Psychiatric History

Download as ppt, pdf, or txt
Download as ppt, pdf, or txt
You are on page 1of 31

PSYCHIATRIC

HISTORY
SKILL LAB
NBSS
2007

INTRODUCTION
Greeting
Introduction the examiners self
Put the examiner and Patients at ease
Determine the suffering with Compassion and

Empathy
Establish leadership
Balance the roles
IMPORTANT Build doctor-Patient Rapport first

OUTLINE OF PSYCHIATRIC
HISTORY
Identifying Data
2.
Heteroanamnesa
- Chief complaint
- History of present illness
Onset
Precipitating factors
- The Course of Illness
3. Mental Examination
- Observation
- Autoanamnesa
1.

IDENTIFYNG DATA
Name
Age
Education
Marital Status
Occupation
Address/Residence
Religion

CHIEF COMPLAIN
Brief statement in patients own word or

why patients in Hospital or is being seen


in consultation

HISTORY OF PRESENT
ILLNESS
Development of symptoms from the time

of onset to present; physical complain;


relation of live events, conflict, stressors,
drugs, change from previous level
functioning

OUTLINE FOR THE MENTAL


STATUS EXAMINATION
1.
2.
3.
4.

5.
6.
7.

Orientation Time, Place, Person


Perception
Memory
Thought
A. Form/Process
B. Content
Mood
Psychomotor behavior
Insight of illness

MENTAL STATUS EXAMINATION


Descriptions of status of the patients

appearance, consciousness, Speech( Affect &


Tension), Action/Psychomotor and Thought
during interview
Appearance include: Face, Feature, Nutritional
status, Body type, Hygiene, Clothes, Eye
contact
Even patients mute incoherent, or refuses to
answer the clinician can obtain a wealth
information through careful observation

SIGN AND SYMPTOM


Phenomology
Edmund Hussel (1859-1938)
Based on DSM IV and ICD 10
SIGN-SYMPTOMS- SYNDROME

SIGN AND SYMPTOM OF


MENTAL DISORDERS
I.

NEUROSIS
Chronic or recurrent nonpsychotic
disorder characterized mainly by
anxiety, which is experience mainly by
anxiety, which is experienced or
expressed directly or is altered
through defense mechanism; it
appears as symptoms such as an
Obsession, Compulsion, A Phobia or
sexual Dysfunction.

II. PSIKOSIS
Loss of reality testing and impairment of
mental functioning manifested by
Delusions, Hallucinations, Confusion,
and impaired memory
Severe impairment of social and
Personal functioning characterized by
social withdrawal and inability to perform
the usual household and occupation rule

CONCIOUSNESS
State of awareness
- Disorientation
- Clouding of consciousness
- Stupor
- Delirium
- Coma
- Twilight state
- Confusion
- Drowsiness

ATTENTION
Amount of effort exerted in focusing on

certain portions of an experience, ability


to sustain a focus on one activity; ability
to concentrate
Distractibility
Selective in attention
Hipervigilance
Trance
Disinhibition

EMOTION
Complex feeling state with physic,

Somatic and Behavioral Component that


is related to affect and mood

EMOTION Cont
AFFECT

Observed expression of emotion, possibly


inconsistent with patient's description of
emotion
Appropriate affect
Inappropriate affect
Blunted affect
Restricted OR Constricted
Flat affect
Labile affect

EMOTION Cont
MOOD

Pervasive and sustained emotion


subjectively experienced and reported by
a patient and observed by other
Ex : dysphoric, euthymic, expansive,
irritable mood, mood swings, elevated
mood, euphoria, ecstacy, depression,
anhedonia,elation, hypomania, mania,
melancholia, la belle indiference

OTHER EMOTIONS

ANXIETY
FEAR
AGITATION
TENSION
PANIC
APATHY
AMBIVALENCE
ABREACTION
SHAME
GUILT
IMPULSE CONTROL
INEFFABILITY
ACATHEXIS
DECATHEXIS

MOTOR BEHAVIOR
Aspect of psyche that includes impulses,

motivations, wishes, drives, instincts and


craving as expressed by a persons
behavior or motor activity
- echopraxia, catatonia, negativism,
cataplexy, tereotype, mannerism,
automatism, mutism, overactivity,
hypokinesia, mimicry, aggresion, abulia,
anergia, dyskinesia, chorea, convulsion,
seizure, dystonia,

THINKING
Goal directed flow of idea, symbols and

association initiated by a problem or task


and leading toward a reality-oriented
conclusion when a logical sequence
occurs.
General Disturbances inform or process
of thinking; specific disturbances in form
of thought; Specific disturbances in
content of thought

THINKING Cont
General Disturbances inform or Process:

psychosis, illogical; dereism, autistic


thinking, magical thinking, primary
process, emotional insight
Specific disturbances in form of thought:
neologism, word salad, circumstantiality,
incoherence, perseveration, echolalia,
condensation, derailment, flight of idea,
clang association, blocking, glossolalia

THOUGHT incontent
Delusion: false belief, based in correct interence

about external reality, not consistent with


patients intelligence and cultural background;
cannot be corrected by reasoning
Bizare, systematic , somatic delusion, paranoid
delusion (persecution,
grandeur, reference), delusion of self
persecution, delusion of control ( thought of
control, thought of insertion, thought of
broadcasting, thought of control)

THOUGHT-incontent
- HYPOCHONDRIA

Exaggerated concern about health that is not


based on real pathology
butrather on unrealistic interpretation of physical
signs or sensational as abnormal
- OBSESSION
Pathological persistence of an irresistible
thought or feeling that cannot eliminated from
consciousness by logical effort: associated with
anxiety

THOUGHT incontent
- COMPULSION

Pathological need to act on impulse that


if resisted produces anxiety
- Phobia ( spesific phobia, social phobia,
acrophobia, agoraphobia, algophobia,
ailurophobia, claustrophobia, zoophobia)

SPEECH
DISTURBANCE IN SPEECH
APHASIC DISTURBANCE

PERCEPTION
Process of transferring physical

stimulation into psychological


information, mental process by which
sensory stimuli are brought to
awareness

PERCEPTION
Hallucination : false sensory perception

not associated with external stimuli ;


there may or may not be a decagonal
interpretation of hallucination experience
- auditory hallucination
- visual hallucination (form or unform)

PERCEPTION
Olfactory hallucination
Gustatory hallucination
Tactic/haptic hallucination
Somatic hallucination
Illusion; misperception or

misinterpretation of real external sensory


stimuli

MEMORY
Function by which information stored in

the brain is later recalled to


consciousness. orientation :normal state
of oneself and ones surroundings in
terms of time, place, and person

MEMORY DISTURBANCE
Amnesia : anterograde, retrograde.
Paramnesia : dejavu, jamais vu
Hyperamnesia
Repression

Level memory:
-immediate memory, recent, recent pass,
remote

INTELLIGENCE
Mental retardation
Dementia

INSIGHT
Intelectual insight
True insight
Impaired insight
JUDGMENT

SEKIAN

WASSALAMUALAIKUM WR. WB

You might also like