ENGLISH PSY-UNIT-3
Mental Health Assessment
a) Psychiatry history taking
b) Mental status examination
c) Interview technique
UNIT :- 3 MENTAL HEALTH ASSESSMENT
QUE :- (A) EXPLAIN PSYCHIATRY HISTORY TAKING :-
1) Demographic Data :-
- Name of the Patient (Name of Patient) :-
- Age:-
- Sex :-
- Bed No :-
- Ward No :-
- Registration No:-
- Marital Status (Marital Status) :-
- Religion :-
- Literacy / Education :-
- Occupation :-
- Income :-
- Language :-
- Nationality :-
- Identification Mark :-
- Provisional diagnosis :-
- Final diagnosis :-
2) Presenting Chief Complaint :-
- Problems experienced by the patient or observed by the relatives in the current time period.
✓ What the patient says….
✓ relatives je says that….
For example,
The person has not slept for 3 days.
I don’t feel hungry…
Sleep walking or talking…..
*3) Present psychiatric illness history:-
(Present Psychiatric Illness History)*
Take brief history regarding problem help full to detect main problem/disease condition.
✓ Mode of onset,
Acute (symptoms appear in a short period of time)
Sub acute (in a few weeks….)
Chronic (seen in some years…)
✓ duration of symptoms / severity
✓ Trigger factor of symptoms:- which provokes the patient…
✓ Other causes
4) Treatment history (Treatment history) :-
✓ Drug :- name of drug, dose, route, side-effect
✓ ECT (electro convulsive therapy) — taken or not…
✓ Psychotherapy (psychotherapy taken or not….or taking or not…)
✓ rehabilitation
5) Past illness history :-
Getting information about any event that happened in the past that may have an impact…
- Past medical history:-
✓ Did the patient have any medical problems in the past? Collecting its information.
Ex :- TB, DM, fever, epilepsy etc.
✓ Was admitted to the hospital? If yes then when..
✓ Still taking any medications for it?
✓ Is there any addiction (alcohol, smoking) or…!?
- Past surgical history:-
✓ Getting information about any brain surgery done in the past
✓ Obtaining other surgical information
✓ Getting information about any complications during surgery (epileptic episodes)
- Past Psychiatric history :-
✓ Obtaining information about any psychiatric disorder in the past
✓ Is his medication still started or not?
✓ How long did you take the medicine now?
✓ Was admitted to the hospital? How much time ?
6) Family history :-
✓ Family genogram (genogram) 3 generation include in it.
✓ To know if family members have any illness…..
✓ Type of family
✓ Member of family
✓ Past history of psychiatric illness
✓ any drug abuse member in family
✓ Family tree
“(Genogram)”
7) Personal history :-
- Perinatal history (information during pregnancy…) :-
✓ Antenatal history
Whether exposed to any infection or radiation…..
✓ Intranatal history
Type of delivery // Normal vaginal delivery, CS, if any problem during delivery….
✓ Postnatal history
Convulsion, cynosis, infection….
- Childhood history :-
- Who was the primary caregiver mother/father or other…
- Feeding: breast feed/ artificial mode of feeding (what was the mode of feeding…..)
- Age at weaning (When did weaning diet start….)
- Developmental milestones
- Behavior during childhood :-
✓ Excessive temper tantrums
✓ Thumb sucking
✓ Stuttering OR stammering
✓ Head banging
✓ Neurotic symptoms
✓ Pica (eat food…..ex.. clay, ghost, choke)
✓ Enuresis
✓ morbid fears
✓ somnambulism
✓ Habit disorders
✓ Excretory disorders etc.
- Illness during childhood :-
✓ specifically for CNS infections
✓ epilepsy
✓ neurotic disorders
✓ Malnutrition
- Educational history :-
✓ Age at beginning of formal education
✓ Academic performance
✓ Extracurricular achievement
✓ Relationship with peers and teachers:
✓ School phobia
✓ Look for conduct disorder: eg. Stealing
✓ Reason for terminating studies
- Play history :-
✓ Games played- Which games can be played….
✓ Relationship with playmates
- Emotional problems during adolescence :-
✓ Running away from home
✓ Delinquency
✓ Smoking
✓ Drug abuse
✓ Any other
- Puberty :-
✓ Age at appearance of secondary sexual characteristics
✓ Anxiety related puberty changes
✓ Age at menarche (in females)
✓ Reaction to menarche
✓ Cycle regularities, duration of flow
✓ Abnormalities if any
- Occupational history :-
✓ Age of joining job
✓ Any changes in the job – there have been changes in any job….to know the reason…
Current job satisfaction *(Relationship with superiors, subordinates & colleagues)
Reasons for changing jobs Whether job is appropriate to patient’s background
8) Moral and religious belief:-
✓ How much involvement is there in the society!
✓ Do social work!
✓ attitude to society
✓ Hobbies
✓ Religious belief
✓ Type of personality
✓ strength / abilities
✓ attitude
9) Fantasy life:-
✓ Inquire about content of day dreams & dreams. (Get information about day dreams and the same)
10) Reaction pattern to stress :-
✓ What is the response to stress…
disappointments, & circumstances arousing anger, anxiety or depression. Evidence for the excessive use of particular defense mechanism such as denial, rationalization, projection, etc.
QUE (B) BRIEFLY EXPLAIN MENTAL STATUS EXAMINATION (MSE):-
MSE is a standard structure or a whole process with the help of which systematic assessment of psychiatric patients can be done.
In which the patient’s behavior, concentration, thought process, attention, and emotional function are examined, from which the conclusion of the patient’s mentality is made, which is called MSE.
DEFINITION :-
Mental status examination means the evaluation of a person’s intellect, cognitive ability, mood, and thought process.
