evaluate

1. Psychiatric Evaluation
A. Components of Psychiatric History
B. Basic interviewing technique
C. Mental State Examination
Bizuayehu.A

2. Psychiatric History
Is the Record of the Patient's Life
• To be able to Understand the Patient
– Who the patient is
– Where the patient has come from,
– Where the patient is likely to go in the Future.
• Includes information about the patient Obtained
from other Sources
– Parent
– Spouse
– Colleagues
Bizuayehu.A

3. .
A. Components of Psychiatric History
I. Identifying Data
II. Chief Complaint
III. History of Present illness
a. Onset
b. Precipitating Factors
IV. Past illnesses
a. Psychiatric
b. Medical
c. Alcohol and other Substance History
Bizuayehu.A

4. .
V. Family History
VI. Personal History
a. Prenatal and Perinatal
b. Developmental History
c. Childhood
d. Adulthood - Occupational, Marital, Educational
History , Sexual History etc.
VII. Alcohol/Drugs History
VIII. Premorbide Personality
IX. Forensic History
X. Current or Enduring Psychosocial Stressors
Bizuayehu.A

5. I) Identification
Provide a Demographic Summary of the patient by
 Name, Age, Marital Status, Sex, Occupation,
 Language, Ethnic Background, and Religion,
 Patient's current living circumstances
Whether the patient came in on his/her own,
 Referred-Brought in by someone else.

6. Cont…
II) Chief Complaints: + duration
 What do you think is your main problem?
III) History of presenting illness:
Most important part - so Spend Time on this.
Take a detailed account of the illness from the
earliest time at which a change was noted until
consultation.
Record verbatim – if necessary
Bizuayehu.A

7. Cont’d:
 What : is the problem?
 When: did the problem start?
 How: did it develop?
 Triggers: Precipitating and Relieving factors
 Severity: associated impairment due to illness
(Physical, Psychological & Social) – functional
impairment
 Positive-Negative statements & Treatments and its
effect.
Bizuayehu.A

8. Cont…
IV) Family history:
 Any Psychiatric illness, Hospitalization, and
Treatment of the patient's immediate family members
 Family history of Alcohol and other Substance Abuse
or of Antisocial behavior
 The family's attitude toward & insight into the
patient's illness
 Patient's attitude toward each of his parents and
siblings
 Family suicidal history

9. V) Personal History:
 Prenatal and perinatal
 Infancy to School
 Adolescence and Education
 Occupational Record
 Sexual development, Relationships and Marriage
 Present social circumstances

10. Cont….
VI) Past Medical/Psychiatric History
Past Psychiatric History
In the Past have you ever had problems with your
Mental Health/Nerves/Depression?
-Have you ever seen a psychiatrist before?
-Have you ever been admitted to a psychiatric
hospital?
-What treatments have you had?
-Has there ever been a time that you felt completely
well

11. Past Medical History
 Do you have any problems with your
physical health?
 What about in the past?
 Have you ever had any operations or been in
hospital?
 What medications do you take regularly?
 What medications have you had in the past?
Bizuayehu.A

12. Cont….
VII) Alcohol & Illicit Drugs
 Do you Smoke?
 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? Tell me more about that.
 Have you ever been in trouble with the police, or been
Convicted of anything?

13. VIII) Forensic History:
 List of Offences/Charges & Legal outcome.
 Have you ever been in trouble with the
Police?
 Specially any Violent/Sexual Crimes and
Persistent Offending.

14. Cont…
IX) Premorbid Personality:
 When you are feeling well, how would you
describe Yourself?
 How would other people Describe you?
 When you find yourself in difficult situations,
what do you do to 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?

