Вы находитесь на странице: 1из 38

w 

 w   

m Diagnosis based on etiology is not likely


m No external validating criteria

m Addressed by DSM
Õ Diagnostic criteria based on g  


w  
Õ ôomprehensive record of patientǯs life
Õ Derive personality characteristics
Õ Insight into nature of patientǯs relationships with
others
Õ Allow patients to tell their stories in their own words in
the order that they consider most important
w  
I. Identifying data
II. ôhief complaint
III. History of Present Illness
IV. Past Illnesses
V. Family History
VI. Personal History (Anamnesis)
VII. Sexual History
VIII.Fantasies and dreams
IX. Values


Õ Demographic summary of the patient
Õ Provide thumbnail sketch of patient
Õ Be direct in obtaining identifying data
Õ If patient is uncooperative, get information from other
sources
ô
ô 
Õ In patientǯs own words on why patient was brought in
for help
Õ Record also version of other individuals present
 w

 

Õ ôomprehensive and chronological picture of patientǯs


life
Õ Development of symptoms from time of onset to
present; precipitating events and triggering factors;
changes from previous level of functioning
Õ May ask relatives and other informants for difficult
patients
w  

Õ Medical history
Õ Psychiatric history
Õ Alcohol and Substance history
©  
Õ Brief description of
Õ any psychiatric illness, hospitalization, and treatment of
immediate family members
Õ role in patientǯs upbringing
Õ Relationship with the patient
Õ Attitude of patient towards family and siblings
w
   
 
Õ xo understand patientǯs past and its relation to the
present emotional problem
Õ Prenatal and perinatal
Õ Infancy and Early childhood (up to age 3)
Õ Middle childhood (age 3-11)
Õ Adolescence (puberty through adoloscence)
Õ Adulthood
w
 w
  
Õ Home situation into which patient was born
Õ Wanted or planned pregnancy?
Õ Maternal health problems
Õ Maternal substance abuse
 ô 
Õ Mother-child relationship
Õ Feeding habits
Õ Developmental milestones
Õ Symptoms of behavior problems
Õ xhumb sucking, tantrums, tics, night terrors, etc
Õ ôhildǯs personality
ñ
 
Õ ender identification
Õ Disciplinarian in the family and punishments used at
home
Õ Separation anxiety on first school day
Õ Relationship with friends
„
ô 
Õ xo determine patientǯs emerging self-image:
Õ Ascertain values of patientǯs peers
Õ Idealized figures

u Social relationships
u School history
u ôognitive and motor development
u Emotional and physical problems
 
Õ ^ccupational history
Õ Marital and relationship history
Õ Military history
Õ Educatioin history
Õ Religion
Õ Social activity
Õ Legal history
Ú
   
Õ ^nset of puberty and patientǯs attitude towards it
Õ Attitude towards masturbation
Õ Attitude towards sex
Õ Shy, timid, aggressive
Õ Explore any other sexual symptoms
Õ Premature ejaculation, lack of sexual desire, impotence,
etc
© 


Õ        g  

 
 Freud
Õ Repetitive dreams are of particular value
Õ Most common dreams:
Õ Food, examination, sex, helplessness, feelings of
impotence
Õ Valuable sources of unconscious material
’

Õ Social and moral values


Õ Values about money, work, play, children, parents, sex,
community concerns, cultural issues
ñ
 Ú 
Õ Describes the examinerǯs observations and
impressions of the psychiatric patient at the time of
interview
Õ Ask open ended questions
Õ Encourage patient to elaborate and explain


 

Õ ºse descriptive terms for
Õ Appearance (body type, posture, grooming, etc)
Õ Healthy, sickly poised, well kempt, well groomed, tense
posture
Õ Behavior and psychomotor activity
Õ Mannerisms, tics, restlessness, pacing, slowing of body
movements
Õ Attitude toward examiner
Õ ôooperative, friendly, attentive, frank, defensive, apathetic,
hostile
Ú


Õ Describe in terms of quantity, rate of production and
quality
Õ xalkative, unspontaneous, normally responsive,
Õ Rapid, slow, hesitant, monotonous, whispered, slurred
Õ ºnusual rhythms (dysprosody)
ñ