Before MSE, vital signs must be assessed.
(blood pressure, heart rate, respiratory rate, temperature)
- Topics are assessed in MSE :-
1) GENERAL APPEARANCE AND BEHAVIOR
2) SPEECH/TALKING PATTERN
3) MOOD/AFFECT
4) THOUGHT
5) PERCEPTION
6) COGNITIVE FUNCTION
7) MEMORY
8) INTELLIGENCE
9) INSIGHT
10) JUDGMENT
11) ATTENTION
*1) GENERAL APPEARANCE AND BEHAVIOR :-
(General Appearance and Behavior)*
Appearance :-
✓ Seeing how a person looks….old, young,…etc…
Conscious :-
✓ The person is alert, drowsy, stupor or comatose…
Hygiene :-
✓ How do you keep your rice?
✓ Keeps well or not….
Sleep :-
✓ Sleep well or not…
✓ How much time sleeps…
Posture :-
✓ To see how the person’s behavior is during the examination
In which, he speaks openly or not….
Does it answer the question asked or not?
Does he sit with his head down or does he talk facing forward…
Eye to eye contact :-
✓ Talks eye to eye, how much time and when does he look away…
Gait :-
✓ When the patient comes, how does he walk confidently (confidently) or comes as if he is scared….
Facial expressions:-
✓ How does the facial expression give…
Eating pattern :-
✓ Eating properly or not and not eating too much….
*2) SPEECH/TALKING PATTERN :-
(Speech/ Talking Pattern )*
✓ The person starts speaking very quickly or slowly…
✓ Responds to fear or not….
✓ Responds by shouting loudly….
✓ Answer the question true or false….
✓ Repeats one thing after another…..(clang association)
✓ Mumbles…..(mumbring – mumbring)
✓ Instead of talking straight, it turns round.
(Circumstantial)
(Tangential – Tangential – correct answer will not be given)
*3) MOOD/AFFECT :–
Mood / Affect :-*
✓ How is the mood….
Sad, anxious, depressed, angry, euphoric, fear, restlessness, irritable
✓ Keeps Mood Changing…!! How much time does it change..
✓ According to the response (response) is the mood or not…
*4) THOUGHT :-
(thought)*
✓ What are the thoughts of a person…
positive / negative
✓ Thoughts are fast and change from time to time….
✓ Flights of ideas (flight of ideas) :-
Thoughts keep coming but their direction changes.
✓ Vague thoughts
✓ Neologism :-
Pronounce new words that have no meaning.
5) PERCEPTION :-
(Perception) :-*
✓ Hallucination :-
There is no external object/sound/involved/touched even though it appears to be there
Auditory, visual, olfactory, gustatory, tectile
✓ Illusion :-
False perception of external stimuli occurs
✓ Deja vu :- A feeling of what was seen in a previous birth is never met in real life…..
✓ Jamais Vu (Jamais Vu) :- To forget the people of the family with whom one is living…..
*6) COGNITIVE FUNCTION :-
(Cognitive Function) :-*
✓ Knowing whether a person is conscious or not…
✓ Gives us a slow replay (stupor)
✓ Behaves as if in a coma….
✓ How does it give information about old things…. Do you know the whole thing or remember only a little bit….
✓ Whether one has concept of time, space, person, etc….
*7) MEMORY :-
(Memory) :-*
✓ immediate (immediate) memory :-
Say something and ask to repeat it.
✓ remote (remote) memory :-
The date of your marriage, your age, when did you get the job and where did you get it…..do you remember it or not….
✓ recent memory :-
To know whether you remember recent j events or not….
What did you eat in the morning, when did you eat, when did you get up…
*8) INTELLIGENCE :-
(Intelligence) :-*
✓ Can write – read or not…and how was the school performance…..
*9) INSIGHT :-
(Insight) :-*
✓ A person knows about his condition or not…
✓ How is internal intelligence…
✓ To know this, ask him questions about himself and decide whether the insight is present or not based on his answer.
*10) JUDGMENT :-
(Judgment) :-*
The information about this depends on the knowledge, education level of the person…
Everyone’s judgment is different…
*11) ATTENTION / CONCENTRATION :-
(Attention / Concentration) :-*
✓ Before asking the person to subtract 7 from 100 he keeps asking…(100-7 = 93, 93-7 = 86……..)
Or reverse count……(100,99,98,97…..)
Can ask about Month, Week, Days…..
b. Define interview and write the techniques of interview. Define interview and write about interview technique.
Interview A face-to-face conversation to solve the same problem or have the same objective is called an interview.
Interview technique
- Observing
That is to do with non-verbal communication, the patient starts crying while talking, speaks frequently, washes hands, wipes sweat, drinks water while talking, speaks one word at a time, eyes twitch, moves, etc.
- Listening
When the patient is talking to someone, the nurse should be a good and active listener, responding to the patient’s statements such as yes, okay, great, eh? By answering etc., the patient will feel that the nurse is listening to me attentively
- Reflecting Listening to the patient and asking the patient again so the patient feels that the nurse is listening carefully. Valley dating
If Valley Dating Station is aware of any matter, it or the patient will confirm whether the statement is true or false.
Clarify
If the patient is confused about something, ask the nurse what you said.
- Questioning This is a direct way of talking to the patient and can be found out by asking a direct question.As the answers to the questions can only be yes or no, ask open-ended questions to get them.For example, open-ended question. What did you have for breakfast this morning?
- Conforming
This involves asking about the patient’s behavior. For example, the nurse says, “You sometimes turn your face away from me. Do you get angry?”
- Summarizing
After the conversation, the nurse tells the patient about the main points of the whole conversation so that the patient can think again and add or subtract something.