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PSTCHIATRIC INTERVIEW

PSTCHIATRIC INTERVIEW. By Dr. Rabie A. Hawari Consultant Psychiatrist Clinical Assistant Professor. PSYCHIATRIC INTERVIEW. The purpose of interview is:- 1. to obtain historical perspective of patient ’ s life, 2. to establish rapport and therapeutic alliance,

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PSTCHIATRIC INTERVIEW

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  1. PSTCHIATRIC INTERVIEW By Dr. Rabie A. Hawari Consultant Psychiatrist Clinical Assistant Professor

  2. PSYCHIATRIC INTERVIEW The purpose of interview is:- 1. to obtain historical perspective of patient’s life, 2. to establish rapport and therapeutic alliance, 3. to develop mutual trust and confidence, 4. to understand present functioning, 5. to make diagnosis, 6. to establish treatment plan.

  3. INTERVIEW TECHNIQUES - Arrange a comfortable setting with privacy, - Introduce yourself, greet pt. by name, tell reason of i/v. - Put pt. at ease, establish rapport by showing empathy. - Do not make value judgment. - Carefully observe pt.’s nonverbal behavior, posture, mannerisms, and physical appearance. - Avoid excessive note-making. - Do not argue or get angry.

  4. Cont. i/v tech.:- - Use language suitable with pt.’s intelligence. - Length of i/v.:- 15-90 mint. ( average 45-60 mint) less with delirious or uncooperative pt. more with verbal, cooperative pt. - Questions:- * open-ended Q?- for neurotic, verbal, intelligent pt. ““tell me more about that.” * closed-ended Q?- (yes or no) for psychotic, delirium, dementia, limited-time i/v. * avoid suggesting answers (you feel depressed, don’t you?).

  5. PSYCHIATRIC EXAMINATION

  6. PsychiatricExamination Consist of two parts:- History:- is the chronologic story of the pt.’s life from birth to present . Mental Status:- is a cross-section of pt.’s psychological life and represents the sum total of the psychiatrist’s observation and impressions at the moment, and for future comparison.

  7. Psychiatric History Identifying data:- name, age, sex, religion, marital status, education, address, occupation, source of referral and information. Chief complaint (cc):- brief statement in “ pt.’s own words” of why he is in hospital or seen in consultation. “ what seems to be the problem?”.

  8. cont. psych, hx.:- History of Present Illness (hpi):- development of symptoms from time of onset to present, relationship to events, stressors, drugs, change from previous level of functioning. h/o previous hospitalization and treatment. Past Psychiatric / Medical Illness:- psychosomatic, medical, neurological illness, extent of illness, treatment, outcome, hospital etc.

  9. Cont. psych hx.:- Family History:- age of parents & occupation, if deceased.. date & caused, separated, no. of siblings, pt.’s birth order, feelings about each member, psychiatric & medical hx. medications hx. finances.

  10. Cont. psych. hx:- Personal History:- * Birth & Infancy:- hx. of pregnancy delivery as known by pt., developmental landmarks- standing, walking, talking, temperament. * Childhood:- feeding habits, toilet training, conduct and behavior, personality- shy, outgoing relationship with parent or caregivers, peer. Fear, separation, night-mares, bedwetting. * Adolescence:- peer & authority relationship, school, drug use, puberty. * Adulthood:- work, career, marriage, children, education, finances, religion, legal record.

  11. Cont. psych hx. Sexual History:- sexual development, orientation, masturbation, anorgasmia, p.m.ejaculation. “ How did you learn about sex?”…“ are there or have there been any problems or concerns about your sex life?”. Premorbid personality:- sociable, extrovert, friends, hobbies, habits, tense, anxious, short tempered, perfectionist, easy going, other’s opinion.

  12. Mental Status General Appearance:- note appearance, gait, dress, grooming (neat or unkempt), posture, gestures, facial expressions. Does pt. appear older or younger than stated age?. introduce yourself, direct pt. to take a seat. * unkempt and disheveled  organic mental disorder, * pin-point pupils  narcotic addiction, * withdrawn psychomotor retardation  depression.

  13. Cont. MSE. Behavior :- Activity – psychomotor agitation or retardation, Emotional – anxious, tense, panicky, sad, Voice – loud, hoarse, faint, Eye – contact, Other behavior – tics, tremors, mannerism, negativism, automatism, apraxia, echopraxia, * fixed posturing, odd behavior schizophrenia, * hyperactive mania, stimulant (cocaine), * hypoactive depression, * tremor anxiety.

  14. Cont. MSE. Attitude during i/v:- How pt. relate to examiner – irritable, aggressive, seductive guarded, defensive, apathetic, cooperative, sarcastic * suspiciousness  paranoia, * seductive  hysterionic traits, * apathetic  Organic Mental Disorder - Q? “ you seem irritated about some thing, is that an accurate observation?”.

