History collection format in psychiatric Nursing (Courtesy Department of Psy...Mental Health Center
Psychiatric History collection format in general psychiatric unit adapted from the department of psychiatry, National Institute of Mental Health and Neuroscienses Bangalore.
History collection format in psychiatric Nursing (Courtesy Department of Psy...Mental Health Center
Psychiatric History collection format in general psychiatric unit adapted from the department of psychiatry, National Institute of Mental Health and Neuroscienses Bangalore.
No special investigations are always available or required to make a psychiatry diagnosis. All emphasis is put on proper detailed history taking and mental status examination. This slides provides the best approach one can use to come up with a psychiatric diagnosis.
How to take history and mental status examination for a psychiatry patient.
Making a formulation and assessment of premorbid personality.
A step guide for better clerkship and diagnosis making in psychiatry.
No special investigations are always available or required to make a psychiatry diagnosis. All emphasis is put on proper detailed history taking and mental status examination. This slides provides the best approach one can use to come up with a psychiatric diagnosis.
How to take history and mental status examination for a psychiatry patient.
Making a formulation and assessment of premorbid personality.
A step guide for better clerkship and diagnosis making in psychiatry.
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
The Profile4-year-old biracial male living with his grandmother lourapoupheq
The Profile
4-year-old biracial male living with his grandmother in a high-density public housing complex.
Discussion
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.
To prepare:
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion.
Note
: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s social determinants of health?
What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select
one
of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the
Seidel's Guide to Physical Examination
text, or another tool with which you are familiar, related to your selected patient.
Develop
at least five
targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.
By Day 3 of Week 1
Post
a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Note:
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link, and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on
Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond
to
at least two
of your colleagues
on 2 differe ...
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the
Comprehensive Psychiatric Evaluation Template
AND the Rubric
as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.
In the
Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· ROS
·
Read rating descriptions to see the grading standards!
In the
Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
·
Read rating descriptions to see the grading standards!
In the
Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
DSM-5 diagnostic criteria for each differential diagnosis and explain what
DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis.
Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
·
Read rating descriptions to see the grading standards!
Reflect on this case. Include what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety sympt.
Response Post #1Culture is defined as customary beliefs, soc.docxwilfredoa1
Response Post #1
Culture is defined as customary beliefs, social forms, and material traits of a racial, religious, or social group (Webster, 2019). Competence suggests having the capacity to function effectively as an individual and an organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities (CDC, 2015). In healthcare, it is very important to be aware of different culture backgrounds. It helps with not only being able to communicate effectively but also knowing what diseases, sickness, etc. that the person is at greatest risk for. For example, in the treatment of depression, compared with white Americans, black and Latino patients are actually less likely to receive treatment (Ball et al., 2019).
The patient I was given is a 14 year old biracial male living with his grandmother in a high-density public housing complex. For the purpose of obtain a health history with this particular patient it is important to consider everything about this patient. The patients age, sex, ethnicity, living conditions, etc. will all need to be taken into account. This particular age group are reluctant to talk and have a definite need for confidentiality (Ball et al., 2019). It is important that adolescent patients be given the opportunity to speak to you privately about concerns or issues that they may have (Ball et al., 2019). It is meaningful that you let the patient know the limits of confidentiality and that if any information provided suggests that an adolescence safety or others safety may be at risk, that its grounds to “break” confidentiality (Ball et al., 2019). Prior to the office visit, there a previsit questionnaires and screeners that the patient can fill out and this sometimes helps allow the patient to write down concerns or have a choice of concerns (Ball et al., 2019). Then based off the answers, it can help you ask appropriate questions during the interviewing process.
Based off of the patients age, ethnicity, and living conditions I would use the HEEADSSS screening tool. This screening tool assess the home environment, education/employment, eating, activities, drugs, sexuality, suicide/depression, and safety from injury and violence (Ball et al., 2019). Questions that can be asked needs to be open ended questions such as …
Tell me about where you live?
How are you liking school?
What do you like to do, any activities in school or out of school?
