History taking ,psychiatric interview
Dr Maha Suliaman Younis
Assistant professor in Psychiatry
Identifying Data
Name ,Age ,Sex , Address ,marital status •
Occupation –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
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•
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 dates
Past 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 .1
rapport
2-empathy ;To express doctors .2
understanding
3-validation; to give credence and .3
value to the patients feelings
Interviewing technique
.1
1. 1-open ended question : to obtain much
information without leading question
2. 2-Facilitation ; to encourage patient to
elaborate on an answer may be verbal ore
body language
3. 3-Reflection ; to encourage the patient to
expand on the answer by repeating part of the
patient previous response
4. Silence ; to increase the patients
responsiveness
Diagnostic tests in psychiatry .1
• Psychological tests to assess functioning
;intelligence ,personality ,psychopathology
• Objective ; questions with right or wrong
answers and projective tests questions require
interpretation of the answers and responses
• -Cognitive tests ;I.Q
• Personality ; MMPI,, Rorschach test
• Neuropsychological test ; to detect the localized
brain lesions like Halstead –Reitan Batterytest
Biological Evaluation
1. Measurement of biogenic amines;change in
caticolamines
2. Plasma levels of anti psychotics and
antidepressants drugs
3. Dexamethasone suppression test (DST)with
the normal hypothalamic –adrenal –pitutary
axis
4. Endocrine functioning
Tests
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CTMRI
PET
EEG
EEGand evoked potential