Psychiatric Mnemonics & Clinical Guides Rapid Psychler Press

Psychiatric Mnemonics
& Clinical Guides

Second Edition

Mnemonic comes from the Greek word mnemon, meaning mindful. Mnemosyne was a
Titan, and the goddess of memory in Greek Mythology. She and Zeus bore nine
daughters, called the Muses, who presided over the arts:

Erato (lyric poetry) Calliope (epic poetry) Clio (history)

Euterpe (music) Melpomene (tragedy) Urania (astronomy)
Thalia (comedy) Polyhymnia (religious music) Terpsichore (dance)

Every great advance in science has issued from a new audacity of imagination.
John Dewey

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Psychiatry as a Medical Specialty

Psychiatry is at once a frustrating and fascinating field for both students and practitioners.

It is frustrating in that there are no longer the pathognomonic findings or objective signs
found in physical medicine. There is no one single sign or symptom that is unique to a
particular psychiatric diagnosis. We cannot rely on a blood test, MRI or laparoscopy to
clear up diagnostic uncertainty. Substance use can perfectly mimic any clinical condition
so that only time and abstinence will help with the distinction. It is also not possible to
isolate the person or other social factors from the illness. A surgical patient, for example, is
not likely to be kept in hospital longer because of concomitant depression, but this would
be quite likely on a psychiatry service.

Psychiatry is fascinating because it deals with the most basic of human problems
emotion, perception, cognition and behavior. Treating mental illness provides the
practitioner with an endless variety because it involves the most complicated entity in the
known universe (the human brain that is, not managed care). Whereas most cases of
congestive heart failure or glaucoma have set treatment protocols, psychiatric illnesses
can and do demand creative and varying interventions.

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Psychiatry is an all-encompassing field. Every patient on every service experiences an

emotional reaction to his or her illness. Convincing a patient to take medications, minimize
risk factors and to comply with discharge arrangements all involve elements of
understanding human nature.

The exploration of the cause and effect of illness along the mind-body continuum is an
area still in its infancy. For example, the interplay between emotions and changes in
immune or endocrine function are now established subspecialties in the field.

Psychological factors clearly have an effect on medical conditions, and an understanding

of this association helps not only to make us better clinicians (in any field), but better
students, teachers, spouses, parents, and indeed, people. Despite its current drawbacks
and limitations, psychiatry provides a rich and varied approach to understanding and
treating mental illness.

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The General Psychiatric Interview

A psychiatric interview obtains information that develops a provisional diagnosis and
treatment plan. Investigations, short-term and long-term treatment plans are developed
using a Bio-Psycho-Social perspective. An interview outline is as follows:

Identifying Data: age, gender, marital status and living arrangements, race, religion,
occupation, means of support, sexual orientation

Presenting Complaint: quote the patients words where possible

History of Present Illness

duration and severity of symptoms; course since onset of symptoms
degree of social and occupational impairment
precipitating and perpetuating factors for current difficulties
ask for specific information to get as vivid a picture as possible

Psychiatric History
previous hospitalizations; duration of stay; involuntary commitment
types of treatment: medications, ECT, various forms of therapy
efficacy of past treatments; compliance with treatment; side effects
prior diagnosis or diagnoses given; history of harm to self or others

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Medical History
presence, course and severity of medical conditions
use of prescription and non-prescription medication
alcohol use, recreational drug use, head injuries, pregnancies
neurologic conditions, environmental exposure, unexplained symptoms

Personal History
birth complications; developmental milestones; prolonged enuresis
education level obtained, special requirements, extracurricular interests
history of abuse physical, emotional, sexual, verbal
legal involvement; military service (type of discharge); institutional care
occupational and relationship history

Family History
presence of psychiatric and medical conditions in first-degree relatives
types of treatment used; effectiveness of treatment
history of suicides and attempts, neurologic conditions, mental retardation
substance abuse may have masked symptoms in relatives
past diagnostic systems were less structured and precise than the DSM-IV

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Mental Status Examination

often considered the physical exam or brain stethoscope of psychiatry
inquiries must be made into current suicidal and homicidal intentions

The Emergency Room Interview

A psychiatric interview in the emergency room seeks to answer the question, Why is the
patient here now ? The focus is to obtain information that helps determine an appropriate
disposition. Of particular importance in this decision are the following areas:

Presenting Complaint and History of Present Illness

Psychiatric History
Medical History and Substance-Related Disorders
Legal Involvement and History of Dangerousness
Mental Status Examination

Prior to seeing the patient

Assess the acuteness of the situation to ensure that this remains
the patients emergency, not yours.

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be aware of the security arrangements available; attend to your safety

are the police or security guards in attendance or nearby?
read the emergency chart
peruse the patients hospital file for pertinent information
how was the patient brought to the hospital? (e.g. police, friends, on own)
is the patient intoxicated, restrained, or being held involuntarily?
has bloodwork been drawn? (e.g. medication toxicity, ethanol level)
is an overdose or head trauma suspected?
is someone available to provide collateral history?
does someone from the emergency staff have additional information?

When seeing the patient

The mental status of the patient is of paramount importance. Patients that have
perceptual abnormalities, formal thought disorders, or delusions are the most likely to
become dangerous. The following suggestions can help minimize the risk of violence:

dont challenge the patients beliefs, especially when starting the interview
give explanations for your actions; demonstrate openness

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respect the patients autonomy

maintain your composure
stress that thoughts and feelings are verbalized, not acted upon
allow adequate, even ample space for patients
sit close to the exit to facilitate your escape if necessary
do not block the door should the patient bolt
seating arrangements should be altered to suit the patient
introduce others and explain their purpose in the room
be attuned to your feelings; dont react with anger or sarcasm

The Consultation-Liaison Interview

Consultation psychiatry involves the management of patients in medical or surgical
settings. Consultation requests usually involve:

Problems with cognition delirium, psychosis, excessive denial

Problems with affect anxiety, despondency, apathy, hostility, euphoria
Problems with behavior dependency, hostility, non-compliance
Capacity to consent to treatment and/or manage financial issues

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Acute medical illnesses in patients with chronic psychiatric problems

Coping strategies/stress management for serious or prolonged illnesses
Ideas/attempts of self-harm or towards someone else

These areas are of special significance in consultation psychiatry:

Hospitalization Particulars
length of stay prior to consult request
how did the patient come to medical attention?

Medical/Surgical History
type, course and severity of the illness
treatment currently being used and its efficacy
plans for future investigations and treatment
what has the patient been told about his or her condition?

History of the Reasons for the Consultation

precipitating and perpetuating factors
exacerbations and remissions of behavioral problems

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was anything brought in by visitors? (e.g. ethanol, pills from home, etc.)
possible association with procedures, interventions, medications, etc.

Medication Review
psychiatric complications of non-psychiatric medications (e.g. steroids)
medical problems caused by psychiatric medications (e.g. lithium)
possible effects of psychiatric medications on pre-existing conditions

Laboratory Investigation Review

has appropriate testing been carried out and the results reported?
have serum levels been ordered for applicable medications?
is there an association between biochemical or hematologic abnormalities and a
change in clinical status?

Review of Information
expand on the admitting history, e.g. substance abuse, family history
speak to the referring source for information not on the chart
check the emergency record and all multidisciplinary notes to obtain and corroborate
information

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