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Presentation on theme: "CHIEF COMPLAINT HISTORY OF PRESENT ILLNESS INTERVIEWING ABOUT FEELINGS Class 2."— Presentation transcript:


2 Chief Complaint  Chief Complaint – The client’s stated reason for seeking care at the present time.  This is also sometimes called the ‘Presenting Problem’  This is typically the answer to your variation on the opening question: “Tell me what brings you here today.”  Record the answer verbatim

3 Chief Complaint  Sometimes the client’s stated reason for coming for help is not the most important issue they are facing  As the interview progresses, be on alert for information indicating problems underlying or in addition to the chief complaint

4 Chief Complaint  Use non-directive/open-ended questions early  Questions that allow a broad range of responses  This yields greater rapport and more reliable information  This encourages “free speech”  Use directive or closed-ended questions later  Yes-or-no questions or questions with limited response options  To narrow down specifics more efficiently

5 Free Speech  Give client opportunity for free speech after they have stated their chief complaint.  Allow client to elaborate freely on chief complaint  Encourages widest possible range of information  Encourages rapport by indicating your interest  Gives clinician time to begin to observe and evaluate client’s personality and presentation  Allow “free speech” to continue as long as information being given is relevant and important  To wrap up “free speech,” briefly summarize each problem and ask client to assess your accuracy

6 History of Present Illness  Use information given in “free speech” to begin diagnostic exploration.  Description of Sx  Presence/absence of vegetative Sx  Consequences of Illness  Onset and sequence of Sx  Stressors  Previous Episodes of Illness  Previous Tx  You need basic fund of information regarding Sx and disorders in order to conduct this part of interview thoroughly and efficiently

7 History of Present Illness  As you begin, diagnostic assessment, be alert for indications of problems in the major areas of clinical interest (see Morrison, p. 23 & Ch. 13):  Difficulty thinking  Substance misuse  Psychosis  Mood disturbance (depression and mania)  Anxiety disorders  Physical complaints  Social and personality problems

8 Identifying Major Signs and Symptoms  First look for “tip-offs:” indicators that would make you consider certain diagnostic areas  Consider the main diagnoses in that area and be familiar with the general Sx profile for those diagnoses  Get good historical information about all Sx so you can check if it strengthens or weakens your diagnostic hypotheses  Do a thorough MSE so you can check for typical features related to diagnoses your are considering

9 Description of Sx  Symptom – any subjective sensation that makes the client think something is wrong  Specific description of nature and quality of Sx Type Severity  Timing, duration, frequency of Sx  Stressors or contexts related to Sx

10 Vegetative Sx  Vegetative Sx are body functions that are concerned with maintaining well-being  Sleep  Appetite  Weight change  Energy level  Diurnal variation of mood  Sexual interest

11 Consequences of Illness  How has illness affected functioning (social, family, occupational/educational)  Can indicate severity  Some Dx depend on social consequences  Are social problems seen by client as source of problems, really the result of mental problems?  Ask open-ended questions first, then get specifics about any problem areas indicated by client

12 Onset and Sequence of Sx & Stressors  Get timing and progression of Sx, including which Sx started first  Get as precise information as you can  Here you are going to be directive  Stressor – Any condition or event that seems to cause, worsen, or precipitate client’s mental health problems.  Stressors can also be caused by mental health problems and then exacerbate those problems  Typically, look for stressors occurring within the past year  Ask if anything significant was going on in client’s life around time of onset of Sx or that led them to seek Tx now.

13 Previous Episodes and Tx  Knowing about previous episodes of an illness can help with Dx and Px  Ask about or assess degree of recovery between episodes  How did client deal with previous episodes?  Ask if client has ever sought Tx before  Specific type Especially ask re Rx and hospitalization  When  How much/how often  Degree of compliance  Perceived effectiveness

14 Getting Valid Information  Getting facts about client’s illness that are as valid as possible is the most important goal of the interview  Use open-ended questions as much as possible  Talk the client’s language  Choose questions that invite facts, not speculation Avoid asking “why?”  If client presents contradictory information, get clarification, but gently Take responsibility for misunderstanding on yourself

15 Interviewing About Feelings  Getting information on how your client feels about the facts s/he presents is as important as getting the facts.  Most people will willingly and easily tell you about their feelings.  If they don’t, you need to elicit feelings

16 Eliciting Feelings  Directly ask  Use open-ended questions  Express sympathy/concern  Reflect feelings  If you’re wrong, at least they’ll tell you their actual feelings  Pick up on emotional cues  Verbal and non-verbal  Interpretation  Can be risky

17 Interviewing for Feelings  Follow-up for details when you have indications information is significant  Learn what defense mechanisms client uses, i.e., how do they cope with feelings?  Can be potentially harmful or effective (see Morrison, p. 66)

18 Interviewing for Feelings  Some clients will be excessively emotional which can impede the progress of the interview. In this case:  Acknowledge the emotion  Talk quietly  Explain what information you need  Redirect if client’s comments change the topic  Switch to a closed-ended more directive style  Ensure client understands what you are asking for  There may be times when you have to let the emotions run and postpone the rest of the interview for another time.


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