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

Psychotherapy Vs Therapy

 

 Psychotherapy Vs Therapy 

Psychologists typically use one or more theories of psychotherapy.

A theory of psychotherapy serves as a road map for psychologists, directing them as they work to comprehend clients' problems and come up with answers.

The following are the top five categories of psychotherapy techniques:

• Psychodynamic therapy and psychoanalysis. By identifying the unspoken meanings and motivations behind harmful behaviours, feelings, and ideas, this method aims to change them. The therapeutic relationship between therapist and patient in psychoanalytically oriented therapies is close. By examining their interactions in the therapy relationship, patients discover more about themselves. Although Sigmund Freud is often associated with psychoanalysis, it has evolved and changed since his initial theories.
• Behavioural therapy This strategy focuses on how learning influences the emergence of both typical and aberrant behaviours.
• Ivan Pavlov's discovery of classical conditioning, or associative learning, made significant contributions to behaviour treatment. As a result of their association between the sound of the dinner bell and food, Pavlov's famous dogs, for instance, started drooling when it rang.
• The process of "desensitising" involves classical conditioning in action: A therapist may assist a client with a phobia by repeatedly exposing them to whatever anxiety-inducing stimulus they have.
• E.L. Thorndike, another influential theorist, made the discovery of operant conditioning. Rewards and penalties are used in this sort of learning to influence behaviour.
• Since the development of behaviour therapy in the 1950s, a number of variations have emerged. 
• Cognitive rehabilitation Instead than focusing on what people do, cognitive therapy stresses what they think.
• According to cognitive therapists, faulty thinking is the root cause of dysfunctional emotions or behaviours. People can alter how they feel and act by altering their thinking.
• Albert Ellis and Aaron Beck are two influential figures in cognitive therapy.
• Humanistic therapy: This method highlights people's ability to make intelligent decisions and reach their full potential. Other significant themes are caring and respect for others.
• This kind of treatment was influenced by humanistic philosophers like Jean-Paul Sartre, Martin Buber, and Sren Kierkegaard.
• Three forms of humanistic therapy have a particularly strong impact. The notion that therapists are experts on their patients' inner experiences is rejected in client-centered therapy. Instead, by expressing their concern, care, and interest, therapists aid clients in changing.
• Gestalt therapy places a strong emphasis on what is known as "organic holism," or the value of being present in the moment and taking ownership of your own actions.
• Existential therapy self-determination, and the search for meaning are key themes in existential therapy.
•  Holistic or integrative therapy Many therapists don't commit to any particular method. Instead, they combine aspects from many approaches and customise their treatment to meet the needs of each client.

 

 

Types of Amnesia 

Memory loss can take the form of amnesia. Some amnesics find it challenging to create fresh memories. Others struggle to recollect details or prior events. People who have amnesia typically still know who they are and their motor skills.

Amnesia is a memory impairment brought on by brain injury, illness, or psychological trauma. Anterograde amnesia and retrograde amnesia are the two basic categories of amnesia. The inability to recall knowledge that was learned before to a specific date, typically the date of an incident or procedure, is known as retrograde amnesia.

These may include significant life experiences, cherished memories, significant figures, and essential truths we have been given or taught.

Types of Amnesia

Amnesia comes in a variety of forms. Here is a list of some of the more typical ones:

Anterograde amnesia is the inability to recall recent information. Recent events and knowledge that have to be stored in short-term memory vanish. This typically happens after a brain trauma, such as when a hit to the head results in brain damage. The individual will recall information and occasions that occurred prior to the injury.

Retrograde amnesia is somewhat the reverse of anterograde amnesia in that the affected individual can recall events that happened after the trauma but not those that occurred before it. Anterograde and retrograde amnesia can very rarely happen simultaneously.

Transient global amnesia: including the ability to make new memories in some cases of transient global amnesia. The likelihood of this is higher in older persons with vascular (blood vessel) illness and is extremely rare.

