PSYCHIATRIC HISTORYSKILL LAB NBSS 2007

INTRODUCTIONGreetingIntroduction the examiners selfPut the examiner and Patients at easeDetermine the suffering with Compassion and EmpathyEstablish leadershipBalance the roles

IMPORTANT Build doctor-Patient Rapport first

OUTLINE OF PSYCHIATRIC HISTORYIdentifying DataHeteroanamnesa- Chief complaint- History of present illness Onset Precipitating factors- The Course of Illness3. Mental Examination- Observation- Autoanamnesa

IDENTIFYNG DATANameAgeEducationMarital StatusOccupationAddress/ResidenceReligion

CHIEF COMPLAINBrief statement in patients own word or why patients in Hospital or is being seen in consultation

HISTORY OF PRESENT ILLNESSDevelopment of symptoms from the time of onset to present; physical complain; relation of live events, conflict, stressors, drugs, change from previous level functioning

OUTLINE FOR THE MENTAL STATUS EXAMINATIONOrientation Time, Place, PersonPerceptionMemoryThoughtA. Form/ProcessB. ContentMoodPsychomotor behaviorInsight of illness

MENTAL STATUS EXAMINATIONDescriptions of status of the patients appearance, consciousness, Speech( Affect & Tension), Action/Psychomotor and Thought during interview Appearance include: Face, Feature, Nutritional status, Body type, Hygiene, Clothes, Eye contactEven patients mute incoherent, or refuses to answer the clinician can obtain a wealth information through careful observation

SIGN AND SYMPTOMPhenomologyEdmund Hussel (1859-1938)Based on DSM IV and ICD 10SIGN-SYMPTOMS- SYNDROME

SIGN AND SYMPTOM OF MENTAL DISORDERSNEUROSISChronic or recurrent nonpsychotic disorder characterized mainly by anxiety, which is experience mainly by anxiety, which is experienced or expressed directly or is altered through defense mechanism; it appears as symptoms such as an Obsession, Compulsion, A Phobia or sexual Dysfunction.

II. PSIKOSISLoss of reality testing and impairment of mental functioning manifested by Delusions, Hallucinations, Confusion, and impaired memorySevere impairment of social and Personal functioning characterized by social withdrawal and inability to perform the usual household and occupation rule

CONCIOUSNESSState of awarenessDisorientationClouding of consciousnessStuporDeliriumComaTwilight stateConfusionDrowsiness

ATTENTIONAmount of effort exerted in focusing on certain portions of an experience, ability to sustain a focus on one activity; ability to concentrateDistractibilitySelective in attentionHipervigilanceTranceDisinhibition

EMOTIONComplex feeling state with physic, Somatic and Behavioral Component that is related to affect and mood

EMOTION ContAFFECTObserved expression of emotion, possibly inconsistent with patient's description of emotionAppropriate affectInappropriate affect Blunted affectRestricted OR Constricted Flat affectLabile affect

EMOTION ContMOODPervasive and sustained emotion subjectively experienced and reported by a patient and observed by otherEx : dysphoric, euthymic, expansive, irritable mood, mood swings, elevated mood, euphoria, ecstacy, depression, anhedonia,elation, hypomania, mania, melancholia, la belle indiference

OTHER EMOTIONSANXIETYFEARAGITATIONTENSIONPANICAPATHYAMBIVALENCEABREACTIONSHAMEGUILTIMPULSE CONTROLINEFFABILITYACATHEXISDECATHEXIS

MOTOR BEHAVIOR Aspect of psyche that includes impulses, motivations, wishes, drives, instincts and craving as expressed by a persons behavior or motor activityechopraxia, catatonia, negativism, cataplexy, tereotype, mannerism, automatism, mutism, overactivity, hypokinesia, mimicry, aggresion, abulia, anergia, dyskinesia, chorea, convulsion, seizure, dystonia,

THINKINGGoal directed flow of idea, symbols and association initiated by a problem or task and leading toward a reality-oriented conclusion when a logical sequence occurs.General Disturbances inform or process of thinking; specific disturbances in form of thought; Specific disturbances in content of thought

THINKING ContGeneral Disturbances inform or Process: psychosis, illogical; dereism, autistic thinking, magical thinking, primary process, emotional insightSpecific disturbances in form of thought: neologism, word salad, circumstantiality, incoherence, perseveration, echolalia, condensation, derailment, flight of idea, clang association, blocking, glossolalia

THOUGHT incontentDelusion: false belief, based in correct interence about external reality, not consistent with patients intelligence and cultural background; cannot be corrected by reasoningBizare, systematic , somatic delusion, paranoid delusion (persecution,grandeur, reference), delusion of self persecution, delusion of control ( thought of control, thought of insertion, thought of broadcasting, thought of control)

THOUGHT-incontentHYPOCHONDRIAExaggerated concern about health that is not based on real pathologybutrather on unrealistic interpretation of physical signs or sensational as abnormalOBSESSIONPathological persistence of an irresistible thought or feeling that cannot eliminated from consciousness by logical effort: associated with anxiety

THOUGHT incontentCOMPULSIONPathological need to act on impulse that if resisted produces anxietyPhobia ( spesific phobia, social phobia, acrophobia, agoraphobia, algophobia, ailurophobia, claustrophobia, zoophobia)

SPEECHDISTURBANCE IN SPEECHAPHASIC DISTURBANCE

PERCEPTIONProcess of transferring physical stimulation into psychological information, mental process by which sensory stimuli are brought to awareness

PERCEPTIONHallucination : false sensory perception not associated with external stimuli ; there may or may not be a decagonal interpretation of hallucination experienceauditory hallucinationvisual hallucination (form or unform)

PERCEPTIONOlfactory hallucinationGustatory hallucinationTactic/haptic hallucinationSomatic hallucination

Illusion; misperception or misinterpretation of real external sensory stimuli

MEMORYFunction by which information stored in the brain is later recalled to consciousness. orientation :normal state of oneself and ones surroundings in terms of time, place, and person

MEMORY DISTURBANCEAmnesia : anterograde, retrograde.Paramnesia : dejavu, jamais vuHyperamnesiaRepressionLevel memory:-immediate memory, recent, recent pass, remote

INTELLIGENCEMental retardationDementia INSIGHTIntelectual insightTrue insightImpaired insightJUDGMENT

SEKIANWASSALAMUALAIKUM WR. WB