Do you ever hang out with your friends outside of school? What do you like to do? Are you ever in situations that make you uncomfortable? Have you ever tried drugs or alcohol?
In order to assess for suicide/depression, there are screening tools. The screening questions may include asking about sleep disorders, appetite/eating behavior change, feelings of “boredom”, emotional outbursts and highly impulsive behavior, hopeless/helpless feeling, history of family with depression or suicide, suicidal ideation, history of psychosocial/em.
Department of Psychiatry and Behavioral SciencesUniversity o.docxsalmonpybus
Department of Psychiatry and Behavioral Sciences
University of Nevada, Reno School of Medicine
Bio-Psycho Social-Spiritual Model
In all our teaching, we invite students to conceptualize patient problems by using a bio-psycho-social-spiritual
formulation. This model is used throughout our curriculum in psychiatry. We ultimately want students to arrive
at patient formulations that allow for understanding and drive formation of treatment plan. Formulations help
explain "how did this patient get to this psychiatric status?"
What follows is a description of the components of the bio-psycho-social-spiritual formulation. We have
added prompts for the students to help them think about and organize clinical material. Students are
encouraged to include each component in formulations.
This model generally includes the following:
Biological
Past
Genetics:
Consider whether any blood relatives that have had psychiatric problems, substance use problems or
suicide attempts/suicides. Is there a history of close relatives who have been hospitalized for
psychiatric reasons? What kind of treatments did they get, how did they respond?
History of Pregnancy and Birth:
Consider pregnancy variables: Was there in-utero exposure to nicotine, alcohol, medications or
substances? Anything unusual about pregnancy?
Note birth complications, such as prematurity, birth trauma or extended periods of hospitalization.
Relevant Previous Illnesses
Consider any history of head injury, endocrine disorders (e.g. thyroid, adrenal), seizures, malignancies,
or neurological illnesses.
Consider potential lasting effects of past substance use on brain functions such as cognition, affective
regulation, etc.
Present
Current Illnesses:
Identify current illnesses and any direct impact they may have on psychiatric presentation.
Medications:
Assess current medication regimen. Consider whether these medications have psychoactive effects
(e.g. steroids, beta blockers, pain medications, benzodiazepines, SSRI's, antipsychotics). Consider
possible side effects of current medications.
Substances:
Consider the influence of nicotine, alcohol and street drugs on current psychiatric symptoms.
Consider the possible effects of substance withdrawal.
Psychological
Past
Comment on any past history of trauma (child abuse, combat, rape, serious illness), as well as resiliency
(how the patient coped with trauma, e.g. friends, family, religion).
Consider the sources of positive self image and positive role models.
Comment on the patient's experience with loss.
Comment on the patient's quality of relationships with important figures, such as grand parents, friends,
significant teachers, or significant employers.
Comment on how past medical problems, substance use or psychiatric problems impacted the
patient's development and their relevance to patient today.
Present
Describe the recent events and experiences that precipitated the admission or appointment.
What are the current stressors? Do they.
Initial Psychiatric InterviewSOAP Note Template There are diff.docxLaticiaGrissomzz
Initial Psychiatric Interview/SOAP Note Template
There are different ways in which to complete a Psychiatric SOAP (Subjective, Objective, Assessment, and Plan) Note. This is a template that is meant to guide you as you continue to develop your style of SOAP in the psychiatric practice setting.
Criteria
Clinical Notes
Informed Consent
Informed consent given to patient about psychiatric interview process and psychiatric/psychotherapy treatment. Verbal and Written consent obtained. Patient has the ability/capacity to respond and appears to understand the risk, benefits, and (Will review additional consent during treatment plan discussion)
Subjective
Verify Patient
Name:
DOB:
Minor:
Accompanied by:
Demographic:
Gender Identifier Note:
CC:
HPI:
Pertinent history in record and from patient: X
During assessment: Patient describes their mood as X and indicated it has gotten worse in TIME.
Patient self-esteem appears fair, no reported feelings of excessive guilt,
no reported anhedonia, does not report sleep disturbance, does not report change in appetite, does not report libido disturbances, does not report change in energy,
no reported changes in concentration or memory.
