6. ១.ការពិនិត្យស្ថ
ា នភាពផ្
ល ូវចិត្ត
(Mental Status Examination)
Delusion: false belief
• Persecutory delusion: idea that person or object is trying to hurt the
patient.
• Jealousy delusion: unusual jealous toward another person.
• Erotomanic delusion: someone famous or unknown is in love with the
patient.
• Grandiose delusion: the patient feels himself
important/valuable/powerful.
• Somatic delusion: false belief that the patient has physical problem.
7. ១.ការពិនិត្យស្ថ
ា នភាពផ្
ល ូវចិត្ត
(MentalStatusExamination)
Hallucination: false perception
• Auditory hallucination: hear s.o speaking to you or telling you to do
certain things.
• Visual hallucination: seeing things that are not there.
• Tactile hallucination: feeling of movement in your body.
• Olfactory hallucination: smell unpleasant odor.
• Gustatory hallucination: taste are often strange or unpleasant.
10. Result from history taking
1.Chief complaint: headache, poor sleep, and thinking a lot.
2.Present illness
A. Onset: since October 2019
B. Precipitating factor: His wife died.
C. Present symptoms:
At first he has upset, thinking a lot, and poor sleep.
Then, he blamed himself for not taking his wife to hospital on time. He
feel inferior. It made him headache and difficult to fall asleep. Those
symptoms also accompany with decrease appetite, loss weight (3kg),
low energy, did not want to go out and forgetful. Last month, all
symptoms got worse especially sleepless and want to stay alone. He
took one tablet of sleeping pill which helped for short time only. Now he
woke up at 3 am and could not sleep again. The other symptoms also
got worse. So his neighbor recommended him to visit psychiatric unit.
11. 3. Past Illnesses
• Psychiatric illness: no
• Medical illness: appendisectomy
• Alcohol and substance use: he drinks 1-2 can of beer
occasionally. Never got drunk. He never uses any illicit
drug.
12. 4. Personal history
• He was delivered naturally; nothing abnormal
• Good child development
• Start school at 6 years old. Stop school at grade 9 due to
poverty. Average student with lot of good friends.
• Got married at age 22 to a seller who was 2 years
younger than him.
13. 5. MSE
• Appearance: good grooming, good personal hygiene,
walk in slowly.
• Coherence speech, low voice, speak slowly.
• Dysphoric mood with appropriate affect.
• No hallucination nor delusion.
• No suicidal thought.
• Good memory
• A bit of poor concentration
• Oriented to time, place, and person
• Good insight
14. Group discussion
• Work in group to find out the abnormality in this case.
• 15mn.
• Choose one representative to talk about the result.
15. Diagnostic criteria of depression
(ICD-10)
A. The depressive episode should last for at least 2 weeks.
B. Main symptoms:
1.depressed mood for at least 2 weeks
2.loss of interest or pleasure in activities that are normally
pleasurable
3.decreased energy
C. Additional symptoms:
1.loss of confidence or self-esteem
2.excessive and inappropriate guilt
3. recurrent thoughts of death
4. diminished ability to think or concentrate
5. change in psychomotor activity: agitation or retardation
6. sleep disturbance of any type
7. change in appetite: decrease or increase weight change
16. Diagnostic criteria of depression
(ICD-10)
D. There have been no hypomanic or manic symptoms
sufficient to meet the criteria for hypomanic or manic
episode at any time in the individual’s life.
E. Not due to psychoactive substance or any organic
mental disorder.
17. Group discussion
• What are the differential diagnosis?
• Work in group
• 10mn
• Choose representative to talk
19. Bereavement Depression
Duration Less than 2
months
At least 2
weeks
Psychomotor
retardation (PR)
Few days Prolong and
marked PR
Guilty No Yes
Worthlessness No Yes
Thought of
death
No Yes
Daily
functioning
Likely to
improve over
time
Prolong and
marked
functional
impairment
Hallucination/de
lusion
No Yes
23. 4. Management plan
• Pharmaco-therapy:
• Amitriptyline 25mg: 1 tablet for 4 days then increase to 1 ½ tablet at
night
• Alprazolam 0.5mg: ½ tablet night time
• Non-pharmaco-therapy:
• Psycho-education
• Problem solving
• Reactivate social networks
24. Psycho-education
• Depression is very common and it does not mean that
the person is lazy or weak.
