Code Blue Group: Psychiatry History Format

University of Hargeisa
Faculty of Medicine and Surgery
Code Blue Group - Final Year Medical Students, 2020/2021
Psychiatry OSCE History Format Broad-Spectrum

Prepared by: Mukhtar Abdirahman Moh’oud “Keenadiid”

NO Checklist Achieved Not

1. Create Safe environment
2. Introduce to yourself + Confirm the patient’s Name, Age and Address:
My name is Keenadiid and I’m final year medical student at UOH. I’m
here to take you an interview about your condition. Before I start the
interview, please can I confirm your name, age and address?
3. Explanation:
Today I am here to get a better understanding of how you feel and see if there
is any way that I can help at all.
I am going to ask you quite a few questions now…please tolerate with me
& it is all right if you prefer not to answer some of my questions. And if
you feel uncomfortable or want to stop at any time please let me know.
4. Gain consent after understanding:
Does everything I’ve said make sense? Are you happy for me to take the
interview?
5. Chief complaint:
What is your main complain today?
Can you tell me in your own words what happened and why you were
brought in? what do you think your family sent to see us?

6. Show sympathy:
I am sorry to hear that, can I ask you further questions?
7. HPI Analysis: OPDFARS

Onset: When did it start? What has been happening recently?

Did you remember How it started?
Progression: do you feel your condition actually getting worse or better?
Duration: How long have you had this problem?
How long has it been going on?
Predisposing: what do you think may be the cause if your condition?
Frequency: is there any change? I mean is there any time you feel well?
Aggravating: is there anything that makes your condition worse?
Relieved: have you found anything make your condition better
Severity: how does your condition affect your life, job and Family?
8. Ask Core Symptoms according the patient’s condition and given
scenario (See below)

By: Keenadiid
 Code Blue Group: Psychiatry History Format
9. Ask Biologic Symptoms:
a. Sleep
❖ How about your sleep?
❖ Is there any change in your sleep?
❖ How does your condition affect your sleep?
b. Appetite
❖ Has there been any change in your appetite?
❖ Do you eat more or less?
c. Weight
❖ Has your weight changed recently?
❖ Have you lost weight or gained? If yes, how many Kg
d. Sexual Function
Signpost: I hope you would not mind If I ask you some sensitive
questions such as sexual problems as may your condition affect sexual
function: is that ok with you?
❖ Have there been any changes in your sexual function recently?
❖ If yes, tell me more about? When did the sexual dysfunction
start?
❖ Does it coincide with the onset of your condition?
10. Risk Assessment:
a. Thoughts;
❖ Have you ever thought about killing yourself?
❖ How often do you get these thoughts?
❖ Are you able to resist them?
b. Method:
❖ Have you ever thought about ways of doing it?
c. Attempt:
❖ Have you actually tried to harm yourself?
❖ What stops you from doing it?
❖ Have ever tried to harm to the other people?
11. Exclude other common possible causes (see below)

12. Past Psychiatric History:

❖ Have this ever happened in the past?
❖ Do you have any psychiatric illness in the past?
❖ Have you ever harmed yourself or others in the past?

13. Past Medical History:

❖ Do you suffer from any other medical illness?

14. Drug History:

❖ Are you taking any medication?
❖ Do you have any drug allergies?

15. Family History:

❖ Has anyone in your family suffered from psychosis, anxiety,
depression or other psychiatric illness?

By: Keenadiid
 Code Blue Group: Psychiatry History Format
16. Social History:
❖ Employment:
• Are you currently working?
• How is your work
• Any stress?
❖ Family:
• Are you single or married?
• Do you have any children?
❖ Support
• Do you get support from friends and family?
❖ Bad Habit
• Do you smoke, drink alcohol, or any recreational drugs?
❖ SUBSTANCE ABUSE
17. Check Insight and Judgement:
❖ Do you think you have a problem?
❖ what do you think caused you to feel like this? Are there any
particular stresses at work or home which have contributed?
❖ How would you feel about taking medications for your problem?
❖ If someone in your family will slap you and you have a gun/knife
what will you do?
18. Ask if the patient has any questions
19. Thank the Patient
20. Summarize

