of the ff: “warts if 3/6 i-una MRI >3 : Antisocial pd
Bipolar & related d/o [ ] absent minded (concentration) [ ] impulsive Dependent pd
[ ] BP1 (at least 1 manic ep in lifetime + [ ] restless [ ] unlawful acts* (cruelty- animals) [ ] need 2b taken care of & clingy
w/ or w/o MDE/hypo ep + marked ISOF) [ ] tense (muscles) [ ] no remorse. (think “NR”) fear of being alone
[ ] BP2 (hypomanic ep + MDE + [ ] sleepless [ ] aggressiveness (FF/ assaults) aggressively seek relationships
unequivocal change in functioning [ ] irritability [ ] manipulative (for profit/ pleasure)
but ISOF not severely affected) [ ] fatigue [ ] recklessness (safety self & others) OCpd4
[ ] Cyclothymia [ ] irresponsible (work, bills) [ ] preoccupation w details, rules
- periods of hypomanic symptoms Anxiety d/o & stress related d/o organization s.t. major pt lost
+ depressive symptoms, for 2 yrs [ ] GAD :A.  worry diff aspects x 6 mos [ ] Grandiosity, need admiration - Narci pd [ ] perfectionism (detrimental)
(not full hypomanic, not full MDE) B. difficult to control worry, empathy, w/ fantasy unlimited success, manip [ ] devotion to work (excessive)

2019
- not symptom free for > 2 mos C. >3 “ artsif” (see 2nd column) [ ] conscientiousness- morals
[ ] MDD w PF [ ] Panic disorder [ ] panic attacks (>4) - ≠ obs & comp (~OCD)
- consistent mood disorder with - recurrent unexpected panic attacks
Intermittent psychosis / features only - > 1 mo worry of subsequent attacks Heart: palpitations, fast HR, chest pain * NBAF- not better
r/o thyrotoxicosis, heart attack, shortness of breath, choking accounted for by
[ ] Adjustment disorder thromboembolism Nausea, abdominal distress another medical /mental /sub
- emot’l ssx w/in 3 mos -stressful event [ ] Agoraphobia > 6mos, marked ISOF Trembling, sweating, chills/heat, * ISOF: impairment Socio-
- resolves w/in 6 mos-stressor removed Outside home, open spaces paresthesias (numbness/tingling) Occupational Functioning default
Closed spaces, public transport Dizziness, light headed, unsteady w/ a few exceptions*
[ ] excess alcohol → “CAGE” Fears: impending doom/ death /crazy Prognosis BEST-> worst
_cut down, _annoyed [ ] OCD- w/ obsessions & comp Dissociation (depersonalization/derealization) MDD PF>schizoaffective>
_guilt, _eye opener (>1 hr/daily) + marked ISOF Schizophreniform>Schizophrenia

Use A4: Psych Hx Guide : Nov 2020 Kaplan 11th ed table 5.2-1, Clin Interview by Othmer, MSE OSCE & other Psych Hx pdf references page 7