Introduction And Interviewing Skills 2024 BUC 5th Year PDF

Badr University College of Medicine (BUC) By Prof. Walaa Sabry Head of Psychiatry Department Psychiatry Course for 5th Year Medical 1 Saturday, May 18, 2024...

Badr University College of Medicine (BUC) By Prof. Walaa Sabry Head of Psychiatry Department Psychiatry Course for 5th Year Medical 1 Saturday, May 18, 2024 Students  Introduction to Psychiatry History, Mental State Examination & Interviewing Skills Psychiatry Course for 5th Year Medical 2 Saturday, May 18, 2024 Students  INTENDED LEARNING OBJECTIVES (ILOs) By the end of the lecture the candidate will be able to: 1. Recognize the scope of psychiatry 2. Discuss different diagnostic classificatory systems of Psychiatry 3. Identify basic skills for history taking and examination in Psychiatric patients. 4. Differentiate between various psychiatric symptoms & signs Psychiatry Course for 5th Year Medical 3 Saturday, May 18, 2024 Students  Definition of psychiatry Psychiatry is the medical specialty for diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. 3 Psychiatry Course for 5th Year Medical Saturday, May 18, 2024 Students  Diagnosis in psychiatry Mental disorders are often diagnosed in accordance with clinical concepts listed in diagnostic manuals such as the International Classification of Diseases (ICD), edited and used by the World Health Organization (WHO) and the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA). 3 Psychiatry Course for 5th Year Medical Saturday, May 18, 2024 Students  Diagnosis in psychiatry In 2013, the American Psychiatric Association (APA) defined mental disorders in the DSM-5 as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.“ The final draft of ICD-11 contains a very similar definition. Such classification systems help communicate information and provide a basis for research. Psychiatry Course for 5th Year Medical 6 Saturday, May 18, 2024 Students  Treatment in psychiatry The combined treatment of psychiatric medication and psychotherapy has become the most common mode of psychiatric treatment in current practice. 3 Psychiatry Course for 5th Year Medical Saturday, May 18, 2024 Students  Treatment in psychiatry ✓Treatment may be delivered on an inpatient or outpatient basis, depending on the severity of functional impairment or on other aspects of the disorder in question. ✓Research and treatment within psychiatry as a whole are conducted on an interdisciplinary basis with other professionals, such as epidemiologists, nurses, or psychologists. 3 Psychiatry Course for 5th Year Medical Saturday, May 18, 2024 Students  Interviewing and communication skills A psychiatric interview is different from a medical interview: 1) Disturbed thinking, behavior and emotions can interfere with meaningful communication. 2) Significant Collateral information from significant others. 3) Significant personal history and pre-morbid personality. 4) Need for more observation of patient’s behavior. 5) Difficulty in establishing rapport may be encountered more often. 6) Lack of insight Psychiatry Course for 5th Year Medical 9 Saturday, May 18, 2024 Students  Interviewing and communication skills Psychiatry Course for 5th Year Medical 10 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 1. Beginning of the interview. Make eye contact with the patient. Greet the patient by name. Shake hand if appropriate. Ask the patient to sit down. Introduce your self Psychiatry Course for 5th Year Medical 11 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry Explain the purpose of the interview. Say how much time is available. Explain the need to take notes and ask if this acceptable Psychiatry Course for 5th Year Medical 12 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 2- Bonding and making rapport 3- normalizing statement Say>>> “How do you like this weather?” Don’t Say>>>> “How are you today?” 4. Showing Empathy (verbal and non verbal) I can imagine to what extent you are suffering Facial expression- Tone of voice- Gentle Touch Psychiatry Course for 5th Year Medical 13 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 5. Showing Respect. How...???? 6. Showing Interest How... ???? 