Patient does not report increased activity, agitation, risk-taking behaviors, pressured speech, or euphoria. Patient does not report excessive fears, worries or panic attacks.
Patient does not report hallucinations, delusions, obsessions or compulsions. Patient’s activity level, attention and concentration were observed to be within normal limits. Patient does not report symptoms of eating disorder. There is no recent weight loss or gain. Patient does not report symptoms of a characterological nature.
SI/ HI/ AV: Patient currently denies suicidal ideation, denies SIBx, denies homicidal ideation, denies violent behavior, denies inappropriate/illegal behaviors.
Allergies: NKDFA.
(medication & food)
Past Medical Hx:
Medical history: Denies cardiac, respiratory, endocrine and neurological issues, including history head injury.
Patient denies history of chronic infection, including MRSA, TB, HIV and Hep C.
Surgical history no surgical history reported
Past Psychiatric Hx:
Previous psychiatric diagnoses: none reported.
Describes stable course of illness.
Previous medication trials: none reported.
Safety concerns:
History of Violence
to Self: none reported
History of Violence t
o Others: none reported
Auditory Hallucinations:
Visual Hallucinations:
Mental health treatment history discussed:
History of outpatient treatment: not reported
Previous psychiatric hospitalizations: not reported
Prior substance abuse treatment: not reported
Trauma history: Client does not report history of trauma including abuse, domestic violence, witnessing disturbing.
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
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Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
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According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. The psychiatric history is the record of the patient's life; it
allows a psychiatrist to understand:
Who the patient is,
Where the patient has come from, and
Where the patient is likely to go in the future.
The history is the patient's life story told to the
psychiatrist in the patients own words from his or her own
point of view or from other sources, such as a parent or
spouse.
The most important technique for obtaining a psychiatric
history is to allow patients to tell their stories in their own
words in the order that they consider most important.
As patients relate their stories, skilful interviewers
recognize the points at which they can introduce relevant
questions about the areas described in the outline of the
history and mental status examination.
2020-09-09 2
3. The identifying data provide a succinct
demographic summary of the patient by name,
age, marital status, sex, occupation, language (if
other than English), ethnic background, and
religion, insofar as they are pertinent, and the
patient's current living circumstances.
Place or situation in which the current interview
took place, the source(s) of the information, the
reliability of the source(s), and whether the
current disorder is the first episode for the
patient.
Whether the patient came in on his or her own,
was referred by someone else, or was brought in
by someone else.
2020-09-09 3
4. The presenting complaint, in the patient's own words,
states why he or she has come or been brought in for
help.
It should be recorded even if the patient is unable to
speak, and the patient's explanation, regardless of how
bizarre or irrelevant it is, should be recorded verbatim
in the section on the presenting complaint.
If the patient is comatose or mute that should be
noted in the chief complaint as such.
Specify the duration of Chief complaints
Examples of Chief Complaints follow:
I am having thoughts of wanting to harm myself.•
People are trying to drive me insane.
I feel I am going mad.
I have no complaint
I am here because of my skin rash
2020-09-09 4
5. Comprehensive and chronological picture of the
events leading up to the current moment in the
patient's life.
This part of the psychiatric history is probably the
most helpful in making a diagnosis
When was the onset of the current episode, and what
were the immediate precipitating events or triggers?
An understanding of the history of the present illness
helps answer the questions:
Why now?
Why did the patient come to the doctor at this time?
What were the patient's life circumstances at the
onset of the symptoms or behavioural changes, and
how did they affect the patient so that the
presenting disorder became manifest?
2020-09-09 5
6. The patient's symptoms, extent of incapacity, type of treatment received,
names of hospitals, length of each illness, effects of previous treatments, and
degree of compliance should all be explored and recorded chronologically.
Particular attention should be paid to the first episodes that signalled the
onset of illness, because first episodes can often provide crucial data about
precipitating events, diagnostic possibilities, and coping capabilities.
