PSYCHIATRY LEARNING SYSTEM

INTRODUCTION
• The psychiatric evaluation of a patient
may involve a variety of procedure,
including a physical and neurological
examination. By far, the most frequently
used procedure is what is called the
mental status examination (MSE). This
chapter focuses on the MSE and the
means of conducting the examination, the
psychiatric interview.
• PURPOSES OF THE INTERVIEW
• The psychiatric history attempts to answer the
question, “How did this person happen to
become the way he is now?” and thus gives a
longitudinal view of the patient. The psychiatric
history encompasses chief complaints and
history of the present illness, as well as a
personal and family history and other features
included in the general medical history. It should
focus on relationships between occurrence of
symptoms and life events and feelings.
• The interview is a basic tool of the physician. It
is a systematic attempt to gain knowledge of the
patient and the nature of the illness. It is through
the interview that a history of the patient’s
present illness and past life is elicited, and the
same principles apply in the interview of
patients, whether they are seen in a psychiatric
or medical setting. It is also through the
interview that a mental examination, an essential
part of the physical examination is performed.
– Psychological stressors (or precipitating
events)
– Predisposing factors
– Area of conflict about instinctual drives
– Defense mechanisms used
• OUTLINE FOR PSYCHIATRIC
HISTORY
• PATIENT IDENTIFICATION
– Name, age, sex, marital status, cultural
background, occupation
– Source of referral
– History of hospitalizations
– Estimated reliability of information
• CHIEF COMPLAINT/PRESENTING
COMPLAINT
• PRESENT ILLNESS
• This is chronological story of the difficulties
which prompted the patient to see the
psychiatrist (or the difficulties which prompted
other to refer him to a psychiatrist). The report
of the present illness should contain precise
descriptions of symptoms of the first
occurrence of symptoms. Attention should be
given to possible relationships between
symptoms and life events, especially feelings,
fantasies, and thoughts associated with these
life events.
• SYSTEMIC REVIEW
• PERSONAL HISTORY
• A longitudinal view of the patient’s
personality development and origin of his
psychopathology.
• FAMILY HISTORY
– Economic and social status of parents,
personality of parents, quality of patient’s
relationship with parents, compatibility of
parents.
– Personality of siblings, relationship of patient
to siblings, birth order of patient.
– Remarkable family history, medical history,
particularly family history of psychiatric
illness, suicide, eccentric relatives.
• INFANCY AND EARLY CHILDHOOD
• The patient can report only what he has been told.
Sometimes an interview with the patient’s parents is
indicated.
• CHILDHOOD
• School; Special likes and dislikes in school subjects;
relationships with peers, teachers; sports and
extracurricular activities, interference with schooling by
illness, accidents trouble at home.
• Childhood personality: Passivity/aggressiveness,
independence/dependence, rebelliousness/conformity,
attitudes toward responsibility, competition, frustration,
pleasure, reactions to family events such as births,
deaths, illness, separations, etc.
• ADOLESCENCE
– School, special relationships with teachers, issues
of achievement, sports.
– Religious upbringing.
– Relationship to family, examples of rebelliousness.
– Special interests.
– Health and physical development, reactions to
onset of puberty.
– Personality; changes in disposition and
temperament.
– Psychosexual development: attitudes toward peers
of same and opposite sexes, how information about
sexuality was acquired; interest in sex literature,
homosexual information, interests experiences,
heterosexual contact (dating, intercourse, parties,
dancing).
• ADULT ADJUSTMENT PRIOR TO ILLNESS
• a. Education:chronologic educational events
• b. Occupation:employment history & ambitions, gains.
• c. Psychosexual:marital history of current status, sexual
adjustment; parenting history & attitudes toward child
bearing relationship with children prior to onset of
present illness.
• d. Family:nature of relationship to family of origin.
• e. Military record:date of service, type of discharge,
combat experiences, hospitalizations, rank in service.
• f. Social adjustment: organizations, community activities,
friends, political activities, antisocial activities, criminal
record.
• g. Habits:smoking and a careful history of drug and
alcohol abuse.
• h. Interests:hobbies, sports, recreation, etc.
• FURTHER EXAMINATION OF
PREMORBID PERSONALITY AND
ONSET OF PRESENT ILLNESS
• END