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Psychiatric assessment by dr perjan
1. Psychiatric
Assessment
• by
Dr.Perjan Hashim Taha
M.B.Ch.B. Msc.C.A.P. F.I.C.M.S.(Psych)
2013
2. The psychiatric interview
• Similarities between the psychiatric interview
and the general medical interview
• The goal of all communication between doctor
and patient is to diagnosis and treatment and
further the aims of the working alliance between
doctor and patient.
3. The psychiatric interview
• Differences between the psychiatric interview
and the general medical interview
• It must communicate personal concerns about
disturbed mental functioning through language
• In all cases, special tact and sensitivity are
required of the psychiatric interviewer
5. Psychiatric
Stages:
Assessment
Preparation
Collection of information: by h. and MSE
Evaluation of information: for DD.
Using of information: for R.
6. Preparing for Interview
Put patient at ease
Ensure privacy
Ensure safety of interviewer
Free from interruption
Comfortable
Arrange the chair at angle and should little at higher level
than patient
8. ?Psychiatric Interview?
Skill to encourage disclosure of personal
information for a professional purpose
Empathy → rapport → therapeutic alliance
9. :If there is possibility of violence
• Another person should know when and
where is the interview
• Ensure that help can be called if needed
(emergency call button)
• Ensure that neither the patient or any
obstruction is between the interviewer and
the exit
• Remove from sight any object that can be
used as a weapon
10. Starting of Interview
• Welcome the patient and explain the reason for
the assessment
• Greet the companion and explain how long is
expected to wait
• Keep confidentiality
• Start by open question ( tell me about your
problem?)
• Interviewer should be ( relaxed, unhurried, eye
contact, alert to verbal and non verbal cues,
control over talkative patient)
11. Assessment
• The interviewer should introduce and identify
himself, clearly explain the purpose of the
meeting with the patient.
• Invite the patient to begin in as open-ended a
manner as possible
Eg : what sort of trouble have you been having?
Tell me about the problem that bring you
here.
12. Specific interviewing
techniques
• Learn to be quiet.
• Pay attention to body language.
• Start broadly and then focus in.
13. Specific interviewing
techniques
• Remember that the patient is more
scared than you are.
• Tell the patient what you think he or she
is feeling.
• When an interview goes down, try
repeating the patient’s last words.
• Go ahead and ask the “unaskable”.
15. Psychiatric Assessment Parts
• Psychiatric History
• MSE
• Physical Examination
• Neurological Examination
• Further Investigation
16. Psychiatric History
• Name: Age: Sex: Marital status:
• Occupation: Address: Date of admission:
• Name of the informant and his/her relationship to patient
• Reason and source of refferal
I- Present Complain and duration:
II- History of present Condition:
Symptoms (onset, duration, flactuation, details)
Expected symptoms
Relationship between symptoms and physical dis., or social problem
Functional impairment
Previous R. effects and S.E.
use simple terms and try to avoid technical scientific terms
17. Chief Complaint
• What brought the patient in? Patient’s own
words
• Why now and not 6 months ago?
• What happened in the past week?
• Past 24 hours?
18. III- Family history:
1- Father and mother: including: name, age, occupation, health (mental and
physical), education, personality, attitude, and emotional relation of each with
the patient. Include divorce and separation from each. If dead time, place and
cause of death and age of the parent and the patient then.
2- Siblings: The rank of the patient. In Chronological order include name, age,
sex, occupation, marital status, health (mental and physical), personality, social
and economical status, relation with the patient and his feeling towards them.
3- Relatives: Relations and illness. Ask specifically about abnormal personality,
mental disorders, epilepsy and alcoholism.
4- Home atmosphere:
19. IV- Personal history:
1- Pregnancy and birth: include date and place of birth, mother’s condition during
pregnancy, delivery (normal, prolonged, instrumentation and operation),
(premature, low birth weight, convulsions)
2- Early childhood:
• Feeding breast or bottle.
• Development (milestones): attachment, talking, walking, bowel and bladder control
? • Neurotic symptoms; bed wetting, temper tantrum, nail biting, thumb sucking, night
terror, sleep walking, stammering, fears, mannerism, and tics.
• Behavior; playing, (alone), hostility, hyperactivity and relation with others specially the
family.
3- Adolescence and adulthood: Include social life (isolation and peer group),
difficulties and crises, fantasies.