Traumatic amnesia: Memory loss occurs after a severe brain injury, such as one sustained in a vehicle accident. The person could briefly lose consciousness or go into a coma. The amnesia is typically transient, although the length of time it lasts typically depends on the severity of the injury. Amnesia is a crucial sign of a concussion.

·       Hysterical (fugue or dissociative) amnesia:  It is extremely rare for someone to lose both their identity and their past. It's possible that when they wake up, they have no idea who they are. They do not even recognise their own reflection when they glance in the mirror. An ID card, credit card, or driver's licence will be useless. It is typically brought on by a situation that the person's mind is unable to adequately handle. Within a few days, the memory normally slowly or unexpectedly returns, but the memory of the frightening experience might never fully return.

·          Childhood amnesia, also known as infantile amnesia, is the inability to recall past events. This condition may result from difficulties with language acquisition or from the brain's memory centres not fully developing while the person is still a child.

       Posthypnotic amnesia: The inability to recollect hypnotic events.

       When someone has source amnesia, they can recall certain facts but not how or from where they learned them.

DSM Criteria

A. The primary disturbance is one or more episodes of amnesia that are too severe to be explained by regular forgetfulness. These episodes typically involve the inability to recall significant personal information and are of a traumatic or stressful nature.

B. The disturbance is not solely caused by Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder. It is also not brought on by a neurological or other general medical condition, or by the direct physiological effects of a substance (such as a drug of abuse or medication) (e.g., Amnestic Disorder Due to Head Trauma).

C. The symptoms hinder social, vocational, or other critical areas of functioning or cause clinically substantial distress.

Symptoms

Amnesia is a rare condition.

The following signs of amnesia are typical:

• In anterograde amnesia, the capacity to learn new information is diminished.
• Retrograde amnesia impairs one's capacity to recall prior events and previously known knowledge.
• There could be confusion or disorientation.
• There could be issues with short-term memory, as well as partial or complete memory loss.
• The individual might not be able to place places or identify people.

   Causes

Memory impairment may result from any brain disorder or injury. The process of remembering involves the simultaneous use of numerous brain regions.

Amnesia can result from damage to the hippocampus and thalamus, two brain regions that make up the limbic system, which regulates our emotions and memories.

Medical amnesia

Amnesia brought on by brain damage or injury.

Some causes include:

Stroke

• Brain inflammation known as encephalitis brought on by a bacterial, viral, or autoimmune infection
• A lack of oxygen brought on by, for instance, a heart attack, respiratory problems, or carbon monoxide poisoning
• Certain drugs, including the sedative Ambien
• Subarachnoid haemorrhage, often known as brain bleeding between the skull and the brain,
• A brain tumour that affects the memory-related area of the brain
• There are a few seizure disorders.
• Temporary memory loss may occur as a result of electroconvulsive therapy (ECT), often known as electroshock therapy, a type of psychiatric treatment that induces seizures for therapeutic purposes.
• Head injuries can result in temporary memory loss, though this is not always the case.

 

Psychological amnesia

This is brought on by an emotional shock and is also referred to as dissociation amnesia, such as:

• a crime with violence
• Sexual or other forms of maltreatment
• Conflict in the armed forces
• a disaster of the natural kind
• a terrorist incident

Any unbearable life circumstance that results in intense psychological stress and internal strife can create amnesia to some extent. Instead of interfering with the formation of new memories, psychological stressors are more likely to disturb existing, intimate memories.

Treatment

Amnesia typically goes away on its own without any medical assistance. However, therapy can be required if there is an underlying physical or mental condition.

Some patients can benefit from psychotherapy. Memories that have been forgotten may be recalled with success through hypnosis.

Family assistance is essential. Music, fragrances, and images could be helpful.

Techniques and ideas to aid with memory impairment are frequently used in treatment.

This may involve:

Collaborating with an occupational therapist to learn new information to supplement lost memories or to build on already-learned material to learn new information.

