Psychiatric assessment
Psychiatric assessment
OverviewThischapter describes the skills ofhistory taking inpatients withmentalillness.It describes howto perform a Mental State Examination and the MiniMentalStateExamination.· It provides you with a template for how to make sense of psychiatrichistories and describes how to perform a risk assessmentIt includes guidance about personal safety,which should be read carefullyFinally, it covers important issues about stigma and prejudice in relation tomental illness
• This chapter describes the skills of history taking in patients with mental illness. • It describes how to perform a Mental State Examination and the Mini Mental State Examination. • It provides you with a template for how to make sense of psychiatric histories and describes how to perform a risk assessment. • It includes guidance about personal safety, which should be read carefully. • Finally, it covers important issues about stigma and prejudice in relation to mental illness. Overview
2.1Corehistory-takingskillsAs with other branches of medicine, the student doctor should begintaking a history byformally introducing himself/herself tothe patient,showing someformal identification and seeking permission fromthepatient to take a history. The student doctor should explain that he/shewould like to take notes, and again seek permission from the patient to dothis
2.1 Core history-taking skills • As with other branches of medicine, the student doctor should begin taking a history by formally introducing himself/herself to the patient, showing some formal identification and seeking permission from the patient to take a history. The student doctor should explain that he/she would like to take notes, and again seek permission from the patient to do this
2.1Corehistory-takingskillsSome students are nervous about taking histories from patients withpsychiatric problems. Acommon fear is that the patient may be aggressiveorthreatening.This,however,is extremely unlikely,as most patients whosuffer from mental ill health are not violent.Some patients,however,maybe tired or very depressed,and theymay be unableto concentrate forlong periods of time.The history may have to be taken in instalmentsover a few days.Patients who are treated in the community or in aninpatient settingmayhave afixed programme of daily activities,whichshould not be interrupted. In such cases, it is best to make an appointmentwith the patient and negotiate a mutually convenient time to meet
2.1 Core history-taking skills • Some students are nervous about taking histories from patients with psychiatric problems. A common fear is that the patient may be aggressive or threatening. This, however, is extremely unlikely, as most patients who suffer from mental ill health are not violent. Some patients, however, may be tired or very depressed, and they may be unable to concentrate for long periods of time. The history may have to be taken in instalments over a few days. Patients who are treated in the community or in an inpatient setting may have a fixed programme of daily activities, which should not be interrupted. In such cases, it is best to make an appointment with the patient and negotiate a mutually convenient time to meet
Themainhistory-takingskills1.Formalintroduction2.Explanation of nature and purpose of interview·3.Elicitconsent:4.Use of open questions moving to closed for specific details5.Useoffacilitatorystatements·6.Pick up cues (either verbal or non-verbal)when appropriate.7.Maintain control of Interview using empathic statements and refocusingtechniques
The main history-taking skills • 1. Formal introduction • 2. Explanation of nature and purpose of interview • 3. Elicit consent • 4. Use of open questions moving to closed for specific details • 5. Use of facilitatory statements • 6. Pick up cues (either verbal or non-verbal) when appropriate • 7. Maintain control of Interview using empathic statements and refocusing techniques