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1. Dr.PAL KIER,MD
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2. GENERAL MEDICINE/I Psychiatry
 In Psychiatry
 Detailed Hx.
 Thorough MSE
The single most important method of arriving to
Dx.in psychiatry is a very good psychiatric
interview.
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3. What are the objectives of
Psychiatric interview
 The interview is used as a way of eliciting signs and symptoms
 To gain a knowledge about the pt. and the nature of his problem
 To give a chance to the pt. to express his/her emotion .
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4. What are the preliminary requirements to
conduct the interview
 ROOM : Sound proof, free from interruption, privacy, safety, to
every body,
 make sure the interview cannot be overheard .
 THE FIRST ENCOUNTER TO THE PATIENT: welcome him
by name and by hand shake observe how the patient respond and
tell him your name and welcome the attendant too.
 Give a brief explanation why he is with you.
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5. What are the preliminary requirements to
conduct the interview(cont.)
 SEATING POSITION OF THE PATiENT
- not opposite to the interviewer, at the side of the desk,
chair should not be lower than the interviewer.
 QUESTION TECHNIQUES: no leading questions ,do not be
judgmental
 NOTE TAKING AND RECORDING: Record some verbatim
statements only ,if the patient is against it is better to stop and listen
 TIME: not more than one hour
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6. Specific interviewing
technique
 OPEN-ENDED QUESTION
 CLOSED-ENDED QUESTION
 REFLECTION
 FACILITATION
 CONFRONTATION
 POSITIVE REINFORCEMENT
 SUMMATION
 EXPLANATION
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7. Psychiatric history writing -
I- Identification: Name ,age, sex, marital status,
religion, ethnicity, occupation,
address, visit, referred from, escorted or brought by
source of information,
the reliability of the source of information
II- Chief Compliant: Exactly why the patient come to the hospital ,
In the patient’s own words regardless how bizarre ,
implausible ,irrelevant it is you should write it
if the information does not come from the patient
note who supplied it,
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8. Psychiatric history writing cont.
III- History of Present Illness( HPI)
• It provides a comprehensive and chronological picture of
the events.
• this part of the psychiatric history is the most helpful in
reaching a diagnosis
• For each problem elicited in the chief compliant include the
following information.
1. the time onset
2. Mode of onset
3. Development overtime
4. Precipitating or reliving factor
5. Help given
6. Impact of the problem
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9. Psychiatric history writing
cont.
Negative and positive statement :
Mood symptoms, symptoms of anxiety,
Symptoms psychosis, History of substance abuse,
Suicidal ideation
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10. Psychiatric history writing
cont.
IV-PAST PSYCHIATRIC ILLNESS
1. Was there any particular trigger?
2. What was the exact nature of the illness?
3. How long it lasted?
4. What was the treatment?
5. Was there hospitalization?
6. How long it lasted?
7. How well functioning between the episodes of mental illness?
8. Was there suicidal ideation or attempt
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11. Psychiatric history writing
cont.
V-PAST MEDICAL ILLNESS
1. Details of any previous serous medical illness(epilepsy,head
injury………)
2. Treatment ,the out come, the duration
3. Number of hospitalization
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12. Psychiatric history writing cont.
VI-FAMILY HISTORY
 Patient’s parents
 Siblings
 Relationship with the family
 Are they supportive towards him/her
 Is there psychiatric history in the family, suicide,
 the diagnosis, hospitalization, kind of medication
 History of Epilepsy
 Is there parental violence or suicidal behavior
 Parental excessive drinking
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13. Psychiatric history writing cont.
PERSONAL HISTORY
 Early life Development
 Schooling
 Occupation
 Marital history
 Forensic history
 Sexual history
 History of Substance abuse: alcohol, chat…………
-quantity, quality ,frequency, poly drug abuse
 PESONALITY BEFORE ILLNESS
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14. VIII-MENTAL STATUS
EXAMINATION
 Like a physical examination
 is examiner's observation and impression of the patient .
 should be orderly and systematic.
 should be carried out completely for every patient .
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15. A-General Description of the patient-
 1- Appearance:
Dress:
Unusual combination of clothing:
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16. A-General Description of the patient-
 Self neglect: Men may appear unshaven, the face may
be unwashed, hair uncombed. Women may wear
carelessly.
 Finger nails might be long and dirty
 Unusual accessories: Schizophrenic patient sometimes
pack there pockets with there belonging or carry a large
holders of personal possessions.
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17. B-Motor Activity of the
patient
 GAIT : Unusually slow, fast, unusual character of gait.
 Abnormal Motor Activity like Mannerism, Posturing
,
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18. C-Speech Activity of the
patient
 Speed: fast,slow ,and normal
 Volume: Loud,Low,Normal
 Quantity: Too little,too much or normal
 Tone : Low pitched,high pitched
 None-social speech muttering ,neologism,ward salad
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19. D-Emotion
 Mood: you evaluate the mood by asking the feeling of
the patient
 sadness,elation,anxious
 Affect: what the interviewer observing during the
interview you read it from facial expression of the patient
 flat,blunt , constricted,,normal range,labile
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20. E-THOUGHT DISTURBANCE
 FORM:
 flight of ideas circumstantialities,tangentially,loosing of
association,Neologism,
 CONTENT:
 Delusion, overvalueidea, obsession Suicidal Ideation,
withdrawal, Broadcasting
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21. F-perceptual disturbance
 Hallucination
 Illusions
 Depersonalization
 Derealization
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22. G-Sensorium and level of consciousness
 Alertness and level of consciousness
 Orientation: to time, place ,person
 Memory: Remote,Recent Immediate
 Concentration and attention
 Capacity to read and write
 Abstract thinking
 General knowledge
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23. H-Insight & Judgement
 Has insight
 Has no insight
 Poor judgment
 Good judgement
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24.  Diagnosis using DSM V criteria
 PLAN OF TREATMENT
 PSYCHOPHARMACLOGY
 PSYCHOTHERAPY
 ECT
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25. QUESTIONS??????
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