Clinical Interview and Psychiatric History

 

Clinical Interview

Psychiatric History and  Mental Status

Clinical interview: psychiatric history and mental status 

• general introduction
• meeting the patient and selecting a location
• Using interviewing methods
• taking a medical history

General introduction 

• The goal of a diagnostic interview is to acquire data to aid the examiner in making a diagnosis, which then informs treatment.
• Descriptive phenomenology, which includes signs, symptoms, and clinical course, forms the basis of psychiatric diagnosis.
• A mental status assessment and a psychiatric history make up the two components of the psychiatric examination.

Choosing a place and meeting the patient 

• A diagnostic interview's objective is to gather information to help the examiner make a diagnosis, which subsequently guides treatment.
• Psychiatric diagnosis is based on descriptive phenomenology, which includes signs, symptoms, and clinical course.
• The two parts of the psychiatric examination are a mental status evaluation and a psychiatric history.

Applying interviewing techniques 

• Allow the interview to run naturally, let the patient narrate his life's experiences in any sequence he chooses, and provide structure by encouraging him to comment on his thoughts and feelings. who struggle with thought organisation - particular questions
• Ask the patient a question that will encourage them to speak (open vs. closed questions)
• the use of leading questions
• assist the patient in elaborating ("Please continue by telling me more").

Applying interviewing techniques 

• Reflect back to your patient how you are experiencing (express your patient's sentiments in the right words).
• You mean, you didn't feel better?, the patient wondered.
• summarise the patient's remarks Additional advice: Avoid using jargon, speaking in the patient's words, asking why, separating thinking from feelings, and giving assurance too soon.

Taking a psychiatric history 

1.Finding information (name, age, ethnic, sex, occupation, number o children, place of residence)

2. Source of referrals

3. The main issue ('What brought you to meet me?')

4. Background of the current issue:

• onset of the issue
• duration and direction
• psychological signs
• severity of the issue
• potential precipitators

Taking a psychiatric history 

5. Past psychiatric history:

• all prior incidents and signs
• hospitalizations, prior therapies, and how they responded

The best indicator of future medical care

1. Reaction is a result of prior treatment!
2. Taking a mental health history

6. Personal history:

Infancy:

• birth history, developmental milestones

Childhood:

• early education, education, and academic performance

Adolescence:

• beginning of puberty, first sexual encounter
• peer interaction

Adulthood

• education, experience in the military, and employment
• social interactions, sexual history, union, and offspring

Taking a psychiatric history 

7. Family history of mental illness

8. Medical history:

• current medical state and being treated
• significant ailments and cures from the past
• medical inpatient stays
• surgical background

9. Drug and alcohol history

Mental status examination 

1. Appearance and behavior (dress, facial expression, eye contact, motor activity)

2. Speech (rate, clarity)

3. Emotions

• patient's description is subjective
• Objective: Expression of emotion is conveyed by facial expression, posture, and vocal tonality.

(Mood: a persistent emotion; Affect: how a patient expresses their emotions; Variability, Intensity, Liability, Appropriateness)

Mental status examination

4. Thought

a) thought form:

• the connections between ideas (logical, goal-directed, loose associations)

b) thought content:

• delusions (false beliefs) (false beliefs)
• both the insertion and disengagement of thoughts
• decrease in both personal and real aspects (sense of unreality or strangeness)
• preoccupations, obsessions - undesirable thoughts that are resistant to logic
• Phobia: an excessive, irrational fear

Mental status examination 

Examples of questions (concerning thought

disorder):

• Do you believe someone is out to get you?
• Do you believe that others are able to read your mind or hear your thoughts?

Additional advice

• Always seek explanation when something doesn't seem to make sense!
• The most crucial issue is identifying whether psychosis is present.

Mental status examination

5. Perception:

Hallucination ("Do you ever hear voices or see things other than what you can see or hear? "), illusion, and misinterpretation of sensory information

Do individuals not see or hear?

to what degree the patient is motivated to

predicated on hallucinatory behaviour

Mental status examination 

6. Sensorial and intellectual functions:

• alertness (degree of awake) (degree of wakefulness)
• orientation to the circumstance, person, place, and time
• concentration (to focus and a sustain attention) (to focus and a sustain attention)
• instantaneous recall of current and distant memories (repeat 5 number forwards and backwards)
• calculation (basic arithmetic) (simple arithmetic)
• wealth of information
• abstraction (proverbs, comparisons), 
• discernment, and understanding