Dr Donna Arya History History Taking In Psychiatry history medical history and examination Getting the environment right The basic introduction for any patient Open questions closed questions ID: 919638
Download Presentation The PPT/PDF document "History and Examination in Psychiatry" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
History and Examination in Psychiatry
Dr Donna Arya
Slide2History
Slide3History 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
Slide4What 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?
Slide5What 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
Slide6What to include 3
Substance misuse
Smoking
Alcohol
Illicit drugs
Premorbid personality
Past Medical history
Family history
Forensic history
Slide7Mental State Examination
Slide8Introduction
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
Slide9Main components
Appearance and Behaviour
Speech (thought form/ structure)
Mood
Thoughts (content)
Perceptions
Cognition
Insight
Impression
Slide10Appearance &
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?
Slide11Speech
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
Slide12Mood
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
Slide13Thought 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
Slide14Perceptions
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
Slide15Cognition
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
Slide16Insight
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?
Slide17Impression
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
Slide18Practice 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
Slide19