Presentation on theme: "Dr Donna Arya. In Psychiatry history= medical history and examination Getting the environment right The basic introduction for any patient Open."— Presentation transcript:
Dr Donna Arya
In Psychiatry history= medical history and examination Getting the environment right The basic introduction for any patient Open questions closed questions Its all information! Active listening
Complains of.. Pts own words History of present case How they came to your attention What did other people notice Effect on their life Past Psychiatric History Fist illness Hospitalisations Use of Mental Health Act Use of previous medications Medication and allergies Taking them?
Personal History The pregnancy Developmental milestones Health and happiness in childhood School & qualifications Relationships Bullying Occupations Sexual history Current social situations ▪ Married ▪ Accomodation ▪ Children ▪ Financial situation
Substance misuse Smoking Alcohol Illicit drugs Premorbid personality Past Medical history Family history Forensic history
Equivalent of Physical Examination in other Specialties Here and now- a snapshot Serial MSEs highlight progress Don’t assess mechanically, like a checklist Best results- informal, conversational style Observe as well as listen Quote ‘verbatim’ Conjure a mental image in listener
Age (range) Ethnicity (in general) Appropriateness of dress (kempt/unkempt) Anything striking, unusual, out of place Rapport Eye contact Appropriateness of interaction Movements/ posture Anything striking/ inappropriate?
Rate Volume Rhythm Tone Spontaneity Content (good/poor) Coherence Any thought disorder? Thought block Flight of ideas Circumstantiality Tangentiality Loosening of associations Word salad Neologisms Rhyming/punning
Orientation in time/ place/ person Attention/concentration/short term memory Deduce from taking history/general conversation Any concerns? MMSE, frontal and parietal lobe tests, psychometry, MRI scan
Why are you in hospital/clinic? Do you have an illness? If so, is it physical, psychological, spiritual, social What has made you ill? What will make you better? Medication, talking therapy, housing? Do you want to keep taking medication? Do you want to keep taking drugs/alcohol? Where do you see yourself in 5 years?
Summarise main features in the MSE Should help to make a diagnosis Should be taken in context of the full Psychiatric History and Collateral History
Further Practice Observe people’s behaviour eg- night bus colleagues’ normal behaviour! Simulated Auditory Hallucination Experiment Observe other people’s interviews and write MSE Read experienced Clinician’s MSEs More practice makes it second nature