history and examination in psychiatry
DESCRIPTION
Dr Donna Arya. History and Examination in Psychiatry. History. History Taking. In Psychiatry history= medical history and examination Getting the environment right The basic introduction for any patient Open questions closed questions Its all information! Active listening. - PowerPoint PPT PresentationTRANSCRIPT
History and Examination in Psychiatry
Dr Donna Arya
History
History Taking
In Psychiatry history= medical history and examination
Getting the environment rightThe basic introduction for any
patientOpen questions closed questions
Its all information! Active listening
What to include 1 Complains of..
Pts own words History of present case
How they came to your attention What did other people notice Effect on their life
Past Psychiatric History Fist illness Hospitalisations Use of Mental Health Act Use of previous medications
Medication and allergies Taking them?
What to include 2 Personal History
The pregnancy Developmental milestones Health and happiness in childhood School & qualifications Relationships Bullying Occupations Sexual history Current social situations▪ Married▪ Accomodation▪ Children▪ Financial situation
What to include 3
Substance misuse Smoking Alcohol Illicit drugs
Premorbid personalityPast Medical historyFamily historyForensic history
Mental State Examination
Introduction Equivalent of Physical Examination in
otherSpecialtiesHere and now- a snapshotSerial MSEs highlight progressDon’t assess mechanically, like a
checklistBest results- informal, conversational
styleObserve as well as listenQuote ‘verbatim’Conjure a mental image in listener
Main components
Appearance and BehaviourSpeech (thought form/ structure)MoodThoughts (content)PerceptionsCognition Insight Impression
Appearance & Behaviour
Age (range)Ethnicity (in
general)Appropriateness
of dress (kempt/
unkempt)Anything
striking,unusual, out of
place
RapportEye contactAppropriateness
of interactionMovements/
postureAnything
striking/ inappropriate?
Speech
Rate Volume Rhythm Tone Spontaneity Content
(good/poor) Coherence
Any thought disorder? Thought block Flight of ideas Circumstantiality Tangentiality Loosening of
associations Word salad Neologisms Rhyming/punning
Mood Subjectively
quote patient 0-10 scale
Objectively Somatic symptoms
sleep (EMW) appetite/ weight diurnal variation Concentration Energy libido
Other enjoyment/pleasure guilt/self blame self esteem Motivation hopes/future plans
Risk (or separately) Suicide DSH
Thought content
In general Open-ended
questions Preoccupations Obsessions/
compulsions Worries/anxieties Panic attacks Intensity▪ Delusions▪ overvalued ideas
Sub-types Paranoid▪ Persecutory▪ derogatory
Grandiose Religious Hypochondriacal Nihilistic Passivity
phenomena Ideas of reference
Perceptions Sensory modality
auditory visual olfactory gustatory tactile/somatic
Timing, associations,
frequency, coping strategies
Auditory 2nd/ 3rd person
Sub-types (content) Paranoid Persecutory Derogatory Grandiose Religious Hypochondriacal Nihilistic Command
CognitionOrientation
in time/ place/ personAttention/concentration/short term
memory Deduce from taking history/general
conversationAny concerns?
MMSE, frontal and parietal lobe tests, psychometry, MRI scan
Insight Why are you in hospital/clinic? Do you have an illness?
If so, is it physical, psychological, spiritual, social
What has made you ill? What will make you better?
Medication, talking therapy, housing? Do you want to keep taking
medication? Do you want to keep taking
drugs/alcohol? Where do you see yourself in 5 years?
Impression
Summarise main features in the MSE
Should help to make a diagnosisShould be taken in context of the fullPsychiatric History and Collateral
History
Practice Practice PracticeFurther PracticeObserve people’s behaviour
eg- night bus colleagues’ normal behaviour!
Simulated Auditory Hallucination Experiment
Observe other people’s interviews and
write MSERead experienced Clinician’s MSEsMore practice makes it second
nature