Psychiatric History and Mental Status Examination

Psychiatric History  Identifying Data  Chief Complaint  History of Present Illness  Previous illness  Personal History (Anamnesis)  Identifying Data  Chief Complaint  History of Present Illness  Previous illness  Personal History (Anamnesis)

Identifying Data  Name  Age  Marital Status  Occupation  Ethnic Background  Religion  Current Circumstances of Living  Source of information; Reliability  Name  Age  Marital Status  Occupation  Ethnic Background  Religion  Current Circumstances of Living  Source of information; Reliability

Chief Complaint  Should be written in the patient’s own words stating why he/she has come or been brought in for help  It should be written in verbatim; no matter how absurd, illogical, irrelevant or bizarre it is.  The accompanying person or relative’s complaint should also be taken into account.  Should be written in the patient’s own words stating why he/she has come or been brought in for help  It should be written in verbatim; no matter how absurd, illogical, irrelevant or bizarre it is.  The accompanying person or relative’s complaint should also be taken into account.

History of Present Illness  A comprehensive and chronological picture of the events leading up to the current moment in the patient’s life.  Onset, precipitating factors/events, personality type  Evolution of the patient’s symptoms, how illness affects patient’s life, nature of dysfunction  A comprehensive and chronological picture of the events leading up to the current moment in the patient’s life.  Onset, precipitating factors/events, personality type  Evolution of the patient’s symptoms, how illness affects patient’s life, nature of dysfunction

Previous Illness  Past episodes of both psychiatric and medical illnesses  Causes, complications, treatment, the effects of the illness on the patient’s life  Alcohol and other substance abuse; quantity and frequency  Past episodes of both psychiatric and medical illnesses  Causes, complications, treatment, the effects of the illness on the patient’s life  Alcohol and other substance abuse; quantity and frequency

Personal History  Patient’s past life and its relationship to the present emotional problem  The predominant emotions associated with the different life periods should be noted  Patient’s past life and its relationship to the present emotional problem  The predominant emotions associated with the different life periods should be noted

1.Pre-natal and perinatal history 2.Early childhood (0-3 yo) 3.Middle childhood (3-11 yo) 4.Late childhood (puberty-adolescence) 5.Adulthood 6.Psychosexual history 7.Family history 8.Dreams, fantasies and values 1.Pre-natal and perinatal history 2.Early childhood (0-3 yo) 3.Middle childhood (3-11 yo) 4.Late childhood (puberty-adolescence) 5.Adulthood 6.Psychosexual history 7.Family history 8.Dreams, fantasies and values

Mental Status Examination  Describes the sum total of the examiner’s observations and impressions of the psychiatric patient at the time of interview

1.General Description 2.Mood and Affect 3.Speech 4.Perceptual Disturbances 5.Thought Disturbances 6.Sensorium and Cognition 7.Impulse Control 8.Judgment and Insight 1.General Description 2.Mood and Affect 3.Speech 4.Perceptual Disturbances 5.Thought Disturbances 6.Sensorium and Cognition 7.Impulse Control 8.Judgment and Insight

General Description  Appearance: posture, poise, clothing grooming –Body type, hair, nails –Healthy, sickly, ill at ease, poised, odd looking, young-looking, disheveled, childlike, bizarre –Signs of anxiety  Appearance: posture, poise, clothing grooming –Body type, hair, nails –Healthy, sickly, ill at ease, poised, odd looking, young-looking, disheveled, childlike, bizarre –Signs of anxiety

 Behavior and psychomotor activity: –Quantitative and qualitative aspects of the patient’s motor behavior –Mannerisms, tics, gestures, twitches, stereotyped behavior, echopraxia, hyperactivity, agitation, combativeness, flexibility, rigidity  Behavior and psychomotor activity: –Quantitative and qualitative aspects of the patient’s motor behavior –Mannerisms, tics, gestures, twitches, stereotyped behavior, echopraxia, hyperactivity, agitation, combativeness, flexibility, rigidity

 Attitude toward examiner: –Cooperative, friendly, attentive, interested, frank, seductive, defensive, hostile, playful, evasive, guarded –Level of rapport  Attitude toward examiner: –Cooperative, friendly, attentive, interested, frank, seductive, defensive, hostile, playful, evasive, guarded –Level of rapport

