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History and Examination in Psychiatry - PowerPoint PPT Presentation


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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.

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Presentation Transcript
history taking
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
what to include 1
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
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
What to include 3
  • Substance misuse
    • Smoking
    • Alcohol
    • Illicit drugs
  • Premorbid personality
  • Past Medical history
  • Family history
  • Forensic history
introduction
Introduction
  • Equivalent of Physical Examination in other
  • Specialties
  • Here and now- a snapshot
  • Serial MSEs highlight progress
  • Don’t assess mechanically, like a checklist
  • Best results- informal, conversational style
  • Observe as well as listen
  • Quote ‘verbatim’
  • Conjure a mental image in listener
main components
Main components
  • Appearance and Behaviour
  • Speech (thought form/ structure)
  • Mood
  • Thoughts (content)
  • Perceptions
  • Cognition
  • Insight
  • Impression
appearance behaviour
Age (range)

Ethnicity (in general)

Appropriateness of dress

(kempt/unkempt)

Anything striking,

unusual, out of place

Rapport

Eye contact

Appropriateness of interaction

Movements/ posture

Anything striking/ inappropriate?

Appearance & Behaviour
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

Speech
slide12
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

Mood
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

Thought content
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

Perceptions
cognition
Cognition
  • Orientation
    • in time/ place/ person
  • Attention/concentration/short term memory
    • Deduce from taking history/general conversation
  • Any concerns?
    • MMSE, frontal and parietal lobe tests, psychometry, MRI scan
insight
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
Impression
  • Summarise main features in the MSE
  • Should help to make a diagnosis
  • Should be taken in context of the full
  • Psychiatric History and Collateral History
practice practice practice
Practice Practice Practice
  • Further Practice
  • Observe people’s behaviour
    • eg- night bus
    • colleagues’ normal behaviour!
  • Simulated Auditory Hallucination Experiment
  • Observe other people’s interviews and
  • write MSE
  • Read experienced Clinician’s MSEs
  • More practice makes it second nature