With regard to medical history, the psychiatrist should obtain a medical
review of symptoms and note any major medical or surgical illnesses and
major traumas, particularly those requiring hospitalization.
Episodes of cranio-cerebral trauma, neurological illness, tumors, and seizure
disorders or HIV-AIDS.
A history of infection with syphilis is critical and relevant.
All patients must be asked about alcohol and other substances used, including
details about the quantity and frequency of use. It is often advisable to frame
questions in the form of an assumption of use, such as, “How much alcohol
would you say you drink in a day?”•Rather than “Do you drink?”
Many medical conditions and their treatments cause psychiatric symptoms
e.g. Endocrinopathies such as hypothyroidism or Addison's disease may
manifest with depression, treatment with corticosteroids can precipitate
manic and psychotic symptoms.
In addition, the coexistence of physical disease may result in secondary
psychiatric symptoms.
A middle-aged man in the aftermath of a heart attack may suffer from
anxiety and depression.
2020-09-09 6
7. A brief statement about any psychiatric illness,
hospitalization, and treatment of the patient's
immediate family members should be placed in
the family history part of the report.
Does the family have a history of alcohol and
other substance abuse or of antisocial behavior?
The psychiatrist should determine the family's
attitude toward, and insight into, the patient's
illness.
Does the patient feel that the family members
are supportive, indifferent, or destructive? What
is the role of illness in the family?
2020-09-09 7
8. Prenatal and Perinatal
Full-term pregnancy or premature
Vaginal delivery or caesarian
Drugs taken by mother during pregnancy (prescription and recreational)
Birth complications
Defects at birth
Infancy and early childhood
Infant-mother relationship
Problems with feeding and sleep
Significant milestones
Standing/walking
First words/two-word sentences
Bowel and bladder control
Other caregivers
Unusual behaviours (e.g., head-banging)
Middle childhood
Preschool and school experiences
Separations from caregivers
Friendships/play
Methods of discipline
Illness, surgery, or trauma
2020-09-09 8
9. Adolescence
Onset of puberty
Academic achievement
Organized activities (sports, clubs)
Areas of special interest
Romantic involvements and sexual experience
Work experience
Drug/alcohol use
Symptoms (moodiness, irregularity of sleeping or eating, fights and arguments)
Young adulthood
Meaningful long-term relationship
Academic and career decisions
Military experience
Work history
Prison experience
Intellectual pursuits and leisure activities
Middle adulthood and old age
Changing family constellation
Social activities
Work and career changes
Aspirations
Major losses
Retirement and aging
2020-09-09 9
10. Marital and Relationship History
History of each marriage, legal or common law.
Education History
How far did the patient go in school? What was the highest grade or graduate
level attained? What did the patient like to study, and what was the level of
academic performance? How far did the other members of the patient's family go
in school, and how do they compare with the patient's progress? What is the
patient's attitude toward academic achievement?
Religion
Was the family's attitude toward religion strict or permissive, and were there any
conflicts between the parents over the child's religious education?
Does the patient have a strong religious affiliation, and, if so, how does this
affiliation affect the patient's life?
What does the patient's religion say about the treatment of psychiatric or medical
illness? What is the religious attitude toward suicide?
Social Activity
Social life and the nature of friendships, with an emphasis on the depth,
duration, and quality of human relationships.
Does the patient prefer isolation, or is the patient isolated because of anxieties
and fears about other people? Who visits the patient in the hospital and how
frequently?
Sexual History
Whether sexually active or not?
Sexual orientation
2020-09-09 10
12. Describes the sum total of the examiner's
observations and impressions of the psychiatric
patient at the time of the interview.
Whereas the patient's history remains stable, the
patient's mental status can change from day to
day or hour to hour.
The mental status examination is the description
of the patient's appearance, speech, actions,
and thoughts during the interview.
2020-09-09 12
13. Appearance
Describe the patient's appearance and
overall physical impression, as reflected by
posture, poise, clothing, and grooming.
Examples of items in the appearance
category include body type, posture, poise,
clothes, grooming, hair, and nails.