Õ Mood
Õ patientǯs subjective emotional state
Õ Depressed, despairing, irritable, anxious, euphoric,
frightened, perplexed
ñ

Õ Affect - objective emotional expression; what examiner infers
from patientǯs facial expression/expressive behavior

Õ Normal range
Õ Variation in facial expression, tone of voice, hand and body
movements
Õ ôonstricted
Õ Reduced range and intensity of expression
Õ Blunted
Õ Further reduced emotional expression
Õ Flat
Õ No signs of affective expression, monotonous voice, immobile
face
ñ

Õ Appropriateness
Õ ôonsidered in context of what patient is discussing
w

    

Õ Hallucination
Õ false sensory perception not based on reality (auditory,
visual, olfactory, tactile)
Õ Delusion
Õ Ȃ false interpretation of external reality

Õ V
  Ȃ as person falls asleep
Õ V
  Ȃ as person awakens
Õ   
Ȃ extreme feelings of detachment from
self or environment
x w

Õ An assessment the process of the patientǯs thinking.


Õ Involves the quantity of ideas (pressured thought,
poverty of ideas) and the way in which the ideas
(thoughts) are produced.
Õ Are they logical and relevant; are they fragmented and
irrelevant?; Do they flow logically, or are they
disconnected and Ǯfragmentedǯ?
x w

Õ Flight of ideas Ȃextreme rapid thinking


Õ Loose associations Ȃ ideas not related
Õ Blocking Ȃ interruption of train of thought before
completion
Õ ôircumstantiality Ȃ irrelevant details but gets back
to point
Õ xangentiality Ȃ no flow of conversation, never gets
back to point
x ô

Õ What a person is actually thinking about: ideas,
beliefs, preoccupations, obsessions
Õ Delusions
Õ fixed, false beliefs in keeping with patients cultural
background; may be mood congruent or incongruent
Õ ôompulsions
Õ things done over and over or in a particular way
Ú
  ô
Õ Assess brain function, including intelligence, capacity
for abstract thought and level of insight and
judgement
Ú
  ô
m Alertness and level of consciousness
u Disturbance of consciousness indicate organic brain
impairment
u Patient unable to sustain attention to environmental
stimuli
u ôlouding, stupor, coma, lethargy, alert
m ^rientation
u According to time, place and person
u Impairment appears in that order; clears in reverse
Ú
  ô
m Memory
u 3  
Õ childhood data, important events before illness
Õ Last to be impaired
u 3    Ȃ past few months
u 3   Ȃ past few days
u p
    
Õ Repeat 3 words immediately and 3-5 min later
u ô  
Õ ºnconsciously making up false memory when memory is
impaired
Ú
  ô
m ôoncentration and attention
u Subtracting serial 7ǯs from 100, simple calculations,
spelling backwards
m ôapacity to read and write
u Patient asked to read a sentence and do as it says;
write a complete sentence
m Visuospatial ability
u Patient asked to copy a figure (eg. ôlock)
Ú
  ô
m Abstract xhinking
u Ability to deal with concepts
Eg. Similarity between apple and pear?
u ôoncrete answers
u iving specific examples to illustrate the meaning
u ^verly abstract answers
u iving too generalized an explanation
Ú
  ô
m Information and intelligence
u Ability to do mental tasks such as counting change
u xakes into account patientǯs educational level and
socioeconomic status
u Psychiatrist estimates patientǯs intellectual capability
and capacity to function
  
Õ Ascertains patientǯs awareness of socially appropriate
behavior
Õ Measure of patientǯs potential danger to self and
others
0 

Õ Patientǯs understanding of the likely
outcome of his behavior
Õ ôan patient predict his/her actions in
imaginary situations (eg. Smelling smoke
in a movie theater)
 
u Patientǯs degree of awareness that they are ill
Õ 6 levels:
1. ôomplete denial of illness
2. Slight awareness of illness and needing help but denies it at
the same time
3. Awareness of being sick but blaming it on external factors
4. Awareness that illness is due to something unknown in the
patient
5. Intellctual insight Ȃ can admit they are ill and acknowledge
their failure to adapt due to own irrational feelings
6. xrue emotional insight Ȃ awareness of own motives and
feelings leads to a change in personality/behavior
3
 
Õ Estimate of psychiatristǯs impression of patientǯs
truthfulness or veracity