Psychiatric History and Mental Status Examinaiton

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Psychiatric History & Mental status examination

Transcript of Psychiatric History and Mental Status Examinaiton

  • LOGO Psychiatric History & MSE Bivin JB Department of Psychiatric Nursing Mar Baselios College Of Nursing
  • History and MSE Most important diagnostic tools To obtain information to make an accurate diagnosis From the time patient enters the interview room till he/she leaves the room
  • History & MSE Rapport A relationship of mutual understanding or trust and agreement between people
  • Basic principles of History taking Introduce yourself Explain the purpose and approx how long it will take Ask Open Ended Questions Allow the patient to Explain Things In his/her Own Words Encourage the patient to Elaborate and Explain Avoid Interrupting Guide the Interview As Necessary Avoid Asking Why? Questions Listen and Observe For Cues You might need an informant
  • History Demographic data Name Sex race Locality marital status Occupation Religious belief living circumstance
  • History Chief complaints Patient's problem or reason for the visit Recorded as the patient's own words Ask leading questions such as "What brings you here today? How can I help you?
  • History of present illness main part of the interview gather basic information of specific symptoms Include both pertinent positives and negatives Record important life events Different approaches may be needed depending on the circumstances Emergency department consult Routine Out patient evaluation
  • Onset Abrupt Acute Insidious Course Continuous Episodic Remittent
  • Precipitating factor A failed romance A death in the family Serious illnesses Failure in exams Problems in relationships
  • Important Obtain a clear chronological account of symptoms ( e.g. depression, psychosis) & the effects of these symptoms on behaviour
  • Past history Psychiatric & Medical History Life chart Family history 3 generation Genogram Family history of Psychiatric illness Family history of Medical illness Living situation Interpersonal issues
  • Personal history Birth & early development Disorders during childhood Schooling and occupation Menstrual history Marital history
  • Premorbid personality Social relations Mood Attitude towards work and responsibility Response to criticisms and praise Leisure activities and hobbies
  • Questions for PMP assessment Before all this happened, how would you describe yourself? How would other people describe you? When you find yourself in difficult situations, how do you cope? What sort of things do you like to do to relax? Do you have any hobbies? Do you like to be around other people or do you prefer your own company? Are you religious? Do you have any ambitions or plans?
  • Alcohol & drug history Do you smoke? How many? Since when? Do you take a drink? How much do you drink? Have you been drinking any more or less than normal recently? Have you ever taken drugs?
  • Forensic history Have you ever been in trouble with the police, or been convicted of anything? ***
  • LOGO Mental Status Examination
  • Definition Cross-section of the patients psychological life and sum total of nurses observations & impression of that moment. Some part of the MSE are through simple observation Others requires asking specific questions MSE is the evaluation of the patients present status
  • Descriptive Vs. Psychodyanamic Descriptive Karl Jaspers Method of describing subjective experience & pt behavior Atheoretical Not rest on any particular explanation for the cause of the abnormal status Close-observation & empathetic exploration of the subjective experience (Phenomenology) Psychodyanamic Sigmund Freud Assessing the behavioral changes by explaining the psychological process which is unaware to the pt Psychoanalysis/Hypno therapy/Dream analysis
  • Mental status examination General appearance & behavior Psychomotor activity Speech Thought Mood Perception Cognitive functions
  • General appearence Attitude toward the interview situation Consciousness Orientation Cooperativenes Rapport and attitude toward the interviewer Dress Attention Span Catatonic signs
  • Clinical implications Dilated pupil: Drug intoxication Pupil constriction: Narcotic misuse/dependance Gaze shift/stooped posture: Depression Unusual attire/colourful dress: Mania Over familiarity: Mania Seductive: Histrionic PD
  • Psychomotor activity Goal directed activity Decreased Normal Increased Level of activity: Lethargic, tense, restless, agitated Type: Grimaces, Tics, Tremors Unusual gestures
  • Disorders of motor activities Tics: Rapid irregular movements involving groups of facial or limb muscles Mannerisms Abnormal & occasional bizarre performance of a voluntary, goal-directed activity Stereotypy A negative & bizarre performance; Not goal-directed Catalepsy General term for an immobile position that is constantly maintained
  • Posturing Assumption of various abnormal bodily positions for a long time (Psychological pillow) Negativism Patient resists carrying out the examiners instructions & his attempts to move or direct the limbs Catatonia Syndrome characterized by cataleptic posturing, stereotypy, mutism, stupor, negativism, automatic obedience, echolalia & echopraxia. 1. Excitement & 2. Retardation
  • Echopraxia Imitation of another persons movements Ambitendency Series of uncertain, incomplete movements carried out when a voluntary action is anticipated Abulia Reduced impulses to act or think; associated with indifferences about the consequences of action Akinesia: Inability to move Akathisia: inability to seat/stand still
  • Clinical implications Excessive body movement (PM Agitation) Anxiety, mania, stimulant abuse Psychomotor retardation Depression, organicity, catatonic F20, drug- induced stupor Tics/grimaces S/E of Psychotropic Medications Repeated movements OCD Picking up of dirt from clothes: Delirium, Drug-toxicities
  • Speech Tone Tempo Volume Reaction time Coherent Relevant Sample of Speech:
  • Disorders of speech Pressure of speech Rapid speech that is increased in amount & difficult to interpret Poverty of speech Restriction in the amount of speech Dysprosody: Loss of normal speech melody Dysarthria: Difficulty in articulation Cluttering: erratic & Dysrythmic speech Stuttering Frequent repetition/ prolongation of a sound/syllable leading to markedly impaired speech fluency
  • Clinical implications Speech expressive problems Brain involvement, developmental problems, Eg: ELD Pressure of speech Mania Mutism/Alogia Depressive Sx/Catatonic F20
  • Thought Form Stream Posession Content Delusion Overvalued idea Depressive cognition Suicidal idea
  • Disorders of form of thought Derailment: Thoughts slides on to a subsidiary content Substitution: Major thought is substituted by a subsidiary one Omission: Senseless omission of a thought or a part of it. Fusion: Heterogenous elements of thoughts are intervowen with each other Driveling: Distorted intermixture of constituent part of one complex thought Evident through neologism, word salad etc
  • Disorders of stream of thought 1- Pressure of thought 2- Poverty of thought: A slowing down of the thinking process which hampers the formation of associations & may prevent the patient from reaching the original goal of his thoughts. 3-Thought blocking: The patient experiences a sudden break in the chain of thought (Schizophrenia). 4-Flight of ideas: A series of thoughts verbalized rapidly with abrupt shifts of subject matter with logical sequence. (Mania as well as in organic mental disorders)
  • 5- Loosening of associations: A disorder of thinking & speech in which ideas shift from one subject to another with remote or no apparent reasons. (F20) 6- Perseveration: Repetitive behavior or repetitiv