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PSYCHIATRIC

REY M. MOLLENIDO, M.D. by HISTORY

PSYCHIATRIC HISTORY
Record of the patients life for the psychiatrist to
Understand WHO the patient is Where he/she has come from Where he/she is likely to go

PSYCHIATRIC HISTORY
Patients life story told to the psychiatrist
In the patients own words From his/her point of view

PSYCHIATRIC HISTORY
Most of the time, need to interview other people involved with the patient
Parents Spouses Siblings Neighbors Police Social Workers

PSYCHIATRIC HISTORY
WHEN STARTED ? FACTORS ? ILLNESS COURSE HOME REMEDY? VIEWS ON ILLNESS

Chief Complaint
MEDICAL HISTORY PSYCHIATRIC HISTORY

The psychiatrist has to:


collect data about the symptom formation correlate with Psychiatric & Medical History

PSYCHIATRIC HISTORY
MEDICAL HISTORY

Chief Complaint

PSYCHIATRI C HISTORY

Come up with a picture of the patients individual personality characteristics

PSYCHIATRIC HISTORY
Looks into the patients
Strengths and weaknesses Nature of relationships with others Coping mechanisms Functionality/dysfunctionality Both patients perspective & that of significant others

PSYCHIATRIC HISTORY
Important:
let patient tell his/her story In his/her own words In the order they consider most important

PSYCHIATRIC HISTORY
Let the patient tell his/her story
You will see the gaps but dont interrupt yet In the meantime note down your questions Later, you can confront, clarify, summarize,

PSYCHIATRIC HISTORY
The PSYCHIATRIC HISTORY is only one portion of the PSYCHIATRIC REPORT

PSYCHIATRIC REPORT
Psychiatric History Mental Status Examination Further Diagnostic Studies Summary of Findings Diagnosis Psychodynamic Formulation Comprehensive Treatment Plan
(page 243246)

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

Outline of the PSYCHIATRIC HISTORY


The Outline is not a rigid structure, but a guide When getting the history, always the Patient first. Ask if you may interview the family afterwards Common questions for the History & MSE (pages 230-232).

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

Identifying Data
Can be in outline form or paragraph form Provides a thumbnail sketch of potentially important characteristics

Identifying Data
Name Age Sex C.S. Address Religion Educational Attainment Contact # Occupation Source of referral Sibling rank Sources Reliability of Sources

The Power of the Identifying Data


This is the case of M.C., a 24 year single male, a Roman Catholic, a 2nd year student of Nautical Engineering from Villa, who was brought in due to sleeplessness and fear of everyone around him to the point of becoming violent.

The Power of the Identifying Data


This is the case of K.M, a 42 year old single male from Calinog, a Roman Catholic, a security guard, with a high school education, who was brought in due to insomnia and no appetite.

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

Chief Complaint
Why the patient has come, or has been brought, or has been referred Questions may be in line with:
How can I help you today? What brings you here to the ER? Why have you come here today?

Chief Complaint
Brief statement; in verbatimthe patients own words The more, the better Get also from the family, the relatives, the police or tanod, the neighbors, and the social workers

The Power of the Chief Complaint


Everything is terrible. I want to kill myself There nothing wrong with meits my wife, shes an NBI Agent My heart is beating so hard, I feel like Im gonna die. ---

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

History of Present Illness (HPI)


Comprehensive and chronological tracing of the Chief Complaint
from the onset through its course up to the patient was brought for consultation

History of Present Illness (HPI)


As in the Medical History, start from past
9 YRS PRIOR TO CONSULTATION (PTC) REFERRAL (PTR) ADMISSION (PTA)

History of Present Illness (HPI)


For each complaint or symptom, determine:
the time of onset to present relation of life events relation of life events, conflicts, stressors, drugs change from previous level of functioning

How did this all begin?

History of Present Illness (HPI)


When noting down the patients history
Leave some spaces in between the events so that you Fill in the blanks later

History of Present Illness (HPI)


In each recorded event, detail
the circumstances the thoughts & feelings of the patient the reactions.

Sample HPI
9 YRS PTA, the patient came out of the bank and claimed to hear a female voice which only he could hear. He was scared and rushed home, but the voice would not go away. 8 YRS PTA, the patient was in school and witnessed a fight. A few hours later, at home, he began to hear the same voice teasing him. He was terrified and began yelling at the voice. He was brought again to WVSUMC

Sample HPI
9 YRS PTA, the patient came out of the bank and claimed to hear a female voice which only he could hear. He was scared and rushed home, but the voice would not go away. Pts mother claimed he would point at the ceiling and yell that an aswang was there 2 Days Later, he was brought to a sirohano who said that a dwendi had a crush on the pt. The pts father did not accept this and brought the pt to the WVSUMC ER, where

History of Present Illness (HPI)


DOES THE PATIENT HAVE A CONTINUOUS MENTAL ILLNESS?

YES

GATHER DETAILS ON THE CURRENT SX FOR HPI DETAILS OF THE CHRONIC ILLNESS GOES IN THE PMH YES

NO
DOES THE PATIENT HAVE A RECURRING MENTAL ILLNESS?

YES

HAS THE PATIENT HAD THIS SX BEFORE?