Acquiring techniques for information organisation to make it simpler to store.

Making use of technological tools, like cellphones, to assist with daily duties and remind patients of significant occasions, when to take medications, and other such reminders. A contact list featuring pictures of people's faces could be useful.

For amnesia-related memory loss, there are currently no medications available.

A thiamin (vitamin B1) shortage can cause memory loss in Wernicke-Korsakoff syndrome or malnutrition, thus tailored nutrition can be beneficial.

Objective Vs Projective Test 

Psychological tests measuring a person’s characteristics independently of the taker’s bias or personal beliefs. Such tests typically yield more accurate results than self-reporting or projective models, which reveal unconscious perceptions.

Example: A psychologist gives a test composed primarily of rating scales and true-false questions. 

It is intended to minimise subjectivity or bias on the part of the person administering the measure so that administering and interpreting the results do not depend on the examiner's judgement. Objective tests are measures in which responses maximise objectivity, in the sense that response options are structured such that examinees have only a limited set of options (e.g., Likert scale, true or false).

Although the term ‘objective test’ encompasses a wide range of tests with which most people are somewhat familiar (i.e. Wechsler Adult Intelligence Scale, Minnesota Multiphasic Personality Inventory, Graduate Record Examination, and the Standardized Achievement Test), it is a term that arose out of the field of personality assessment, as a response and contrast to the growing popularity of tests known as projective tests. These ‘projective tests’ require examinees to generate unstructured responses to ambiguous tasks or activities, the content of which is supposed to represent their personal characteristics (e.g. internal attitudes, personality traits).

However, the distinction between objective and projective tests is misleading, as it implies that objective tests are not subject to the influence of bias. Although the fixed response style of objective tests does not require interpretation on the part of the examiner during the administration and scoring of the measure, responses to questions are subject to the examinee’s own response style and biases, in much the same way they are for projective measures; therefore, both test ‘types’ are vulnerable to subjective factors that may affect scores. Additionally, the examinee's personal history, any current worries, and the plethora of variables that can influence the examinee's scores on the assessment are taken into account when interpreting the results of any assessment, projective or objective alike. As a result, both projective and objective exams have the potential to introduce bias and, to varied degrees, depend on interpretation judgement. The advantages of a particular usage of test scores should be assessed rather than categorising tests based on overt but superficial test characteristics.

Merits of Objective Type Test:

1.             A greater sampling of the content is possible with an objective type test.

2.             It can be scored objectively and easily. The scoring will not vary from time to time or from examiner to examiner.

3.              This test reduces

     (a) The role of luck and

     (b) Cramming of expected questions. As a result, there is greater reliability and better content validity.

4.               These questions are more effective at motivating people.

5.       It is time-efficient because answering it takes less time than an essay test. Comparatively, pupils can be shown a lot of exam items. Additionally, it saves the scorer time.

6. Eliminating elements like writing speed, expressive fluency, literary style, readable handwriting, neatness, etc. that are superfluous or extraneous.

7. It gauges the more sophisticated mental functions of comprehension, application, analysis, forecasting, and interpretation.

8.              It permits stencil, machine or clerical scoring. Thus scoring is very easy.

Limitations of Objective Type Test:

1. It is impossible to evaluate objectives like the capacity to organise information, the capacity to deliver information clearly and coherently, etc.

2. Making educated guesses is possible. Including a lot many stuff will undoubtedly decrease your chances of success.

3. The outcome could be deceptive if a respondent stamps every response as correct.

4. The objective test items are tough to construct, but they are simple to answer.

5. They demand more analysis than synthesis, which brings us.

6. The test does not at all test linguistic proficiency.

7. Printing is far more expensive than an essay test.

 

Projective Test

Projective test content is evaluated for meaning rather than being scored to a single standard as with an objective personality test. Projective personality tests claim to be able to gauge elements of your unconscious mind such personality traits, worries, doubts, and attitude. Some employers utilise this kind of testing to determine whether you are a good fit for their workplace. This approach of testing was developed by Francis Galton. In 1897, he carried out his first experiment, which involved picking a few words and allowing his mind to freely associate them.He then took the words that he generated in reaction to the original list and put them into new classifications which led think more about the possibilities of sub-consciousness and thought.

