Introduction 2 to Psychiatry�History Taking & MSE.pptx

Introduction to Psychiatry�History Taking & MSE

1. Introduction to Psychiatry History Taking & MSE Dr. Mostafa Mahmoud Alsabban Lecturer of Psychiatry Al Azhar University- Damietta

2. History of Present illness The backbone of psychiatric case work up Horizontal vs Longitudinal Dimension comprehensive chronological

3. History of the present illness Onset: Acute, Gradual/Insidious. Course: Episodic, progressive, regressive, stationary/Continuous. Duration. Stressors هل اتعرضت لأي ضغوط أو مشاكل قبل المشكلة دي ممكن توصف لي الموضوع بدأ ازاي آخر مرة كنت كويس فيها متى الأعراض دي مستمرة زي ما هي ولا بتزيد ولا بتقل

4. The  Kupfer  Curve

5. History of the present illness Chronological. Stressors (The condition started 12 years ago. 2 days after the patient proposed to a girl and her family refused) . Description of the symptoms. Don’t mention psychiatric terms Exploration of related symptoms Psychiatric or medical services Medications: Doses (scientific names), Response to treatment, Compliance, Stoppage of treatment (when, why) Deficit. Functioning (Biological, social , occupational) Important Negatives eg. Suicide/ Homicide……Manic / Hypomanic Episodes….Hospitalization

6. History of the present illness

7. History of the present illness For each of the presenting complaints

8. History of the present illness For each of the presenting complaints

9. History of the present illness For each of the presenting complaints

10. History of the present illness “Samy has had on and off thoughts of ending his life for about 2 yrs till now. It started after he failed at work. He noticed that every time he drinks cannabis, for the next 48 hours, these suicidal thoughts increase. On the other hand, when he spends time with his kids, the thoughts seem to melt away.”

11. History of the present illness How I can organizes my questioning process? Low mood Psychological symptoms of depression Biological symptoms of depression Psychotic symptoms of depression

12. History of the present illness How I can organizes my questioning process? Open Ended Questions : WHEN,WHAT,WHERE,HOW Clarification Closed Ended Questions Facilitation statements ( Approval nods, yes go on, Proceed, What else) Narrow Focused Questions

13. Past History Past Psychiatric History Substance Use Disorder. Suicide. Violence. Response to Specific treatment e.g ECT, Lithium Past Medical/Surgical History. Epilepsy Endocrinal disease CNS disease: Stroke, Brain Tumor, Head Trauma

14. Past substance use history For each drug

15. Family history

16. Family history 1 st order of birth among 7 sibs. Father: محمد 67 year old a taxi driver, Preparatory school. with a cold distant relationship with him. He was described by the patient as authoritative . Mother: منى Died 3 years ago at the age of 50 due to complications of rheumatoid arthritis. She was a house wife, Preparatory school. With a kind and caring relationship . She was described by the patient to be authoritative.

17. Siblings: He has a cold distant relationship with all of them except Islam &his sister Injy who died was so close to him. He doesn’t like his brother Nour Eldeen as he claims that he suggests his father to treat him badly. اسماعيل  إسلام (Closest)   نور الدين  خليل هاجر انجي 18 years old 22 years old 26 years old 28 years old 30 years old Died 14 years ago at the age of 18, Cancer ثانية ثانوي  دبلوم صنايع  دبلوم صنايع  معهد تجاري ليسانس أداب  اولي كلية Engaged Engaged Married Married with 3 offspring ديليفري  فني تبريد و تكييف  محاسب  Housewife Family history

18. Home atmosphere: quarrelsome, harmonious, cold……. Crowding index: 2/room Monthly income: Adequate, inadequate, barely adequate Family history of psychiatric illness & Response to treatment eg : Bipolar, ADHD, NE, Alzheimer Family history of substance use : Alcohol Family history of medical illness: DM, HTN, Hypothyroidism Family history

19. Family dynamics: The father and Mother were divorced when the patient was a 1 year old. (the patient doesn’t know the reason of divorce). He didn’t see his father frequently till he was 17. He was raised by his mother and grand parents. After he was 17 he started seeing his father more often, but he didn’t like his father as he felt the discrepancy in the way he treats him and his brothers. His father got married to two other women and has 3 offspring from each. His relationship to his siblings is cold and distant . Family history

20. 1. Prenatal and perinatal history Record any relevant perinatal and developmental history Ask if the patient was wanted pregnancy and sex or not Ask about any complications associated with their birth 2. Early childhood (0-3years) Feeding habits. Relation with the mother Early development: Motor, Speech, sphincter control. Symptoms of behavior problems (neurotic traits: fear, shyness, blushing, thumb sucking, nail biting, bed wetting, frequent nightmares. Health during childhood. Personal history

21. 3. Middle childhood (3-12): Early school history. Gender identification. Punishment used at home. Peer relations. Behavior problems 4. Later childhood (puberty through adolescence): School history. Cognitive and motor development. Physical problems Personal history

22. Educational record: Type of school (public, private, azhari ). Scholastic achievements. Relationship to peers and teachers. Graduation   Work record (detailed) Military history Personal history

23. Psychosexual history: He reached puberty at the age of…… Gender role. Gender identity. Hetero/Homo/Bi sexual orientation. Masturbation. Porn acts. Extramarital illegal relations. Marital History : Date, Attitude toward his partner & children, Problems related to sexual practice, Family planning. Forensic history : Prisoned to legal issues or political issues Personal history

24. Premorbid personality Introvert/extrovert. Few/lot of number of friends. Reacts to stress by isolation/ aggression/sadness. Religious background: Believer or not, practicing or not. Personality traits: Pessimism, Optimism, Emotional Lability, Suspiciousness, Shyness, Aloofness, Aggressive, Callousness, Irresponsibility, Dependent. Hobbies: watches TV and plays football Special habits: Smoker of 1 and half Package Per Day. Personal history