NO

NO

GATHER DETAILS FOR PRESENT ILLNESS

History of Present Illness (HPI)


At the end of the HPI ask the DAMPS questions for pertinent (+)s and (-)s Depressive symptoms Anxiety symptoms Manic symptoms Psychotic symptoms Suicidality/Homicidality

History of Present Illness (HPI)


Depressive symptoms
Depressed mood for past two weeks Loss of interest in pleasurable activities Decreased/increased need for sleep Decreased/increased appetite Lack of energy Thoughts of death

History of Present Illness (HPI)


Anxiety symptoms (panic attacks)
Palpitations Cold sweatiness/clammy skin Chest pounding Choking sensation Confusion/terror/nervousness Sensation of air in stomach rising to head

History of Present Illness (HPI)


Manic symptoms
Decreased need for sleep Pressure of speech Goal-directed activities Inflated/grandiose self-esteem May or may not have hallucinations Excessive involvement in pleasurable behaviors that have painful consequences Easily distracted

History of Present Illness (HPI)


Psychotic symptoms
(+) hallucinations (+) delusions Disorganized or regressed behavior Catatonic behavior Negative symptoms

History of Present Illness (HPI)


Suicidality/Homicidality
Dont fear to ask Must be reported

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

Past Illnesses
Previous Psychiatric & Medical Disorders Record details of symptoms:
causes complications extent of incapacity type of Tx received & their effects names of hospitals length of each illnesses

Past Illnesses
Ask for the use of alcohol or other substances
What type of alcohol? Cigarettes? Designer drug? When started and how much taken then? Did it gradually increase? How? Taken alone or with others? Ever try to stop? Did you feel anything different in your body when you tried?

Past Illnesses
Ask for:
Previous operations or consultations Body markings History of neurological disorders or symptoms of convulsions, fainting spells, double vision Previous trauma Previous medications

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

Family History
Any psychiatric illness, hospitalization, & treatment Hx of alcohol & other substance abuse Description of personalities & intelligence of various persons in w/c Pt lived

Family History
List down each member & note their sex, age, civil status, educational attainment, their occupation Role of each person who played in Pts upbringing Family ethnic, national, religious traditions

Family History
Familys attitude toward, & insight into Pts illness How the Pt feels about his family members: supportive? Most trusted? Most distrusted? Role of illness in the family

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

PERSONAL HISTORY (ANAMNESIS)


PRENATAL & PERINATAL HX:
full term? NSVD or CS? alcohol & other substances taken by mother during pregnancy any maternal/birth complications, defects at birth mothers physical & emotional state at time of birth: wanted pregnancy?

PERSONAL HISTORY (ANAMNESIS)


EARLY CHILDHOOD (Birth 3y.o.):
Feeding habits Significant developmental milestones Toilet training Symptoms of behavior problems Personality as a child Relationship with caregivers

PERSONAL HISTORY (ANAMNESIS)


MIDDLE CHILDHOOD (3-11 y.o.):
Gender identification Disciplinarians & punishments at home Early school experiences

PERSONAL HISTORY (ANAMNESIS)


MIDDLE CHILDHOOD (3-11 y.o.):
Earliest friendship & personal relationships Social popularity Role of Pt: leader or follower

PERSONAL HISTORY (ANAMNESIS)


MIDDLE CHILDHOOD (3-11 y.o.):
Participation in peer, group, or gang activities Early patterns of assertion, impulsiveness, aggression, passivity, anxiety, or antisocial behavior emerging during school relationship

PERSONAL HISTORY (ANAMNESIS)


LATE CHILDHOOD (Puberty through adolescence):
Social relationships School history Cognitive & motor development Emotional & Physical problems

PERSONAL HISTORY (ANAMNESIS)


ADULTHOOD:
Occupational history Marital & relationship history Military history Educational history

PERSONAL HISTORY (ANAMNESIS)


ADULTHOOD:
Religion Social activity Current living situation Legal history

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

PERSONAL HISTORY
CURRENT LIVING SITUATION
Companions at home Relationship with each What kind of work able to do Able to groom self/ take care of others How gets along with neighbor(s)

PERSONAL HISTORY
SEXUAL HISTORY:
Sexually active Any changes or problems with sex Acquisition of sexual knowledge Onset of puberty/menarche

PERSONAL HISTORY
SEXUAL HISTORY:
Development of sexual identity & orientation First sexual experiences Sex in romantic relationship Changing sexual preferences

Outline of the PSYCHIATRIC HISTORY


Identifying Data Chief Complaint (CC) History of the Present Illness (HPI) Past Medical History (PMH) Family History Personal History:
Anamnesis Current Living Situation Dreams/Values/Fantasies

PERSONAL HISTORY

VALUES:
Social & moral work, money, play, children, parents, friends, sex, community concerns, & cultural issues Are children a burden or joy?

PERSONAL HISTORY

VALUES:
Is work a necessary evil, an avoidable chore, or an opportunity? Patients concept of right & wrong

PERSONAL HISTORY
FANTASIES & DREAMS:
Repetitive dreams Nightmares Recent dreams & meanings Fantasies & daydreams Details of fantasy & attendant feelings

THANK YOU !!!

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