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Chapter Two Clinical Examination of the Psychiatric Patient

Chapter Two Clinical Examination of the Psychiatric Patient. Chen-min Jining Medical University. The Psychiatric History 精神病史采集 Mental status examination 精神状况检查 Mental Health: What‘s normal, What’s not ？精神正常与异常的判断. 医患关系. 良好的医患关系有助于检查、诊断、治疗。 可以减少医疗纠纷的发生。. Psychiatric History. 病史来源

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Chapter Two Clinical Examination of the Psychiatric Patient

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  1. Chapter TwoClinical Examination of the Psychiatric Patient Chen-min Jining Medical University

  2. The Psychiatric History 精神病史采集 • Mental status examination 精神状况检查 • Mental Health: What‘s normal, What’s not？精神正常与异常的判断

  3. 医患关系 良好的医患关系有助于检查、诊断、治疗。 可以减少医疗纠纷的发生。

  4. Psychiatric History • 病史来源 • 询问的顺序：先问现病史 • 记录病史：记录原话、避免使用医学术语、保密

  5. Contents of Psychiatric History • Identifying Data身份资料 • Chief Complaint主诉 • History of Present Illness现病史 • Past Illness既往史 • Personal History 个人史 • Family History 家族史

  6. 方法 自由交谈、询问、观察 环境：安静 家属或亲友不宜在场 时间：可多次进行 一次不超过一小时 内容：一般表现 认知过程 情感表现 意志与行为 . Mental Status Examination

  7. Outline of the Mental Status Examination • V. Thought A. Thought Process B. Thought Content • VI. Sensorium and cognition A. Consciousness B. Orientation and memory C. Concentration and attention D. Reading and writing E. Visuospatial ability F. Abstract thought G. Information and intelligence • VII. Impulsivity • VIII. Judgment and insight • IX. Reliability • I. General description A. Appearance B. Speech Characteristics C. Overt behavior and psychomotor activity D. Attitude • II. Mood and affectivity A. Mood B. Affect C. Appropriateness of affect • III. Speech characteristics • IV. Perception

  8. Mental Status Examination • 一般表现 意识状态 定向力 接触情况：主动或被动，合作情况 日常生活：仪表、饮食、睡眠、大小便、与他人的接触 • 认知过程：感知觉、思维、注意、记忆、智能、自知力 • 情感表现 • 意志行为与活动

  9. Examination of mental state 2

  10. Mini-Mental Status Examination form

  11. Techniques for the Psychiatric Assessment • Time and Setting • Open-Ended and Closed-Ended Questions • Supportive and Obstructive Interventions • Recording and Note Taking • Special Problems in Interviewing

  12. Mental Status Examination • 不合作患者 • 意识障碍患者：定向力、瞬间记忆、注意力 • 有暴力或冲动行为的患者 有家属在场 合适的距离

  13. Other • 体格检查：特别是神经系统 • 实验室及其他检查 脑影象学、脑电图、心电图、血常规、肝功、B超等 • 诊断性心理测验和症状评定

  14. Physical complaints of patients with psychiatric histories taken less seriously

  15. 标准化精神检查和评定量表 1、标准化诊断性精神检查工具 2、评定量表

  16. Mental health: What's normal, What's not？ • 个人经验标准 • 周围人的评价 • 与社会文化和伦理标准比较 • 统计学标准。

  17. 精神科诊断过程 1、横向诊断 2、纵向诊断 3、诊断流程 有病—无病；器质性—非器质性； 重性—轻性；后发疾病—人格发育问题

  18. 诊断流程

  19. DSM IV: Five Axes

  20. THANK YOU

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