Common terms used to describe appearance
are healthy, sickly, ill at ease, poised, old
looking, young looking, dishevelled,
childlike, and bizarre. Signs of anxiety are
noted: moist hands, perspiring forehead,
tense posture, wide eyes.
2020-09-09 13
14. Here is described both the quantitative and
qualitative aspects of the patient's motor
behavior. Included are mannerisms, tics,
gestures, twitches, stereotyped behavior,
echopraxia, hyperactivity, agitation,
flexibility, rigidity, gait, and agility.
Describe restlessness, wringing of hands,
pacing, and other physical manifestations.
Note psychomotor retardation or generalized
slowing of body movements. Describe any
aimless, purposeless activity.
2020-09-09 14
15. Cooperative, friendly, attentive, interested,
frank, seductive, defensive, perplexed,
apathetic, hostile, evasive, or guarded;
Record the level of rapport established.
Was the patient easy to engage with?
2020-09-09 15
16. Mood: Mood is defined as a pervasive and sustained
emotion that colors the person's perception of the
world.
The psychiatrist is interested in whether the
patient remarks voluntarily about feelings or
whether it is necessary to ask the patient how he or
she feels.
Statements about the patient's mood should include
depth, intensity, duration, and fluctuations.
Common adjectives used to describe mood include
depressed, despairing, irritable, empty, guilty,
hopeless, anxious, angry, expansive, elated,
euphoric, irritable, futile, self-contemptuous,
frightened, and perplexed. Mood can be labile,
fluctuating or alternating rapidly between extremes
(e.g., laughing loudly and expansively one moment,
tearful and despairing the next).
2020-09-09 16
17. Euthymia
Normal range of mood, implying absence of depressed or elevated mood
Elevated mood
Air of confidence and enjoyment; a mood more cheerful than normal but
not necessarily pathological.
Expansive mood
Expression of feelings without restraint, frequently with an overestimation
of their significance or importance. Seen in mania.
Euphoria
Exaggerated feeling of well-being that is inappropriate to real events. Can
occur with drugs such as opiates, amphetamines, and alcohol.
Elation
Mood consisting of feelings of joy, euphoria, triumph, and intense self-
satisfaction or optimism. Occurs in mania when not grounded in reality.
2020-09-09 17
18. Affect can be defined as the patient's present emotional
responsiveness, inferred from the patient's facial expression,
including the amount and the range of expressive behavior.
Affect can be described as within normal range. In the normal
range of affect can be variation in facial expression, tone of
voice, use of hands, and body movements.
Affect can be classified as restricted, blunted, flattened,
appropriate, or inappropriate.
Restricted affect
Reduction in intensity of feeling tone
Blunted affect
Disturbance of affect manifested by a severe reduction in the
intensity of externalized feeling tone; one of the fundamental
symptoms of schizophrenia
Flat affect
Absence or near absence of any signs of affective expression.
The patient's voice is monotonous and the face should be
immobile and expressionless. The patient has difficulty in
initiating, sustaining, or terminating an emotional response.
2020-09-09 18
19. Appropriateness of Affect
The appropriateness of the patient's emotional
responses in the context of the subject the
patient is discussing.
Delusional patients who are describing a delusion
of persecution should be angry or frightened
about the experiences they believe are
happening to them. Anger or fear in this context
is an appropriate expression.
The term inappropriate affect is used for a
quality of response found in some schizophrenia
patients, in whom the patient's affect is
incongruent with what the patient is saying
(e.g., flattened affect when speaking about
grandiose ideas).
2020-09-09 19
20. Speech: Spontaneous or non-spontaneous
Rate: Rapid, slow, pressured, hesitant, slurred
Volume: loud, whispered, slurred
Tone: emotional, monotonous, dramatic
The patient may be described as talkative, voluble
Pressure of speech: Increased production of speech
wherein a person can’t be stopped once he starts
speaking
Poverty of speech: Where in the patient is not
speaking much or there is restriction in the amount
of speech or is speaking in monosyllables
Poverty of content of speech: The patient speaks
adequately but it contains little information because
of its vagueness, emptiness or stereotyped phrases
2020-09-09 20
21. Perceptual disturbances, such as hallucinations,
illusions (misinterpretation of normal stimuli),
depersonalisation (sense of unreality in relation to
self) and derealisation (sense of unreality in relation
to surroundings). The hallucinations occur in five
sensory modalities (e.g., auditory, visual, taste,
olfactory, or tactile).
