parmentier 01
TRANSCRIPT
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Lecture Tripoli, Libya
Sunday 23rd January 20100
Mental health history taking
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Dr Henk Parmentier
General Practitioner
- South West London, United Kingdom
- Wonca Working Party on Mental Health
Mental health history taking
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objectives
Learn about mental health history
taking
Learn about psychiatric assessment
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assessment
Questions to answer:
Does the patient has a mental health
problem?
What is the problem?
What is the treatment?
Can I give the treatment?
Is the patient happy to have the
treatment?
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Assessment
A full assessment can take many
sessions and take hours
But it can be done in a few minutes by
a Family Doctor
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Psychiatric assessment
A complete psychiatric requires:
Detailed personal history
Clear account of current problems
Risk assessment
Mental state examination
Physical examination
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Psychiatric history
Administration:
Name
Age and sex
Address, telephone number
Languages
Marital status
Education
occupation
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Presenting problem
What is the current problem?
How long has it been going on?
What events led up to this
presentation?
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History of present illness
What are the specific symptoms and
for how long?
Is there a relationship with social
stressors / physical illness?
Disturbances in mood?, appetite?,
sleep?, sexual drive?
Has any treatment been given yet?
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Personal history
Covers as much information about the
individual’s life from childhood to
present time
Pregnancy, birth, child behaviour,
development, education, relationships
Work history: how many jobs
Marital status: children
Criminal activities
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Previous medical history
Next presentation
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Drug history
Previous drugs: self medication,
prescribed drugs, illegal drugs
Allergic reactions?
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Premorbid personality
how does the patient describe his
personality before getting unwel?
Mood, temperament, character traits,
confedence, religious believes, ambition
Social relationships with family, friends
and at work
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Family history
Ask about individual’s close family and
their health status
Age, health, occupation, how's the
relationship with that person
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Mental state examination
Obtain information about specific
aspects of the patient’s mental
experiences and behaviour at the time
of the interview
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Appearance and behavious
Appearance
Attitude
Motor behaviour
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speech
Rate
Volume
Quantity of information
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Mood and affect
Mood: depressed, euphoric,
suspicious
Affect: restricted, flattened,
inapropriate
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Form of thought
Amount of thought and rate of
production
Continuity
Disturbance in language or meaning
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Content of thought
Delusions
Suicidal thoughts
other
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perception
Hallucinations
Other: derealisation, depersonalisation
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Sensorium ans cognition
Level of consiousness
Memory: immediate, recent, remote
Orientation in place, time and person
Concentration
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insight
Awareness of problems