Psychiatric interviewing

Question 1

Components of history

Answer 1

1. Identifying data
2. Reliability of patient as historian
3. Chief complaint
4. History of presenting illness
5. Psychiatric functional inquiry
6. Past psychiatric history
7. Past medical/surgical history
8. Family psychiatric/medical history
9. Past personal history
10. MSE

Question 2

Identifying data

Answer 2

Age
Sex
Ethnicity
Marital status
Religion
Occupation
Education
Residence
Referral source

Question 3

History of presenting

Answer 3

Reason for help that day
Current symptoms
Stressors
Supports
Functional status
Associated
Safety screen: endangering self or others, dependants at home, ability to drive/care for self safely

Question 4

Psychiatric functional enquiry

Answer 4

Mood
Organic->alcohol, drugs, withdrawal, illness, delirium
Anxiety
Psychosis->delusions, hallucinations, thought form disorders
Safety

Question 5

Past psychiatric history

Answer 5

All previous diagnoses, hospitalisation, treatments
Past suicide
Substance abuse/misuse
Legal problems

Question 6

Past personal history

Answer 6

1. Prenatal and perinatal: wanted, care, illness, violence, substance, complications
2. Early childhood->development, milestones, family, attachment
3. Middle childhood to age 11->school, friends/bullying, stealing, fire setting
4. Late adolescence->drug, legal, relationshup
5. Abuse
6. Occupation, relationships, education
7. Psychosexual->paraphilias, abuse, sexual dysfunction
8. Premorbid personality

Question 7

Mental state examination

Answer 7

1. Appearance and behaviour: dress, posture, gait, rapport, psychomotor, abnormal movements, cooperation
2. Speech: spontaneous, rate, rhythm, tone, quantity
3. Mood and affect: quality (euthymic, depressed, elevated), range, stability, congruence, appropriateness to thought content
4. Thought process: coherence, logical, goal directed/circumstantial/tangential/LOA/word salad, perseveration, echolalia, thought blocking, clang, neologism
5. Thought content: suicide/homicide, preoccupation, ruminations, obsessions, magical thinking, ideas of reference, overvalued ideas, thought insertion, delusions
6. Perception: hallucinations, illusion, derealisation, depersonalisation
7. Cognition: LOC, orientation, memory, attention & concentration, intellects, language, spacial
8. Judgement: understand relation between facts and draw conclusions to determine actions
9. Insight: ability to realise they have a mental illness and understand its implications

Question 8

How to assess insight and judgement

Answer 8

1. Insight
• Do you think that you have a mental
illness?
• Why are you taking this medication?
• Why are you in the hospital?
2. Judgement->Can be observed from collected history and patient’s appearance and actions.
• Is he/she dressed appropriately for
the weather?
• Is he/she acting appropriately in the
given situation?
• Is he/she taking care of self and/or
dependents

Question 9

Cognitive assessment

Answer 9

Cognitive Assessment
Use MMSE to assess:
• Orientation (time and place)
• Memory (immediate and delayed
recall)
• Attention and concentration
• Language (comprehension, reading,
writing, repetition, naming)
• Spatial ability (intersecting
pentagons)
Gross screen for cognitive dysfunction:
Total score is out of 30;