History taking and psychiatric interview

History taking ,psychiatric interview

Dr Maha Suliaman Younis Assistant professor in Psychiatry

Identifying Data

Name ,Age ,Sex , Address ,marital statusOccupation –students? Employment ? Un employed ?retired .governmental ,regular, for women ;house wife Education –failure at school ,leaving for social reasons Religion ,race ?Referral source ,reason for reference,source

Collateral information (informant ) Next of kin ,friend ,spouse ,others To validate reliability of the patients history ,to add feed back ,in cases of drug addiction ,personality disorders, mental confusion,dementia or any other cognitive defect Chief complain (in patients own words )include duration

History of present illness

Reasons for seeking medical help that day Current symptoms Onset ,duration ,course, stressor ,relevant associated symptoms (positive ,negative)Past psychiatric history –previous ,contact with psychiatrist ,sometimes faith healers psychiatric disorders ,previous hospitalization in chronological order with datesPast suicidal attempts ,legal history, substance abuse

Family history

Presence of psychiatric history in the close relatives (even the dead) Relation ships with his family members Past medical history, chronic physical illnesses, medications ,neurological disorders Caffeine use ,smoking

Past personal history

Early Childhood history ,prenatal ,birth history ,post natal illnesses ,middle childhood ,adulthood Pre morbid personality, history from patient and close relative usually parents. Schooling ,during childhood and adolescence Psychosexual history ,legal history

Mental state examination

Appearance ,grooming ,posture ,gait physical appearance, body gesture ,facial expression (sad ,gloomy, anxious ,apprehensive, happy, suspicious )attitude toward examiner (ability to I nteract ,level of eye contact, psychomotor activity (agitation ,retardation )abnormal movement 9tardive dyskinesia, tremor ,akathesia) body gesture

Speech 

Rate; -mute ,slow ,pressured Volume Tone fluency Articulation Quantity spontaneity

Mood and Affect

Mood :subjective emotional state in the patients own words Affect : Objective Emotional state in terms of quality -euthymic ,depressed ,elevated ,anxious Range ; full ,restricted Stability ;fixed ,labile Intensity : flat ,blunted Appropriateness

Thought disorders 

Presence of delusions Presence of perceptual disorders (hallucinations) Differences between true and pseudo hallucinations Any associated medical or neurological symptoms

Cognitive assessment

To evaluate the cognitive state of the patient and exclude any acute defect or dementing process 1-conscousness 2-Attention 3- concentration 4- orientation to -time -place -person

Cognitive assessment

Memory assessment -Instant memory Short memory -Intermediate memory -Remote memory Intelligence -general knowledge (cultural factors had to be considered always ) -Mathematical problem (for the illiterates, had to be within the patients field of experience ) Judgment :problem solving ability Insight


Insight
Present (preserved) Loss Partially preserved In suspected patients of acute or chronic brain disorders mini mental state examination (scored test) is preferred to be applied

Neurological and physical examination

Is it important ? Careful physical and neurological examination had to be done when history of the patient or his family is suggestive otherwise routine examination and investigations is to follow Investigations As the history suggest further than the routine one

Summery

Formulation of the case is to be done in 5-6 line mentioning the positive and important negative symptoms and sign ,family history should be mentioned Provisional diagnosis with second and third deferential diagnosis Management plan ;admission to psychiatric unit ,outpatient follow-up ,drug adminstration,oral ,i.m,i.v, ,ECT,non drug therapy like psychotherapy ,occupational ,behavioral

Interviewing technique

Technique : 1-support : to establish rapport 2-empathy ;To express doctors understanding 3-validation; to give credence and value to the patients feelings

Interviewing technique

1-open ended question : to obtain much information without leading question 2-Facilitation ; to encourage patient to elaborate on an answer may be verbal ore body language 3-Reflection ; to encourage the patient to expand on the answer by repeating part of the patient previous response Silence ; to increase the patients responsiveness

Diagnostic tests in psychiatry

Psychological tests to assess functioning ;intelligence ,personality ,psychopathologyObjective ; questions with right or wrong answers and projective tests questions require interpretation of the answers and responses-Cognitive tests ;I.QPersonality ; MMPI,, Rorschach testNeuropsychological test ; to detect the localized brain lesions like Halstead –Reitan Batterytest

Biological Evaluation

Measurement of biogenic amines;change in caticolaminesPlasma levels of anti psychotics and antidepressants drugsDexamethasone suppression test (DST)with the normal hypothalamic –adrenal –pitutary axis Endocrine functioning


Tests
CT- MRI PET EEG EEGand evoked potential