Psychiatric History & Mental Status Exam Guide
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This document outlines the components and process of conducting a psychiatric history and mental status examination. It details the objectives, diagnoses, formulation, management, and categories of information to cover which include history, mental status examination, and psychosocial investigation. It provides examples of specific components to evaluate such as chief complaint, history of present illness, past psychiatric history, and family history. It also describes the expected signs and findings under each section of the mental status examination.
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Psychiatric History & Mental Status Exam Guide
- 1. PSYCHIATRIC HISTORY & MENTAL STATUS EXAMINATION PSYCHOLOGICAL MEDICINE PHASE II, MD Thursday, September 13, 2018
- 3. DIAGNOSIS – SYMPTOM/SIGN Present? Characteristic, typical, atypical features Details Frequency, intensity, duration, sequence, personal meaning Pattern Longitudinal, evolution, relation between symptoms
- 4. DSM-IV DIAGNOSTIC CRITERIA Core / Characteristic features • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior • Negative symptoms Threshold criteria • Social/Occupational dysfunction: • Duration: 6 months Exclusion • Schizoaffective and Mood Disorder exclusion • Substance/General Medical Condition exclusion • Relationship to a Pervasive Developmental Disorder
- 5. FORMULATION Predisposing Genetic, personality Precipitating Stress, drugs Perpetuating Noncompliance, ongoing stress
- 6. RELAPSE RISK FACTORS Diagnosis Side effects Social support Compliance Insight Inadequate response
- 8. CATEGORIES OF INFORMATION History • Behavioral description • Phenomenology • Causes • Background Mental Status Examination • Expected signs Psychosocial Investigation • Confirming the diagnosis • Excluding specific causes
- 9. COMPONENTS OF PSYCHIATRIC HISTORY Chief Complaint Symptoms that is characteristic or problematic History of Present Illness Further elaboration of the current complaint Past Psychiatric History Background of the illness
- 10. THE FLOW Time • Onset – admission – progress in the ward Specific • History – MSE – Investigation • Layman – terminology Complete • Behavior – phenomenology • Core – characteristic – associated features Priority • Present – absent • Important – unimportant • Establish – rule out
- 11. CHRONOLOGICAL ORDER Attended PLKN 2 months ago. Noted to be quiet and having poor sleep at night 1 week later, noted smiling to himself and wandering at night. A few days later, the condition worsen. Pt talked and shouted for no reason. Threw stones at other trainees tent at night. The relative came and brought pt home On the day of admission, he punched his father
- 12. VERBATIM - TERMINOLOGY • “I heard other trainees were badmouthing me at night”CC • It occurred especially at night time when everybody was asleep • It angered him when the voices discussed about him and commented on his behavior HOPI • Third person (auditory) hallucinations MSE
- 13. COMPLETE • Threshold criteria •Duration •Impairment • Exclusion •Bipolar •Drugs, GMC • Bio-psychosocial • Predisposing/ precipitating/ perpetuating factors • Auditory hallucinations • Delusions? • Disorganization? • Subjective & Objective • “I heard voices” •Seen talking to himself • Fulfill definition • Further description of form and content Psycho- pathology Syndrome Disorder Mental Illness
- 14. COMPONENTS OF PSYCHIATRIC HISTORY Family history Presence of mental illness Personal history Childhood, academic, occupational, relationship, drug use Social history
- 15. COMPONENTS OF MENTAL STATUS EXAMINATION General behavior • Appearance, attitude, rapport, activities • Neglect, abnormal movement Mood & affect • Quality, range, depth, appropriateness, lability Speech • Rate (rapid, slowed, pressured, hard to interrupt) • Volume (loud, soft, monotone, highly inflected or dramatic) • Quality (neologisms, fluent, idiosyncratic)
- 16. COMPONENTS OF MENTAL STATUS EXAMINATION Thought • PROCESS: Flow, form, content, possession • CONTENT: Delusion, obsession, suicidal Perception • Hallucination, illusion • Modality, content Cognition • Attention, concentration, orientation, memory, intelligence • Judgment, insight
- 17. Sign/symptoms • Knows something is wrong Mental illness •That he/she is ill, that illness is psychiatric; Treatment •Understands the need for treatment Test • Response to standard questions Personal • His future plan Social • Evidence from behavior prior to and during interview
- 18. SUMMARY •Abu is an 18-year-old single, unemployed Malay boy from Kota Bharu.IDENTIFICATION •He was admitted to psychiatric ward for punching his father on the of admission.CHIEF COMPLAINT •While attending National Service program about 2 months ago, he was noted to become quiet and had poor sleep. Later he was seen talking to himself, wandering at night, shouting and throwing stones to the other trainees. HISTORY OF PRESENT ILLNESS •One of his siblings has mental illness needing regular treatment.FAMILY HISTORY •He scored grade 2 in SPM in 2011. He is a smoker. He denied use of other substance. PERSONAL HISTORY •It revealed a young man with poor personal hygiene, 3rd person hallucinations discussing and commenting on him, persecutory delusions and disorganized speech. Insight and judgment were poor. MENTAL STATUS EXAMINATION
- 19. FORMULATION Biological Psychosocial Predisposing Mental illness among close relatives Premorbid adjustment, personality, early childhood experience Precipitating Drug abuse, medical illness, steroid Stress e.g., National Service program Perpetuating Current drug abuse Ongoing stress
- 20. DIAGNOSIS & INVESTIGATION Biological & Psychosocial Investigations • to get more information to established provisional diagnosis • A corroborative history from a friend, relative or other professional may be helpful • To rule out differential diagnosis • Urine drug screening test • Brain CT scan
- 21. MANAGEMENT Objective Biological Psychosocial Acute (in-patient) To reduce symptoms ECT, pharmacologic Psycho- education, occupational therapy, psychotherapy, family therapy, group therapy Maintenance (out-patient) To regain function As above As above