The circumstances of the occurrence of any
hallucinatory experience are important; hypnagogic
hallucinations (occurring as a person falls asleep) and
hypnopompic hallucinations (occurring as a person
awakens) have much less serious significance than
other types of hallucinations.
Formication, the feeling of bugs crawling on or under
the skin, is seen in cocainism.
Examples of questions used to elicit the experience
of hallucinations include the following: Have you ever
heard voices or other sounds that no one else could
hear or when no one else was around? Have you
experienced any strange sensations in your body that
others do not seem to see?
2020-09-09 21
22. A young man with schizophrenia heard an insistent
voice repeatedly telling him to stop his antipsychotic
medication. After resisting the command for many
weeks, the patient felt that he could no longer fight
the voice, and he discontinued treatment. Two months
later, he was hospitalized involuntarily and near
cardiovascular collapse. He later said that once he
stopped the medication, the voice further insisted
that he should stop eating and drinking to purify
himself.
A terrified 37-year-old man in acute psychosis glanced
agitatedly about the room. He pointed out the
window and said: My God, the Spanish armada is on
the lawn. They're about to attack.•He experienced the
hallucination as real, and it persisted intermittently
for 3 days before abating. Subsequently, the patient
had no memory of the experience.
2020-09-09 22Dr. Ravi Paul
23. Thought can be divided into PROCESS (OR FORM)
and CONTENT.
Process refers to the way in which a person puts
together ideas and associations, the form in
which a person thinks. Process or form of thought
can be logical and coherent or completely
illogical and even incomprehensible.
CONTENT refers to what a person is actually
thinking about: overvalued ideas, delusions,
preoccupations, obsessions.
THOUGHT PROCESS (FORM OF THINKING)
The patient may have either an overabundance
or a poverty of ideas. There may be rapid
thinking, which, if carried to the extreme, is
called a flight of ideas. A patient may exhibit
slow or hesitant thinking.
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24. Clang associations. Thoughts are associated by the sound
of words rather than by their meaning (e.g., through
rhyming or assonance).
Loosening of association: A breakdown in both the logical
connection between ideas and the overall sense of goal-
directedness. The words make sentences, but the
sentences do not make sense.
Flight of ideas. A succession of multiple associations so
that thoughts seem to move abruptly from idea to idea;
often (but not invariably) expressed through rapid,
pressured speech.
Neologism. The invention of new words or phrases or the
use of conventional words in idiosyncratic ways.
Perseveration. Repetition of out of context of words,
phrases, or ideas.
Tangentiality. In response to a question, the patient gives
a reply that is appropriate to the general topic without
actually answering the question. Example:
Doctor: Have you had any trouble sleeping lately?•
Patient: I usually sleep in my bed, but now I'm sleeping on
the sofa.•
Thought blocking. A sudden disruption of thought or a
break in the flow of ideas.
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25. A young man with schizophrenia, a college
dropout who could work only part time at low-
level jobs and who lived with his high-achieving
family, believed he was the Messiah. He was
fully convinced that his struggles and lack of
occupational success were merely God's tests
until the patient's true identity would be
revealed. As he improved, he would, if asked,
say that he was God's chosen but, when
questioned further, would admit the slight
possibility that he was wrong. On reaching his
best clinical state, he would muse on the
possibility that he was the Messiah but state
that he was not sure.
2020-09-09 25
26. Consciousness
Disturbances of consciousness usually indicate organic brain
impairment. Clouding of consciousness is an overall reduced
awareness of the environment. A patient may be unable to
sustain attention to environmental stimuli or to maintain
goal-directed thinking or behavior. A patient typically exhibits
fluctuations in the level of awareness of the surrounding
environment.
