MD401 - T22 - Psychiatric Patient Assessment and Diagnosis

Psychiatric assessment - steps

Present illness - notice what

1. specific symptoms and behavioral patterns

2. impact on function + suicidal or homicidal risk

Psychiatric disorder - symptom groups

Anxiety, Mood, Psychotic and Somatic

Major Depressive Disorder: DSM-5 - duration

2 wks period

Major Depressive Disorder: DSM-5 - Major Symptoms (2)

1. distress (depressed)

2. impairment

Major Depressive Disorder: DSM-5 - Minor Symptoms

1. major weight loss or gain

2. insomnia or hyperinsomnia

3. agitation or retardation

4. fatigue

5. worthlessness or guilt

6. can’t concentrate, indicisiveness

7. death thoughts

DSM-5 - positive

5 symptoms, one being major

DSM-5 - cutoff

does it disrupt daily life

Hierarchy model - in psycho disorder

should start by rulling out the more severe one first

Past Hx - Information

• all psychiatric illness and their course

• treatment and complaince

• suicidal, violence or homical,

• substance abuse

• past medical history

Past History - note

If the detail is disconected should be added in past hx

โรคประจำตัว should be noted

4P models

Predisposing, Precipitating, Perpetuating, Protective

4P models - Predisposing

Risk factor

4P models - Precipitating

Recent trigger event,

4P models - Perpetuating

Why does the problem still occur

4P models - Protective

what is the strength or support system of the patient?

Hx Taking should cover - what.

Family hx, development hx, and social hx

Hx Taking - Stakeholder

Gather from otehr people as well

What is MSE for?

as a physical examination, to correlate what the pt says to observation

MSE - 10 points

1. Appearance and behavior

2. Motor activity

3. Mood

4. Affect

5. Speech

6. Thoughts

7. Perception

8. Cognition

9. Judgement

10. Insight

MSE - Appearance and behavior

looks, act, and approach

MSE - Motor activities

Quantity and Quality

MSE - Mood

their emotional stage

MSE - Affect

Mood expression (atm)

MSE - Speech

Fluency, amount, rate, volume, tone

MSE - Thoughts

Thought content and process**

what they think, and how does it formulates

MSE - Perception

Abnormal Sensory Process

MSE - Perception - Hallucination vs Illusion

No external stimulus v. Have external illusion

i.e. seeing an insect when it isn’t present, vs. seeing the insect and percieving that its an insect instead

MSE Cognition - what

Consciousness, orientation, attention and concentration, memory (recall, recent, remote), having knowledge abstract reasoning

MSE - Judgement

Capacity to make good decision and act on them

MSE - Insight

awareness, understanding and identification of their illness

scale : no insight, partial insight, full insight