Dr Donna Arya

 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

 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?

 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

 Substance misuse  Smoking  Alcohol  Illicit drugs  Premorbid personality  Past Medical history  Family history  Forensic history

 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

 Appearance and Behaviour  Speech (thought form/ structure)  Mood  Thoughts (content)  Perceptions  Cognition  Insight  Impression

 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?

 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

 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

 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

 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

 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

 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?

 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

 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