Questions Used to Test Cognitive Functions in the
Sensorium Section of the Mental Status Examination
1. Alertness
(Observation)
2. Orientation
What is your name? Who am I?
What place is this? Where is it located?
What city are we in?
3. Concentration
Starting at 100, count backward by 7 (or 3).
Say the letters of the alphabet backward starting with Z.
Name the months of the year backward starting with
December?
2020-09-09 26
27. 4. Memory
Immediate
Repeat these numbers after me: 1, 4, 9, 2, 5.
Recent
What did you have for breakfast?
What were you doing before we started talking this morning?
I want you to remember these three things: a yellow pencil, a cocker
spaniel, and Chipata. After a few minutes I'll ask you to repeat them.
Long term
What was your address when you were in the third grade?
Who was your teacher?
What did you do during the summer between high school and college?
5. Calculations
If you buy something that costs 300K and you pay with a 500K, how much
change should you get?
What is the cost of three oranges if a dozen oranges cost 4000K?
6. Fund of knowledge
What is the distance between Kabwe and Lusaka? What body of water lies
between Zambia and Zimbabwe?
7. Abstract reasoning
Which one does not belong in this group: a pair of scissors, a knife, and a
spider? Why?
How are an apple and an orange alike
2020-09-09 27
28. Judgment
During the course of history taking, the psychiatrist should be able
to assess many aspects of the patient's capability for social
judgment. Does the patient understand the likely outcome of his or
her behavior?
Insight
Insight is a patient's degree of awareness and understanding about
being ill.
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29. A summary of six levels of insight follows:
Complete denial of illness
Slight awareness of being sick and 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 caused by something unknown in
the patient
Intellectual insight: admission that the patient is ill and
that symptoms or failures in social adjustment are caused
by the patient's own particular irrational feelings or
disturbances without applying this knowledge to future
experiences
True emotional insight: emotional awareness of the
motives and feelings within the patient and the important
persons in his or her life, which can lead to basic changes
in behavior.
2020-09-09 29
30. Physical examination
Neurological examination
Additional psychiatric diagnostic
Interviews with family members, friends, or
neighbours by a social worker
Psychological, neurological, or laboratory tests
as indicated: Electroencephalogram, computed
tomography scan, magnetic resonance imaging,
tests of other medical conditions, reading
comprehension and writing tests, test for
aphasia, projective or objective psychological
tests, dexamethasone-suppression test, 24-
hour urine test for heavy metal intoxication,
urine screen for drugs of abuse
2020-09-09 30
32. Diagnostic classification is made according to DSM-IV-TR,
which uses a multi-axial classification scheme consisting of
five axes, each of which should be covered in the diagnosis
Axis I: Clinical syndromes (e.g., mood disorders,
schizophrenia, generalized anxiety disorder) and other
conditions that may be a focus of clinical attention
Axis II: Personality disorders, mental retardation, and
defense mechanisms
Axis III: Any general medical conditions (e.g., epilepsy,
cardiovascular disease, endocrine disorders)
Axis IV: Psychosocial and environmental problems (e.g.,
divorce, injury, death of a loved one) relevant to the illness
Axis V: Global assessment of functioning exhibited by the
patient during the interview (e.g., social, occupational, and
psychological functioning); a rating scale with a continuum
from 100 (superior functioning) to 1 (grossly impaired
functioning) is used
2020-09-09 32
33. Need for admission/ outpatient Rx
Comprehensive treatment planning
requires a therapeutic team approach
using the skills of psychologists, social
workers, nurses, activity and occupational
therapists, and a variety of other mental
health professionals, with referral to self-
help groups (e.g., Alcoholics Anonymous
[AA]) if needed.
2020-09-09 33
Editor's Notes
Mannerism: Habitual involuntary movement; Stereotypy: Continuous mechanical repetition of speech or physical activity; Tics: Involuntary spasmodic stereotyped movement of a group of muscles;