žhttps://www.youtube.com/watch?v=7ac2IND4Yls žgeneral introduction žchoosing a place and meeting the patient ž applying interviewing techniques ž taking a psychiatric history ž mental status examination žthe purpose of a diagnostic interview is to gather information that will help the examiner make a diagnosis - the diagnosis guides treatment ž psychiatric diagnoses are based on descriptive phenomenology: signs, symptoms, and clinical course ž the psychiatric examination consists of the two arts: a psychiatric history, and mental status examination žchoose a quiet place ž new patients will almost certainly be anxious (being worried by their symptoms and about what the assessment will be like) ž shake hand and introduce yourself, use formal address (i.e. Mr., Ms.), invite patient to sit down ž be sure your patient understands the reason for your meeting (e.g. to evaluate the problems) ž your interviewing style: helping your patient tell you what is wrong! žallow the interview to flow freely, let patient describe the events of his/her live in any order he/she chooses, encourage him/her to elaborate on thoughts and feelings ž provide structure for pts. who have trouble ordering their thoughts -specific questions ž phrase your question to invite the patient to talk (open vs. closed questions) ž avoid (mis)leading questions ž help patient to elaborate ( „Tell me more about it, please go on“) žreflect your patient‘s feeling back to him (correctly verbalise patient‘s feelings) žparaphrase the patient‘s thought („You mean, you did not feel better?“) ž summarise what the patient has said žadditional tips : avoid jargon, use the patient‘s words, avoid asking why, identify thoughts versus feelings, avoid premature reassurance žIdentifying data: (name, age, ethnic, sex, occupation, number o children, place of residence) žReferral source žChief complaint („What brings you to see me?“) žHistory of the present problem: › onset of problem › duration and course › psychiatric symptoms › severity of problem › possible precipitants žPast psychiatric history: › all previous episodes and symptoms › prior treatments and response, hospitalisations ž žThe best predictor of future treatment response is past treatment response ! žPersonal history: ›Infancy: – birth history, developmental milestones ›Childhood: – pre-school years, school, academic performance ›Adolescence: – onset of puberty, early sexual experience, –peer relationships ›Adulthood – education, military experiences, employment – social life, sexual history, marriage, children žFamily history of mental illness ž žMedical history: › current medical condition and treatment › major past illnesses and treatments › medical hospitalisations › surgical history › žDrug and alcohol history 1.Appearance and behaviour (dress, facial expression, eye contact, motor activity) 2.Speech (rate, clarity) 3.Emotions (affect) 1.subjective - patient‘s description 2.objective -emotion communicated through facial expression, body posture and vocal tone ž žMood - a sustained emotion, žAffect - the way the patient shows feelings - variability, intensity, liability, appropriateness) 4.Thought a.thought speed b.thought form: –the way ideas are linked (logical, goal-directed, loose associations) c.thought content: –delusions (false beliefs) –thought insertion, thought withdrawal –depersonalisation and derealisation –preoccupations, obsessions - unwanted idea that cannot be eliminated by reasoning –phobia- obsessive, unrealistic fear › žExamples of questions (concerning thought disorder): ›Do you think anyone wants to hurt you? ›Do you feel that others can hear your thoughts or read your mind? › žAdditional tips: žWhen something does not appear to make sense, always ask for clarification!! ž 5.Perception: ›misinterpreting sensory input - illusion ›perceiving sensory input in the absence of any actual external stimulus - hallucination › ›(„Do you ever hear voices or see things other people do not hear or see?“) › ›Determine to what extent the patient is driven to actions based on a hallucination ! 6.Sensorial and intellectual functions: ›alertness (degree of wakefulness) ›orientation to person, place, time and situation ›concentration (to focus and a sustain attention) ›memory recent and remote, immediate recall (repeat 5 number forwards and backwards) ›calculation (simple arithmetic) ›fund of knowledge ›abstraction (proverbs, similarities) ›judgement and insight ž2 diagnostic systems: › ›American (American Psychiatric Association, APA) – DSM 5 › › › European and international (WHO) – ICD-10 DSM5-SM.jpg ICD10.jpg žPsychiatry studies the causes of mental disorders, gives their description, predicts their future course and outcome, looks for prevention of their appearance and presents the best ways of their treatment ž žPsychopathology describes symptoms of mental disorders žSpecial psychiatry is devoted to individual mental diseases žGeneral psychiatry studies psychopathological phenomena, symptoms of abnormal states of mind: ›consciousness ›perception ›thinking ›mood (emotions) ›memory ›intelligence ›motor ›personality žConsciousness is awareness of the self and the environment ž ž Disorders of consciousness: ›qualitative › quantitative –short-term –long-term žQuantitative changes of consciousness mean reduced vigility (alertness): ž › somnolence › sopor › coma glasgow-coma-scale.jpg žQualitative changes of consciousness mean disturbed perception, thinking, affectivity, memory and consequent motor disorders: ›delirium (confusional state) – characterized by disorientation, distorted perception, enhanced suggestibility, misinterpretations and mood disorders ›obnubilation (twilight state) – starts and ends abruptly, amnesia is complete; the patient is disordered, his acting is aimless, sometimes aggressive, hard to understood žOrientation by oneself (autopsychic) ›Knows his/her name, address, date of birth › žOrientation by circumstances (allopsychic) ›Time ›Place ›Situation › › žNormal affect – brief and strong emotional response ž žNormal mood – subjective and for a longer time lastingdisposition to appear affects adequate to a surrounding situation and matters discussed žPathological affect – very strong, abrupt affect with a short change of consciousness on its peak žPathological mood – two poles: › manic › depressive žPhobia – persistent irrational fear and wish to avoid a specific situation, object, activity žPathological mood: › origin – based on pathological grounds, usually no psychological cause › duration – unusually long-lasting › intensity – unusually strong, large changes in intensity › impossibility to be changed by psychological or voluntary means › ž Pathological moods: › euphoria › expansive › exaltation › explosive › maniac (hypomaniac) › depressive › anxious › apathy (anhedonia) › blunted, flattened affect › emotional lability › helpless https://www.coursera.org/learn/international-psychiatry/lecture/X6IZW/the-affect-in-the-mental-stat e-examination žPerception is a process of becoming aware of what is presented through the sense organs ž žImagery means an experience within the mind, usually without the sense of reality that is normal ž žPseudoillusions – distorted perception of objects which may occur when the general level of sensory stimulation is reduced ž žIllusions are psychopathological phenomena; they appear mainly in conditions of qualitative disturbances of consciousness (missing insight) ž žHallucinations are percepts without any obvious stimulus to the sense organs; the patient is unable to distinguish it from reality žHallucinations: ›auditory (acousma) ›visual ›olfactory ›gustatory ›tactile (or deep somatic) ›extracampine, inadequate ›intrapsychic (belong rather to disturbances of thinking) › hypnagogic and hypnopompic › žPseudohallucinations - patient can distinguish them from reality žThinking: Goal-directed flow of ideas and associations initiated by a problem and leading toward a reality-oriented conclusion. ž žThinking is a very complex and complicated mental function ž žThe evaluation of thoughts is based on what the patient says (via speech) žDisorders of thinking: ž ›Thought process (formal disorders) –Speed –Structure – ›Thought content žQuantitative (formal) disorders of thinking: ›poverty of thought › thought blocking › flight of ideas › perseveration › loosening of associations › word salad - incoherent thinking › neologisms › verbigeration ›https://www.coursera.org/learn/international-psychiatry/lecture/BzKL8/the-thought-process-in-the-m ental-state-examination žQualitative disorders of thought (content thought disorders): ›Delusions: –belief of (usually) bizzare content –formed by logical thinking process but based on a pathological assumption or imput –not corrected by rational arguments –not a conventional belief (not shared) –influence the behaviour – › ›Qualitative disorders of thought (content thought disorders): › –Obsessions (obsessive thought) are recurrent persistent thoughts, impulses or images entering the mind despite the person's effort to exclude them. –Obsessive phenomena in acting (usual as senseless rituals – cleaning, counting, dressing) are called compulsions. – žhttps://www.coursera.org/learn/international-psychiatry/lecture/klFvK/thought-content-and-the-delu sion žaccording to onset ›a) primary (delusional mood, perception) ›b) secondary (systematized) ›c) shared (folie à deux) › žaccording to the topic a)paranoid (persecutory) - d. of reference, d. of jealousy, d. of control, d. concerning possession of thought b)megalomanic (grandiose, expansive) – d. of power, worth, noble origin, supernatural skills and strength, amorous d. c)depressive (micromanic, melancholic) – d. of guilt and worthlessness, nihilistic d., hypochondriacal d. d)concerning the possession of thoughts –thought insertion –thought withdrawal –thought broadcasting ždelusion of self accusation (false interpretation of real past event resulting in feeling of guilt) žhypochondriac delusion (false belief of having a fatal physical illness or bizarre somatic sondition) žnihilistic delusions (false feeling that self, others or the world is non-existent or ending) ždelusions of failure (false belief that one is unable to do anything useful) ždelusion of poverty (false belief that one lost all property) ždelusion of importance (exaggerated conception of one‘s importance) ždelusion of power, extrapotence (exaggerated conception of one‘s abilities/possibilities) ždelusion of identity/origin (false belief of being the offspring of member of an important family) žMessiah delusion ždelusion of persecution (false belief that one is being persecuted) ždelusion of infidelity (false belief that one‘s partner is unfaithful) žerotomanic delusion (false belief, that someone is deeply in love with them) žfalse feeling that one‘s will, thought, movements or feelings are being controlled by someone else ž žMay include: ›Thought withdrawal ›Thought insertion ›Thought broadcasting ›Thought control žSensory stores - retains sensory information for 0.5 sec. žShort - term memory (working memory) - for verbal and visual information, retained for 15-20 sec., low capacity žLong-term memory – wide capacity and more permanent storage ›declarative (explicit) memory –episodic (for events) –semantic (for language and knowledge) › procedural memory – for motor patterns › žQuantitative: ›Hypermnesia ›Hypomnesia ›Amnesia –anterograde –retrograde – –Usually with amnestic desorientation and confabulations – – žQualitative (paramnesia) ž ›Distorted memory tracks žConcentration ž Capacity ž Tenacity ž Irritability ž Vigility ž žHypoprosexia (global, selective) žHyperprosexia žParaprosexia žhypobulia ž abulia ž hyperbulia žPsychosis: https://www.youtube.com/watch?v=ZB28gfSmz1Y&t=35s ž žDepression: https://www.youtube.com/watch?v=4YhpWZCdiZc ž žMania: https://www.youtube.com/watch?v=zA-fqvC02oM&list=PLFZTljPAn-Kx257X3b9ET8qZfVOcC8V5o&index=7&t=0s ž