Mood and Affect  MOOD: pervasive and sustained emotion that colors the patient’s perception of the world –Depressed, despairing, irritable, anxious, angry, expansive, euphoric –Maybe labile  MOOD: pervasive and sustained emotion that colors the patient’s perception of the world –Depressed, despairing, irritable, anxious, angry, expansive, euphoric –Maybe labile

 AFFECT: patient’s present emotional responsiveness –Normal range, constricted, blunted, flat  Appropriateness of the patient’s response to the context of the subject matter the patient is discussing  AFFECT: patient’s present emotional responsiveness –Normal range, constricted, blunted, flat  Appropriateness of the patient’s response to the context of the subject matter the patient is discussing

Speech  Physical character of speech  Quantity, rate of production, quality  Talkative, garrulous, unspontaneous  Rapid, slow, pressured, hesitant, dramatic, monotonous, loud, whispered  Impairment of speech: stuttering  Physical character of speech  Quantity, rate of production, quality  Talkative, garrulous, unspontaneous  Rapid, slow, pressured, hesitant, dramatic, monotonous, loud, whispered  Impairment of speech: stuttering

Perceptual Disturbances  Hallucinations  Illusions  Depersonalization, derealization  Formication  Hallucinations  Illusions  Depersonalization, derealization  Formication

Thought Disturbances  THOUGHT PROCESS (Form of thinking): a way in which a person puts together ideas and associations  Loosening of association, derailment, flight of ideas, racing thoughts, tangentiality, circumstantiality, word salad, neologisms, clang association, blocking, relevant/irrelevant  THOUGHT PROCESS (Form of thinking): a way in which a person puts together ideas and associations  Loosening of association, derailment, flight of ideas, racing thoughts, tangentiality, circumstantiality, word salad, neologisms, clang association, blocking, relevant/irrelevant

 CONTENT OF THOUGHT –Delusions, preoccupations, obsessions, compulsions, phobias, suicidal or homicidal ideas –Delusions: fixed false beliefs  Mood in/congruent  Persecutory/paranoid, grandiose, jealous, somatic, erotic, nihilistic  CONTENT OF THOUGHT –Delusions, preoccupations, obsessions, compulsions, phobias, suicidal or homicidal ideas –Delusions: fixed false beliefs  Mood in/congruent  Persecutory/paranoid, grandiose, jealous, somatic, erotic, nihilistic

Sensorium and Cognition  Assesses organic brain functioning, intelligence, capacity for abstract thought, level of insight and judgment 1.Alertness and level of consciousness 2.Orientation 3.Memory  Assesses organic brain functioning, intelligence, capacity for abstract thought, level of insight and judgment 1.Alertness and level of consciousness 2.Orientation 3.Memory

4. Concentration and Attention 5. Capacity to Read and Write 6. Visuospatial ability 7. Abstract Thinking 8. Fund of Information and Intelligence 4. Concentration and Attention 5. Capacity to Read and Write 6. Visuospatial ability 7. Abstract Thinking 8. Fund of Information and Intelligence

Impulse Control  Critical in ascertaining the patient’s awareness of socially appropriate behavior  A measure of the patient’s potential danger to self and others  Critical in ascertaining the patient’s awareness of socially appropriate behavior  A measure of the patient’s potential danger to self and others

Judgment and Insight  JUDGMENT: patient’s capability for social judgment –Imaginary situations  INSIGHT: patient’s degree of awareness and understanding that they are ill  JUDGMENT: patient’s capability for social judgment –Imaginary situations  INSIGHT: patient’s degree of awareness and understanding that they are ill

Levels of Insight  Complete denial of illness  Slight awareness of being sick & needing help but denying it at the same time  Awareness of being sick but blaming it on others, on external factors, or on organic factors.  Awareness that illness is due to something unknown in the patient  Intellectual insight  True emotional insight  Complete denial of illness  Slight awareness of being sick & needing help but denying it at the same time  Awareness of being sick but blaming it on others, on external factors, or on organic factors.  Awareness that illness is due to something unknown in the patient  Intellectual insight  True emotional insight

Reliability  Estimate of the psychiatrist’s impression of the patient’s truthfulness or veracity