Core Symptoms of Common Psychiatric Conditions

Psychosis
❖ Delusions
• Persecutory: do you think people are against you? Or trying to harm you
• Grandiosity: do you have any special power which other people may not have?
• Perception: do you believe or understand things differently from other people?
• Reference: do you get any special massages from the TV or radio?
• Nihilistic: do you feel that all around are dying and false?
• Delusion of Guilt: Do you feel like you deserve punishment for mistake you
made in the past? Can you tell me the nature of the mistake and punishment
you deserve?
• Content (delusional belief): when do you first realize this was true? And how?
• Unshakeable: how would you feel if I tell you that you don’t have these powers?

By: Keenadiid
 Code Blue Group: Psychiatry History Format

❖ Hallucinations
• Auditory: do you ever hear voices when no one is present?
• Real or pseudo: do the voices come from inside your head or from outside?
• 2nd or 3rd person: do they talk directly to you or about you? Do they comment on
what you do? What do they talk about? Do they want to harm yourself or other
people?
• 1st person: do you ever hear your thoughts repeated like an echo?
Congruence: Does your mood influence the content of the voices? Forexample
When you are sad you hear the voices say sad things
• Visual: have you ever seen things that were not there? What do you see? Give me
example
• Olfactory: have you smelt something that was not present? Can you tell me more about
it?
Gustatory Hallucination: Have you noticed that food or drink seems to have a different
taste recently?
Tactile Hallucination: Have you had any strange in your body? How about people
touching you?
❖ Thought disorder
• Insertion: have you ever felt that someone had put ideas into your head?
• Withdrawal: have you ever felt that someone had removed thoughts for your head?
• Broadcasting: have you ever felt that other people can hear what you are thinking?
❖ Control: have you ever thought that your thoughts or actions are controlled by
someone else without your will? Do they make you do things against your wishes?
❖ Social Deterioration: How do you find your academic performance recently? Can you
concentrate your study?
❖ Negative symptoms: social withdrawal, anhedonia, poor self-care, lack of speech, flat
affect.

Depression
❖ Low mood: have you been depressed recently?
❖ Anhedonia: do you still enjoy the activities that you used to enjoy before?
❖ Fatigue: do you feel you don’t have the same amount of energy as before?
❖ Hopeless: how do you feel about future?
❖ Helpless: do you feel helpless about your current situation?
❖ Worthless: how do you feel about yourself?
❖ Concentration: are you finding it hard to concentrate when you watch TV?
❖ Self-esteem: would you say you have low self-esteem?
❖ Guilt: do you feel that you are responsible for the situation you are in?

By: Keenadiid
 Code Blue Group: Psychiatry History Format

Bipolar
❖ Assess Behavior
a. Excessive spending: Is there any time in your in the past 3 months you spend a lot of
money for shopping.
b. Gambling: If you have a lot of money what you will do?
❖ Assess Mood Symptoms:
a. How is your mood today?
b. How long you have been feeling high?
c. Do you have mood changes?
d. How about feeling low? If so, how many low or high episodes you would experience
in a year?
❖ Assess Irritability:
a. How do you get on with people recently?
b. Do you get upset with people?
c. Do you feel that they annoy you?
d. Do you lose your temper easily?
e. What would you do if these people irritate you?

❖ Assess Grandiosity:
a. How would you compare yourself with other people?
b. Do you believe you are special? If yes, tell me more
c. Do you believe you have powers that other people don’t have?
d. Do you feel that you are the top of the world?

Mania
❖ How is your mood today?
❖ High energy
❖ Increased activity, or agitation
❖ Restless
❖ Decreased need for sleep
❖ Talkativeness
❖ Excessive spending money/gambling? If you have a lot of many what you will do?
❖ Grandiosity: - do you think you have a power that other people don’t have or smarter
than others?
❖ Heterosexuality
❖ Disinhibiting
❖ Flight of ideas

