Psychiatric Interview & Mental Status Exam
Transcript of Psychiatric Interview & Mental Status Exam
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GOOD MORNING
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THE PSYCHIATRIC INTERVIEW, HISTORY,
and MENTAL STATUS EXAMINATION
Joge Los Baños, MD
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THE PSYCHIATRIC INTERVIEW
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Interview of Psychiatric PatientTime managementArrangement of SeatingArrangement of OfficeTaking of NotesFollow-up InterviewsInterviewing Variations
Depressed and Potentially Suicidal patientsAggressive Patients
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THE PSYCHIATRIC HISTORY
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Outline of the Psychiatric History
Identifying Data
Chief Complaint
History of Present Illness
Past Illness
Personal History (Anamnesis)
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Outline of the Psychiatric History
Personal History (Anamnesis) Prenatal and Perinatal History Early Childhood (Birth through Age 3 Years Middle Childhood (Ages 3 to 11 Years) Late Childhood (Puberty Through Adolescence) Adulthood
(Marital, Education, Religion, Social, Current, Legal) Sexual History Family History Fantasies and Dreams
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THE MENTAL STATUS EXAMINATION
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The Mental Status Examination describes the sum total of the examiner’s observations and impressions of the psychiatric patient at the time of the interview
The MSE can change from day to day or hour to hourIt is the description of the patient’s appearance, speech, actions, and thoughts during the interview
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Outline of the Mental Status Examination
General description Mood and affectivity Speech characteristics Perception Thought content and mental trends Sensorium and cognition Impulsivity Judgment and insight Reliability
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I. General Description
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Age Height Nutritional status Body type, Healthy, sickly, Old looking, young
looking Disheveled Childlike, bizarre Hairstyle Complexion
A. Appearance
PosturePoise At easeClothingGrooming, jewelry,
makeup, nailsSigns of anxiety (moist
hands, perspiring forehead, tense posture, wide eyes)
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B. Overt Behaviour and Psychomotor Activity
Mannerisms, tics, gestures, twitches Stereotyped behaviour Echopraxia Hyperactivity Agitation Combativeness Flexibility, rigidity Gait Agility Restlessness, wringing of hands, pacing Psychomotor retardation, generalized slowing down,
aimless, purposeless activity
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C. Attitude towards examiner
Cooperative, friendly, attentive, interested, seductive, frank, defensive, contemptuous, perplexed, apathetic, hostile, playful, ingratiating, evasive, guarded
Level of rapport established
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II. Mood and Affectivity
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A. Mood
Does the patient remark voluntarily about feelings or is it necessary to ask the patient how he/she feels
Depth Intensity Duration Fluctuations Depressed, despairing, irritable,
anxious, angry, expansive, euphoric, empty, guilty, awed, futile, self-contemptuous,
frightened, perplexed, labile
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B. Affect Range: within normal (Broad),
constricted, blunted or flat Difficulty in initiating, sustaining
or terminating emotional response
Mood congruent of incongruent
C. Appropriateness of affect
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III. Speech Characteristics Amount
Talkative, garrulous, voluble, taciturn, unspontaneous, normally responsive to cues from the interviewer
Tone, monotone, rhythmic Rate of production
Rapid or slow, pressured, hesitant, staccato Quality
Emotional, dramatic, loud, whispered, slurred, mumbled, accent
Speech impairment
stuttering, dysprosody
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IV. Perception Hallucinations
Sensory system involved
Auditory
Visual
Tactile
Gustatory
Olfactory
Command
Content of hallucinatory experience
Time of occurrence
Circumstances
Hypnogogic
Hypnopompic
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Illusions
Déjà vu
Jamais vu
Hypersensitivity to light, sound, smell
Distorted perceptions of time
Misconception of movement, perspective and size
Changes in body perceptions
Depersonalization and derealization
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A. Thought process
Loosening of associations
Flight of ideas
Racing thoughts
Tangentiality
Circumstantiality
Word salad or incoherence
Neologisms
Clang associations
Punning
Thought blocking
Vague thought
V. Thought content and mental trends
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B. Thought content
Delusions
Persecution
Reference
Influence
Thought broadcasting
Grandiose delusions
Somatic delusions
Delusional love
Nihilism
Capgras syndrome (belief that people have been taken
away & replaced by duplicates
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Preoccupations
Obsessions
Compulsions
Phobias
Plans
Intentions
Suicide/homicidal ideas
Hypochondriacal symptoms
Specific antisocial urges
Ideas of reference
Poverty of content
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VI. Cognition and sensorium
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Clouded
Somnolence
Stupor
Coma
Lethargy
Alertness
fugue state
obtunded
A. Consciousness
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B. Orientation and memory
Orientation to time, place & person
Do they know how long they have been in the hospital?
Do they know the people around them and their relationship with them?
Do they know who the examiner is?
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Memory
Remote (childhood memories)
Recent past (news events from past few months)
Recent (What did you have for breakfast? What did you do these past few days)
Recall & immediate retention (the interviewer’s name? 6 digits forward and back)
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C. Concentration and attention
Concentration
Subtracting serial 7’s, 3’s
Attention
Spell “world” backward span, name 5 things that start with a particular letter
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Read a sentence (ex. “Close your eyes.”) and then do what the sentence says
Write a simple but complete sentence
D. Reading and writing
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E. Visuospatial ability
Copy a clock face or interlocking pentagons
F. Abstract Thought
Concrete or overly abstract
(Explain similarities of an apple and a pear, between truth and beauty, meaning of simple proverbs)
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G. Information and intelligence
Counting change, how many 25 centavos in 1.25 pesos, vocabulary, general fund of knowledge (relative to educational background, socioeconomic status), past presidents
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Is the patient capable of controlling sexual, aggressive and other impulses?
VII. Impulsivity
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Judgement
Social Judgement – can the patient understand the likely outcome of his behaviour
Test Judgement - imaginary situation, smell smoke in a crowded movie theater; better still, situation pertinent to patient’s case
VII. Judgement and Insight
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complete denial slight awareness of being sick blaming others for the illness
illness is caused by something unknown
Intellectual insight (no application to future experiences)
True emotional insight
Insight
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IX. Reliability
In percent, poor, good
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THANK YOU