4- Education history: School; age to start and finish school, name of schools, reaction to
school, regularity (school phobia, truancy with age), difficulties, attitude to teacher and
peers, achievements and ambitions. University and higher education.
20. 5- Occupational history: Include age of starting to work, list of job(s) and
duration and causes (if any). Regularity, job satisfaction, economical status.
6- Menstrual history: Include; age of menarche, cycle, (regularity, duration,
last period), dysmenorrhea, premenstrual tension, and menopause (time,
reaction and symptoms)
7- Sexual history: Masturbation; worries, guilt, and fantasies, any deviations or
dysfunction.
Orientation; homosexual or heterosexual
Experience; age and type.
21. 8- Marital history:
Marriage; age, date, and number
Partner; age, occupation, personality, and health
Sex; mode of intercourse, orgasm, and impotence
Satisfaction and relationship
Abortion and contraception
Extramarital relationship
Children; list in chronological order, age, sex, health, personality, and relationship.
9- Alcohol, drugs and tobacco:
Include; quantity and frequency of use
22. 10- Past Medical History:
Illnesses, operations, accidents, drug treatments
11- Past psychiatric history:
Include; date, duration, symptoms, and treatment of each.
23. 12- Forensic history:
Illegal acts, courts and prison.
13- Present social circumstances:
Include; living standard, interests and hobbies, and financial status
24. V- Premorbid personality:
1- Mood: cheerful-sad, tense-calm, optimistic-pessimistic, stable-unstable,
apathetic-inhibited.
2- Character: hesitant, self confident-shy timid, tolerant-not, expressive,
trusting-suspicious, irritable-not, sensitive-not, jealous-not.
3- Moral selfish, or altruistic, religious, rigid.
4- Energy; energetic, initiative, sluggish, or fluctuant.
5- Socially; Introvert or extrovert.
6- Fantasy life; Is he a day dreamer.
7- Habit and hobbies
27. Appearance and Behavior
• Observe from the first moment
• Ataxia
• Dressing: dirty? Wear bright color?
• Weight loss
• Facial and emotional expressions:
- corners of mouth, Vertical furrow on brows, Omega sign?
- horizontal creases on forehead, wide palpebral fissures, and
dilated pupils?
• Posture :
• Head and gaze downward?
• Social Behavior:
• Disinhibited behavior=mania withdrawal=schizophrania
• Aggression=antisocial PD as if they are elsewhere=dementia
28. Speech
• Rate
• Fast increased amount= mania
• Slaw and pauses= depression
• Difficulty speaking
• Neologisms
• Flow of speech
• Thought blocking= schiz.
• Flight of ideas= mania
29. Mood
• Depression and mania
• What is your mood like?
• Do you blame yourself?
• Fluctuation and incongruous mood
• Suicidal Ideation is very important
• anxiety
• Feelings and physical symptoms like palpitation, S.O.B.
30. Thoughts
• Thought P rocess: rapid, slow, goal
directed, tangential, circumstantial, loose,
incoherent (word salad), clang
associations, neologisms
• Thought Content: preoccupations,
obsessions, delusions, suicidal, homicidal
• De lus io ns : persecutory, grandiose, religious,
somatic, jealousy, nihilistic
31. Thoughts
• Obsessions
• Do thoughts repeated in coming to your mind? And you find difficulty
in stopping them?
• Delusions: they cannot be asked directly because patient
cannot recognize them
• So by information from other people
• Thought insersion
• Thought withdrawal
• Thought broadcasting
• Delusion of control (passivity)
• Persectary
• Gealous
• Grandious ……………etc
33. Cognitive Functions
• Orientation
• Time, place, person
• Attention and concentration
• Serial 7 test
• Memory
1. Short term memory: name and address
2. Memory for recent events: an event in last few days
3. Remote memory: event in previous years
• Calculations: addition, subtraction, multiplication, and division
• Reasoning: practical judgment;
• abstraction: similarities and proverb interpretation
34. Insight
• Recognize that he is ill
• Illness is physical or mental
• Does he think that he need treatment
35. Suicide Risk
Mood disorders: 15-20%
– Bipolar mixed highest risk
– Delusional depression
Schizophrenia: 5-10% (young male,
insight, high IQ, command hallucinations)
– 3 wks -3 mo from hospitalization
Substance abuse:
– Young male, multiple substances,
recent loss, co-morbid, previous OD
WHAT WORKS TO DECREASE RISK:
LI, CLOZAPINE, ECT, psychotherapy!!