Example: The Rorschach inkblot test, where subjects are asked to describe what they see in ambiguous images, is the best-known projective personality test.

A personality test used in psychology is the projective test. This exam is carried out to comprehend the person's stimuli. In addition, the exam shows several forms of a person's concealed emotions; it also aids in understanding a person's internal issues. The objective test or a self-report test are other names for this.

The responses received from this test are properly analyzed by the experts – the presumptions are analyzed on the basis of a universal standard.

The projective tests are done under the assumption that humans have conscious and unconscious motivation and attitudes.

1. It maintains conscious and unconscious constraints:

The test confirms that every person has different demands, both conscious and unconscious. The projective tests can be used to comprehend these needs. The notion that these projective assessments may lean more toward personality is one that is frequently held. This is why it primarily addresses both conscious and unconscious components of natural human behaviour.

2. It results in spontaneous outcomes:

The person's requirements emerge organically; they are not edited in any way. It is a true representation of a person's cognitive process. Because of this, these projective tests capture the majority of unplanned actions taken by people. Additionally, it depicts the person's demands and desires clearly when they are in the midst of an emotional crisis roller coaster rides.

3. It depends upon non-verbal communication:

The subject of the test is not required to provide verbal information for the test. The person's spontaneous statements made while administering the tests are used to confirm the results.

In plainer language, it is possible to comprehend the genuine personal behaviour. Thus, it is one of the most nonverbal forms of communication wherein individuals express themselves, and which may be influenced by actions, responses, and attitudes.

4. Motivational barriers:

This investigation comprehends every personality reaction's outcome. Most significantly, all of the drives, precepts, and attitudes are easily discernible. And for that reason, adding obstacles to motivation can raise the stakes for this projective test hypothesis.

Types of Projective Tests:

There are various types of projective tests which are carried out on the individuals depending upon the needs of the person.

1. Rorschach test

2. Holtzman Inkblot test

3. Thematic Apperception Test

4. Behavioral test

5. Graphology

6. Sentence completion test:

7. The Draw-A-Person Test

8. The House-Tree-Person Test

 

Advantages of Projective Tests:

Since the findings of projective tests can differ from a person's personality, they have sparked several arguments and conflicts among professionals. But the truth is that these tests have, for the most part, come back positive. The results of this test have benefited a lot of people.

The specialists were able to assist the client in altering their behaviour and adopting a positive outlook on life. There are numerous assumptions that might be considered while doing projective testing.

Projective tests have created many debates and controversies among the experts – because at times the results may vary as compared to the personality of the person. But the fact is that these tests have proved to be positive to a large extent. There are many persons who have been benefitted because of this test.

Because they have a very common and straightforward manner of expressing their personality. Therefore, before making a final judgement, it is vital to comprehend the concept of projective tests.

People may experience various changes in their characters. And those personalities could completely mislead them.

To be clear, projection test includes a section for personality research. This section on personality studies explains the purpose of these projection tests in more detail.

Therefore, it is assumed that in terms of their visual restrictions, the projection test is superior to the stimulus.

The outcome of any form of test or examination will typically depend on the response and reflection of human behaviour. Fortunately, these projection tests led to a distraction where all of the respondent's test findings were taken into account as advantages for their own purposes. As a result, a response can better appreciate the facts and advantages of these projection tests thanks to them.

The person is unaware of what they are disclosing during the projective tests because of these tests. And all of the respondents cited it as one of the main advantages.

When performing a projective examination, the examiner's or expert's age is also taken into account. During such tests, special instructions and hints are given. As a result, projection tests' extra advantages might be used to comprehend typical human behaviour.