Psychiatry Clinical Interview and History Taking

These vocabulary flashcards cover the essential components of psychiatric history taking, clinical interviews, and the Mental Status Examination (MSE) as discussed in the lecture.

Psychiatric Diagnosis Basis

Diagnosis in psychiatry is based exclusively on history ($HISTORY$), clinical interview, and established criteria from international systems like $DSM-5$ or $ICD-11$, rather than imaging or laboratory tests.

Three Parts of a Complete Psychiatric History

A complete psychiatric history includes: 1) $HISTORY$, 2) $PHYSICAL\,EXAMINATION$, and 3) $MENTAL\,STATUS\,EXAMINATION$.

Demographic Data

Information including name, age, gender, marital status, occupation, education, religion, and place of residence, which helps identify stressors or protective factors.

REFFERAL OF SOURCE

Identifies who brought the patient (e.g., self, family, or police), which helps assess the patient's $INSIGHT$.

CHIEF COMPLAINT (CC)

The patient's primary complaint recorded verbatim in their own words.

REFFERAL OF REASON (ROR)

The reason for the patient's referral as stated by their companion or family member, also recorded verbatim.

PRESENT ILLNESS (illness present)

The current state of the illness, including the onset of symptoms, triggers (stressors), and the patient's level of functioning ($function$).

PAST PSYCHIATRIC HISTORY

A record of previous psychiatric visits, hospitalizations, diagnoses, treatments like $ECT$, medication compliance, and history of suicide or self-harm.

PAST MEDICAL HISTORY

Identifies physical conditions that may cause psychiatric symptoms ($medical\,condition\,induced$) or be comorbid, such as hypothyroidism, diabetes, or neurological disorders.

DRUG HISTORY

A record of current and past medications, dosages, and durations; essential for avoiding risks like seizures when tapering medications like sodium valproate.

DELIVERY HISTORY

Details regarding birth, including $APGAR$ scores, presence of $Asphyxia$ or hypoxia, and maternal factors like malnutrition or smoking during pregnancy.

MENTAL STATUS EXAMINATION (MSE)

An assessment performed by the examiner focusing on the patient's current mental state across various domains like appearance, speech, and thought.

General Appearance

The initial assessment of the patient's grooming, self-care, eye contact, and whether their apparent age matches their chronological age.

Attitude

The patient's stance toward the therapist, categorized as friendly, $guarded$ (common in paranoia), $aggressive$, $cooperative$, or $non-cooperative$.

Mood

A sustained internal emotional state felt by the patient, which can range from $Euthymic$ (normal) to $Euphoric$ (elevated) or $Depressed$ (low).

Affect

The external expression of the patient's internal emotion ($mood$) observed by the examiner; it should ideally be $congruent$ with the reported mood.

Affect Types: Blunted vs. Flat

$Blunted$ affect involves a reduction in emotional intensity (common in depression), while $Flat$ affect shows no emotional expression (common in schizophrenia).

Content of Thought: Delusion

A fixed false belief that can be $Bizarre$ (unrealistic) or $Non-Bizarre$. Common types include $Persecutory$, $Somatic$, $Grandiose$, and $Reference$.

Form of Thought: Flight of Ideas

A disturbance in thought flow where the patient jumps rapidly from one topic to another.

Form of Thought: Word Salad (Incoherency)

A mixture of unrelated words that lack meaning, structure, or goal-directedness.

Illusion

A misinterpretation of a real external stimulus, such as perceiving a piece of clothing in a dark room as a person.

Hallucination

A sensory perception in the absence of an external stimulus, with auditory being the most common psychiatric type (e.g., $running\,commentary$ or $commanding$).

Memory Assessment

Evaluated in three stages: $Immediate$ (repeating 3 words), $Recent$ (events of the day), and $Remote$ (past events like the name of a former president).

Orientation

Assessment of the patient's awareness regarding time (date, season), place (city, hospital floor), and person (identity of self and others).

Concentration Assessment

Tested by asking the patient to perform $Serial\,7s$ (subtracting $7$ from $100$) or by naming the days of the week in reverse.

Abstraction

The ability to analyze information beyond literal meaning, often tested by interpreting proverbs or identifying similarities between objects like an apple and an orange.

Insight (5 Stages)

The degree of awareness regarding illness, ranging from Stage $1$ (complete denial) to Stage $5$ (acknowledging illness and actively seeking treatment).