  15. Cont MSE. Mood:- Steady or sustained emotional state – gloomy, tense, sad, hopeless, elated, happy, depressed, resentful, anhedonic Qs?:- “ How do you feel?”, - “ How are your spirits?”, - “ Do you have thoughts that life is not worth living?” - “ Do you have plans to finish your own life?”, * suicide in 25% of depressed pt. * elation  mania.

  16. Cont. MSE Affect:- Feeling tone associated with idea – labile, blunt, flat, appropriate to content, inappropriate, la belle indifference. * changes in affect  schizophrenia. Speech:- Slow, fast, pressured, mute, spontaneous, aphasia, pitch, Paucity, slurred. * pressured  manic. - Slurred  Organic Mental Disorder * paucity  depression.

  17. Cont. MSE. Perceptual disorders:- - Hallucinations (olfactory, auditory, tactile, gustatory, visual). – Illusions. – Hypnopompic or Hypnagogic. - déjà vu, macroposia, feelings of unreality. * Hallucin. Visual  organicity - auditory  schizophrenia - tactile  cocaine, delirium tremens (DT). Q?:- ‘ Do you ever see things or hear voices when alone and no one else can see or hear?’ - ‘ Do you have strange experiences as you fall asleep or upon awakening ?’

  18. Cont. MSE. Thoughts Disorders:- a- Forms:- goal directed, loose of association, flight of ideas, circumstantial, knight’s move, derailment, clang association, perseveration, ability to abstract. * loose of association  schizophrenia, * flights of idea  mania. * inability to abstract  SZ. & Organic Mental Disorder. Q? – proverbs ‘ people in glass houses should not throw stones’ - similarity ‘ car and train’ (transportation)

  19. Cont. MSE Thoughts Disorders:- b- content:- Delusions –(persecutory, paranoid, guilt, grandiose, nihilistic, infidelity, hypochondriasis). -- Thought broadcasting or insertion. – ideas of reference. – obsessions.– suicide or homicide ideas. * Delusion congruent with mood  grandiose = elated. * Mood-incongruent delusion  schizophrenia. Qs? –‘Do you feel people want to harm you?’ - ‘ Do you have special powers?’ - ‘ Are there thoughts that you can’t get out of your mind?’

  20. Cont MSE Sensorium :- consciousness– alert, confused, clouded, stuporous, comatose. – orientation ( T.P.P). Qs? –‘ What place is this?’, –‘ What is the date?’ - ‘ Do you know who I am?’. * clouded consc.  Organic Mental Disorder * orientation to person remain intact longer than time or place.

  21. Cont. MSE Sensorium (cont.):- Memory:- Remote (long-term) :- Qs?. –‘ where were you born?’–‘ Date of marriage?’ * Alzheimer’s  remote remain longer than recent. * confabulation  filling gaps in memory. Recent :- Qs?. –‘ where were you yesterday?’. * organic mental diso.  recent lost before remote. Immediate (short-term):- Qs?.- Name 6 digits forward then backward. Remember 3 non-related items after 5 minutes. * loose of memory  anxiety, dissociative, conversion, organicity * anterograde M. loss  drugs e.g. Benzo * retrograde M loss  after trauma.

  22. Cont. MSE Attention & Concentration:- Qs?.- ‘ days of the week’–‘ serial 7 (100 – 7 ) and keep subtracting’–‘ simple math ( 3+4 )’ * poor  anxiety, depression. * impaired  OMD. Knowledge:- Qs?.- ‘ Name the last 3 kings’–‘ Capital of UAE’ * check educational level to r/o mental retardation. Judgment:- ability to understand relationships b/w facts and draw conclusions. Qs?.- ‘ if you find an envelopment in the street that is sealed, stamped & addressed what are you going to do with it? * impaired  OMD, schizophrenia, intoxication, low I.Q.

  23. Cont. MSE Insight:- = realize that he/she has an illness, = is it physical or mental problem?, = dose it need treatment?. Qs? - ‘ Do you think you have a problem?’ - ‘ What could the nature of the problem?’ - ‘ Do you need treatment?’ * Impaired  OMD, pychosis, low I.Q.

  24. MEDICALANDNEUROLOGICAL EXAMINATION

  25. Medical & Neurological examination:- Some psychiatrics disorders may have an organic cause. therefore neurological and/or medical examinations and investigations my be indicated in most cases examples;- * Medical Psychosis  Thyrotoxicosis, Cushing’s d., intoxication, anticholinergics. * Medical  Depression  DM, Flu, Hypothyroidism, Ca. SLE,Hepatitis,Hypoglycemia. * Drugs  Depression  Antihypertensive(Reserpine), Levodopa, Hormones, cortisone.

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