15. .
B. Basic Interviewing Techniques
Factors Influencing the Interview
 Interview Setting (office, Gen. hospital ward,
psych. Ward, Emergency Room, outpatient)
 Technical Factors (Telephone Interruptions,
use of an Interpreter, Note Taking, the patient’s
illness itself)
Bizuayehu.A

16. .
Essentials of Interview Skill
 Maintain Good Eye Contact
 Adopt a relaxed posture and do not appear to be in a
Hurry
 Show that you have the time to listen
 Show your Interest and Attention
 Developing Rapport: development of a Constructive
Therapeutic Relationship
 Putting patients and interviewers at ease, Show
Compassion
 Facilitation : Leaning forward in the chair, and saying -
yes, and then …? Or Uh-huh,

17. .
1-Identifying Nonverbal Behavior
e.g.
 A patient looks away while you are talking about
Unpleasant Issue
 or Slumps in his Chair, looks down, and Mumbles
 The Tone of the Speech Changes
Bizuayehu.A

18. .
2-Open-ended vs. Close-ended questions
 Open-ended questions Encourage people to tell you
more about what they are thinking and feeling
-Begin with Broad, Open-ended questioning,
• A Close-ended, or directive, question is one that asks
for Specific Information and allows a patient Few
options in answering –
Too many Close-ended Questions can be Restrictive

19. .
 Many levels of openness to questions
 "Tell me about your life?"
 (Close ended: Are you married?, Do you have a
job?, etc. )
 "Tell me what happened last Saturday night?"
 ( Close ended: Did you quarrel with your wife
last Saturday night? )
 "Tell me about the role alcohol plays in your life?"
 ( Close ended: "Tell me how many drinks you
take every night?")
Bizuayehu.A

20. Examples-
Open-ended Close-ended
1. Are you feeling better today?
2. Are you planning to go to the
clinic next week?
3. Did the laboratory result
make you satisfied?
4. Do you take your pills every
day?
5. Is living with Epilepsy less
difficult at the present time?
1. How do you feel Today?
2. When did you plan to go to
Clinic?
3. How did you feel about the
Laboratory Result?
4. How regular you take your
Pills?
5. What is it like to live with
Epilepsy Mental illness at the
present time?
Bizuayehu.A

21. .
3. Reflective listening and Empathic Comment
 A statement that shows you understand another’s
meaning
 You generate a hypothesis of another person’s meaning
and then share it
 The interviewer derives this greater meaning from
 the Context of what the client has said
 the Words the client has used
 the client's Non-verbal behavior.
 Focuses the client's attention on the Thoughts/Feelings

22. .
Some principles of Reflective listening
1. More listening than talking
2. Responding to what is personal rather than to what
is impersonal, distant, or abstract.
3. Restating and Clarifying what the other has said,
not asking questions or telling what the listener
feels, believes, or wants.
4. Trying to understand the Feelings contained in
what the other is saying, not just the facts or ideas.
Bizuayehu.A

23. C. Mental Status Examination
1. Appearance
2. Attitude toward Examiner
3. Speech
4. Overt Behavior and Psychomotor Activity
5. Mood and affect
6. Thinking
– Form
– Content

24. .
7. Perceptions
8. Sensorium and cognition
 Alertness
 Orientation (person, place, time)
 Concentration
 Memory (immediate, recent, long term)
 Calculations
 Fund of knowledge
 Abstract reasoning
 Judgment and Insight
Bizuayehu.A

25. 1.Appearance
Patient's appearance and overall physical impression,
 Posture, Poise
 Clothing, Grooming.
 Hair, and nails
 Examples
 Healthy, sickly,
 Ill at ease, poised,
 Old looking, young looking,
 Disheveled,
 Childlike, and bizarre
 Moist hands, perspiring forehead, tense posture,
wide eyes.

26. 2. Attitude Toward Examiner
 Cooperative,
 Friendly,
 Attentive,
 Interested,
 Frank,
 Seductive,
 Defensive,
 Contemptuous,
 Perplexed,
 Apathetic,
 Hostile,
 Playful,
 Ingratiating,
 Evasive, or guarded;
Record the level of rapport
established.
Bizuayehu.A

27. 3. Speech Characteristics
Describe the physical characteristics of speech in terms of its
o Quantity, Rate of production, Quality, tone
The patient may be described as
 Talkative, chatty,
 Taciturn, Reserved, Quiet
 Unspontaneous
Speech can be
 Rapid or slow,
 Pressured, Hesitant,
 Emotional, Dramatic,
 Monotonous,
 Loud, Whispered,
 Slurred, staccato, or mumbled