• Other people may not understand depression because
they cannot see it and they may say negative things to
you but depression is not your fault.
• People with depression often have negative thoughts
about their life and their future, but these are likely to
improve once the depression is treated and starts to
improve.
25. Psycho-education
• It takes times to get betters so the patient needs to follow
doctor prescription.
• Notice of depressive symptoms: self harm or suicidal
thought. If it appears, come to see psychiatrist
immediately.
• Common side effects
• Follow up in two weeks time.
26. Side effects & Management
Common side effects of TCA (Tricyclic antidepressant) and their
management:
• Blurred vision
• Constipation: taking plenty of water, eat more vegetable
(contain fiber), ripe papaya, etc.
• Dry mouth: frequently sip water, etc.
• Weight gain: exercise, limit the intake of meat, etc.
• Dizziness: slowly get up when changing the position from lay
down to get up.
• Sedation: take medicine at night time and caution when driving.
• Rash, itching (rare): stop medication and see therapist again
• Etc.
27. Problem Solving
• List down all problem
• Choose one problem to work on
• List down all possible solutions
• Advantage and disadvantage of each solution
• Select a solution
• Implement the solution
• Evaluate the outcome
28. List down all problems
• រៀនមិនទាន់រេ
• ពិបាកបញ្ហា ភាសា បារាំង និងអង់រេេស
• នឹកផ្ទះ
• សទះផ្េូវ
• ខ្វះខាតថវិកា
• ផ្ទះជួលពិបាករៅ អ៊ូ អ រពក
• ឪពុកម្តា យរោយរៀបកា
• Etc.
29. Choose one problem to work on
• រៀនមិនទាន់រេ
• ពិបាកបញ្ហា ភាសា បារាំង និងអង់រេេស
• នឹកផ្ទះ
• សទះផ្េូវ
• ខ្វះខាតថវិកា
• ផ្ទះជួលពិបាករៅ អ៊ូ អ រពក
• ឪពុកម្តា យរោយរៀបកា
• Etc.
30. List down all possible solutions
សទះផ្េូវ៖
• រេញពីផ្ទះព្ពឹក
• ជិះម៊ូត៊ូ
• Google map
• រព្បើផ្េូវរវៀង
• ដ៊ូ លាំរៅ
• រោយមិតាភកាិរៅជិត េ៊ូលយក
• Etc.
31. Advantages and disadvantages of each
solution
សទះផ្េូវ៖
• រេញពីផ្ទះព្ពឹក
• ជិះម៊ូត៊ូ
• Google map
• រព្បើផ្េូវរវៀង
• ដ៊ូ លាំរៅ
• រោយមិតាភកាិរៅជិត េ៊ូលយក
• Etc.
Adv: ផ្េូវព្សលះ ព្សួលជិះ េាំរនញរពល ោ មមណ៏លអ
Disadv: ងងុយរេង មកដល់ថ្នា ក់រលឿនរពក
Adv
Disadv
Adv
Disadv
Adv
Disadv
Adv
Disadv
Adv
Disadv
32. Selection a solution
• Select a solution by comparing the advantage and
disadvantage of each solution and chose the one that fit
to you.
33. Implement the solution and evaluate the
outcome
• Implement the chosen solution for a period of time (ex: 2-
4 weeks or can be longer ).
• Evaluate:
• If the chosen solution is good, keep trying it and try to solve other
new issues.
• If the chosen solution is not fit to you, try to think of other possible
solution or compare the adv and disadv of each solution and chose
a gain.
34. Reactivate social networks
• Using psycho-education to explain that when people are
depressed they often stop doing the things that make them
feel good. This can make the depression worse.
• Activities that used to be fun can help people recover from
depression.
• Problem-solving to reduce stress with examples of how they
would do that.
• Relaxation activities.
• Activities such as seeking further support from friends/family
members that they are close to. Use activities that they
know help them. Use reading, religion, inspiring phrases
that give them strength.
• Linking people to different organizations to encourage
engagement.
• Encourage physical activity