By: Keenadiid
 Code Blue Group: Psychiatry History Format

Anxiety
❖ GAD:
a. Do you anticipate disaster, or worry about everyday mattress such as health
issue, money, death, family problem or work difficulties? Duration >6month
b. Are you able to control the worry? Ask fatigue, muscle tension, sleep
disturbance?
❖ Panic attack:
a. Do you get unpredictable attack of extreme anxiety or fear that resolves in
few minutes? Duration, episode, physical sx (palpitation, sweating, shakiness,
difficulty breathing, chest discomfort, nausea) and psychological sx (fear of losing
control, sense of impending death or harm, inability to relax)
❖ AGORAPHOBIA:
a. do you have fear over crowded area, airports, bridges when you are alone?
❖ SOCIAL PHOBIA:
a. do you have difficulty doing activities in public places like eating or giving speech?
❖ SPECIFIC PHOBIA:
a. do you afraid form specific objects like snakes, blood, cat etc?
b. do you avoid specific situations or objects due to fear of getting anxiety?

PTSD
❖ Have you ever experienced or witnessed life threatening event that cause intense
fear, helplessness or horror? If yes What happened? When and where did it happen? How
do you feel at that time?
❖ Do you find that you re-experience that event?
❖ Do you avoid thinking or talking about it?
❖ Do you try to stay away from the reminders of the event?
❖ Do you have any trouble in sleeping?
❖ Do you ever dream about it?
❖ Do you get startled easily?
❖ Are you able to experience feeling as before? (emotional numbing)
❖ Do you feel constantly on-edge, as though something terrible will happen?
❖ Are you worried about significant changes in behavior during the attacks?

OCD
❖ Obsession
a. Do you have recurrent unwanted ideas, image or impulses that seem silly or horrible?
b. Do you excessively worry about dirt, germs or chemicals?
c. Are you constantly worried that something bad will happen because you forget
something important like locking the door?
d. Do you think you are responsible for the situation you are in?

By: Keenadiid
 Code Blue Group: Psychiatry History Format

❖ Compulsion
a. Are there things you feel you must do excessively or thoughts you must think
repeatedly to feel comfortable or ease anxiety?
b. Do you wash yourself or things around you excessively?
c. Do you check things over and over or repeat action many times to be sure they are
done properly?
d. Do you keep many useless things because you feel you cannot throw them away?
e. How do you see about yourself?
f. Are you afraid you will act or speak aggressively when you really do not want?
g. How do you cope about day to day?
h. How these have affected your life and work?

ADHD
❖ Abnormal Behavior at home:
a. Does your child having difficult to sit quietly and watch T.V And sit still to eat and
complete the food?
b. Difficult to take instructions: -not playing quietly, sit quietly to watch T.V and eat
meals.
c. Aggression: -Does your child always break the glass windows, dishes and glasses, De
he or she plays with electric wires, turning on/off TV or light
d. Laying behavior
❖ Abnormal Behavior at School:
a. Does your child have difficult sitting in the class quietly?
b. Does your child have difficult to wait the question or lines in his turn?
c. Does your child have trouble listening the teacher?
d. Does your child speaks quickly inappropriate comments in class?
e. Does your child distracting other students in the class by talking excessively?
f. Does your child always taps them his pencil?
g. Does your child have any difficult doing homework or other tasks in a few minutes
and Make careless mistakes?
h. Does your child have low school performance?
❖ Ask Impulsivity:
a. Does your child run into the street without looking?
b. does your child has difficult to waiting his or her turn?
❖ Any Complications:
a. Head injury or fractures b/c of his over activity e.g. while he is jumping from caboard
or accident happen while he running the street
b. Any time he plays with electric wires, turning on/off TV or light
c. Punishment or child abuse from the teacher or parents due to his
bad behavior
❖ Risk Factors: family stressor: - divorce, criminal, imprisoned or mental illness

Thyroid Disease
Neck swelling, tremor, swelling, physical stigmata (eye changes: lid lag, lid retraction,
exophthalmos; voice changes: hoarseness, low pitch, etc)

By: Keenadiid
 Code Blue Group: Psychiatry History Format

Mental Status Exam

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 Code Blue Group: Psychiatry History Format

Mini-Mental State Examination (MMSE)

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 Code Blue Group: Psychiatry History Format

Standardized Mini-Mental State Examination (SMMSE)

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