28. 4. Overt Behavior and Psychomotor Activity
Quantitative and qualitative
aspects
 Mannerisms,
 Tics,
 Gestures,
 Twitches,
 Stereotyped behavior,
 Echopraxia
 Hyperactivity
 Agitation
 Combativeness
 Flexibility
 Rigidity
 Gait and agility
 Restlessness,
 Wringing of hands
 Pacing
 psychomotor retardation
 Generalized slowing of body
movements
 Any aimless, purposeless
activity.
Bizuayehu.A

29. Cont…
Patient's mood
 Depth, intensity,
duration, and
fluctuations
Mood
 Mood - a pervasive
and sustained
emotion that colors
the person's
perception of the
world

30. Common adjectives
 Depressed
 Despairing
 Irritable
 Anxious
 Angry
 Expansive
 Euphoric
 Empty
 Frightened,
 perplexed.
Mood can be
• labile,
• fluctuating
• or alternating rapidly
between extremes
Bizuayehu.A

31. Affect
Affect
Definition - the patient's Present Emotional
responsiveness
 Affect can be described
 Within normal range; Constricted; Blunted; Flat
 Appropriateness of affect
Bizuayehu.A

32. 6. Thought Content
Thought can be divided into
• Process (or form)
• Content
A) Thought Content
 Delusions
 Obsessions - ideas that are intrusive and repetitive
 Phobias
 suicide or homicide - plans, intentions, recurrent ideas
 Hypochondriacal worries
Bizuayehu.A

33. .
B) Formal Thought Disorders
 Circumstantiality
 Clang associations.
 Derailment.
 Flight of ideas.
 Neologism.
 Perseveration. Repetition of out of context of words,
phrases, or ideas.
 Tangentially
 Thought blocking.
Bizuayehu.A

34. 7. Perception
 Can be experienced in reference to the self or the
environment.
 The sensory system involved
 Auditory
 Visual
 Taste,
 Olfactory,
 Tactile
 The content of the illusion or the hallucinatory experience
should be described

35. cont’d
The circumstances of the occurrence of any
hallucinatory experience are important
 Hypnagogic hallucinations - occurring as a person
falls asleep AND
 Hypnopompic hallucinations - occurring as a
person awakens
 have much less serious significance
 Hallucinations can also occur in particular times of
stress for individual patients
Bizuayehu.A

36. 8. Sensorium and Cognition
Components
– Alertness
– Orientation (person, place, time)
– Concentration and attention
– Memory (immediate, recent, recent past, long term)
– Calculations
– Fund of knowledge
– Abstract reasoning
Bizuayehu.A

37. cont’d
a. Alertness (Observation)
b. Orientation
 What is your name? Who am I?
 What place is this?
 Where is it located?
 What city are we in?
c. Concentration and attention
 Starting at 100, count backward by 7 (or 3)
 Say the letters of the alphabet backward starting with Z
 Name the months of the year backward starting with
December.

38. cont’d
d. Memory
– Immediate memory
• Repeat these numbers after me: 1, 4, 9, 2, 5.
– Recent memory
• What did you have for breakfast?
• What were you doing before we started talking this
morning?
• I want you to remember these three things: a yellow
pencil, a white paper, and a black coat. After a few
minutes I'll ask you to repeat them.
• Also memories of past few days
Bizuayehu.A

39. cont’d
– Long term memory
• What was your address when you were in the
third grade/ married?
• Who was your teacher/?
• What did you do during the summer between
high school and college/ when the EPRDF took
power ?
e. Calculations
– If you buy something that Birr 3.75 and you pay
with a 5 Birr bill, how much change should you
get?
– What is the cost of three oranges if a dozen oranges
cost Birr 4.00?

40. cont’d
f. Fund of knowledge –depend on patient's educational
level
 What is the distance between Gondar and Bahirdar?
 What body of water lies between South America
and Africa?
g. Abstract reasoning - the ability to deal with concepts
 Which one does not belong in this group: a pair of
scissors, a needle, and a spider? Why?
 How are an apple and an orange alike?
Bizuayehu.A

41. .
h. Judgment and Insight
Judgment
 The patient's capability for social judgment
 Can he/she understand the likely outcome of his or her
behavior
 Can the patient predict what he or she would do in
imaginary situations
Bizuayehu.A

42. .
Insight - The patient's degree of awareness and
understanding about being ill
From
 Complete denial of illness
 doubt-
 full insight
Bizuayehu.A