7- Active Listening (“so you have been having all of this problems’). What else?? 8- Responding to body language of patient “You seem quite nervous. Please let me know why are tense? Psychiatry Course for 5th Year Medical 14 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 9- Awareness of your own body language. 10- Mastering and control. 11- Organization and chronological order. 12- Open ended questions. How can I help you?” or tell me about your problem? Psychiatry Course for 5th Year Medical 15 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 13- Facilitation. - Summarizing technique. - Paraphrasing or rephrasing - Mirroring - Transition statements. 14- Probing when necessary. “Please tell me more about”. 15- Open ended/ Closed ended questions (But When??) 16- Time Management. Psychiatry Course for 5th Year Medical 16 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry 17- Giving information Psychiatry Course for 5th Year Medical 17 Saturday, May 18, 2024 Students  Basic interviewing skills in psychiatry ❑ AVOID Leading questions, asking many questions Repeating, making assumptions, jumping to conclusion False message, false hope Being judgmental Medical jargon Commenting on a colleague Challenging or threatening the patient Psychiatry Course for 5th Year Medical 18 Saturday, May 18, 2024 Students  Psychiatric History Personal Data : ▪ Name ▪ Age ▪ Sex ▪ Religion ▪ Nationality ▪ Martial status ▪ Address ▪ Education ▪ Occupation Psychiatry Course for 5th Year Medical 19 Saturday, May 18, 2024 Students  Psychiatric History Presenting complaint (it should be in patient’s own words in Arabic) Why?? Psychiatry Course for 5th Year Medical 20 Saturday, May 18, 2024 Students  Psychiatric History Presenting complaint of the informant should be – Reliable. – Living with the patient Psychiatry Course for 5th Year Medical 21 Saturday, May 18, 2024 Students  Psychiatric History History of the present illness: (onset, course and duration) 1. Start with open questions, e.g. ‘Can you tell me what has been happening?’ 2. Establish when the illness first began e.g. ‘When did you last feel well? 3. What does the patient think might caused symptoms and what makes it better or worse? 4. What has been the effect on daily life/relationships/work? Psychiatry Course for 5th Year Medical 22 Saturday, May 18, 2024 Students  Psychiatric History 5. Depending on the presenting complaint, you will need to ask questions about other symptoms to help you make a diagnosis. Could you give an example? 6. Enquire about mood, sleep and appetite, even if they appear normal, and whether there are risks of harm to self or other. Psychiatry Course for 5th Year Medical 23 Saturday, May 18, 2024 Students  Psychiatric History Main Symptomology – Mood. – Delusions , Hallucinations. – Anxiety. – Substance abuse. – Obsessions. – Negative symptoms. – Suicide. Psychiatry Course for 5th Year Medical 24 Saturday, May 18, 2024 Students  Psychiatric History Family History: ▪ Parents ▪ Living together ▪ Separated ▪ Father Died ▪ Mother Died ▪ others ▪ Consanguinity Psychiatry Course for 5th Year Medical 25 Saturday, May 18, 2024 Students  Psychiatric History Family History: ▪ Social Class -High -Middle -Low ▪ Educational level of father/ mother: Illiterate Read and Write Primary School Prep. School Secondary School University Postgraduate Technical school Psychiatry Course for 5th Year Medical 26 Saturday, May 18, 2024 Students  Psychiatric History Family History: ▪ General home atmosphere Harmonious Quarrelsome Cold Overprotective over criticizing ▪ Number of siblings Males Females Order of patient between siblings Psychiatry Course for 5th Year Medical 27 Saturday, May 18, 2024 Students  Psychiatric History Family history of Medical illness Family history of Psychiatric illness Family history of Substance Abuse Psychiatry Course for 5th Year Medical 28 Saturday, May 18, 2024 Students  Psychiatric History Personal History Prenatal, natal and postnatal Any Abnormality during pregnancy Illness Medications others Delivery Normal Caesarian others Psychiatry Course for 5th Year Medical 29 Saturday, May 18, 2024 Students  Psychiatric History Infant at birth Normal low birth weight cyanosed Jaundiced incubated others Developmental history : Normal / Abnormality: Delayed motor delayed speech Tics Autistic Behavior Conduct Hyperactive Psychiatry Course for 5th Year Medical 30 Saturday, May 18, 2024 Students  Psychiatric History ▪ Neurotic traits : Nail biting Thumb suckling stammering Temper tantrum Nocturnal Enuresis Educational record : ▪ Type of School Public private other ▪ Performance of School Superior Average Failure Psychiatry Course for 5th Year Medical 31 Saturday, May 18, 2024 Students  Psychiatric History Truancy from school Educational level Illiterate Read and Write primary School Prep School Secondary School Technical School University Postgraduate others Psychiatry Course for 5th Year Medical 32 Saturday, May 18, 2024 Students  Psychiatric History Work record Employed Unemployed Military Service Done Exempted due to psychiatric illness Exempted due to other reason Psychiatry Course for 5th Year Medical 33 Saturday, May 18, 2024 Students  Psychiatric History Psychosexual history Age at Puberty Gender identity Male female ▪ Gender orientation Heterosexual Homosexual Bisexual Psychiatry Course for 5th Year Medical 34 Saturday, May 18, 2024 Students  Psychiatric History Martial History Single Married divorced widow Name of Spouse Age Relation of spouse Harmonious Quarrelsome ▪ Children ▪ Number Male Female Psychiatry Course for 5th Year Medical 35 Saturday, May 18, 2024 Students  Psychiatric History Past History : ❖ Past history of substance abuse. ❖ Type of substance. ❖ Nicotine THC Tramadol ❖ Heroin BNZ cocaine others ❖ Past history of Medical illness. Psychiatry Course for 5th Year Medical 36 Saturday, May 18, 2024 Students  Psychiatric History Premorbid Personality : Traits. Character. ( extrovert with large number of friends or introvert with little number of friends ) Religiosity. ( Believer or not , practicing or not ) Hobbies. Special Habits. Psychiatry Course for 5th Year Medical 37 Saturday, May 18, 2024 Students  The Mental State Examination A-General Appearance and examination. B-Speech and Sample of talk. C-Mood And Affect. D-Thought process. E-Perception. F-Cognitive function. Psychiatry Course for 5th Year Medical 38 Saturday, May 18, 2024 Students  The Mental State Examination General Appearance and Behavior. Appearance and cooperation Clean and fair self hygiene Neglected odd Gait and posture Eye to Eye Contact Good poor Grooming Well poor Psychiatry Course for 5th Year Medical 39 Saturday, May 18, 2024 Students  The Mental State Examination Facial expression Level of activity Any Special marks Speech – Spontaneous in answer to questions Psychiatry Course for 5th Year Medical 40 Saturday, May 18, 2024 Students  The Mental State Examination Speech and Sample of talk Clarity Coherent (understandable) / incoherent Rate fast slow average Volume high low average Tone high/ low pitched voice Psychiatry Course for 5th Year Medical 41 Saturday, May 18, 2024 Students  The Mental State Examination Mood and Affect 1. Mood ( subjective patient`s inner experience and description). 2. Affect (patients feeling expression , objective feelings observed by the physician ) – Range (quantity)( restricted , blunt, flat , expanded with full range) – Appropriateness or congruent to the situation or in appropriate or incongruent. – Stability during interview or unstable (labile affect ) Psychiatry Course for 5th Year Medical 42 Saturday, May 18, 2024 Students  The Mental State Examination ▪ Mood/ Affect (quality): Euphoric Elated Exhalation Ecstasy Anxious Sad Depressed Dysphoric Irritable Euthymic Psychiatry Course for 5th Year Medical 43 Saturday, May 18, 2024 Students  The Mental State Examination Thinking Stream of thinking Fast slow Average Form of thinking Off pointing Circumstantial tangential Derailment loose association Incoherent Neologism poverty of thoughts No Abnormality Psychiatry Course for 5th Year Medical 44 Saturday, May 18, 2024 Students  The Mental State Examination Thought Process Thought form and stream are examined during the interview Formal thought disorder FTD : 1. Loosening of associations: there is no discernible link between statements: I am reading ➪ climate change ➪ where’s the piano? 2. Thought block: the patient’s subjective experience of thought is abnormal (thoughts disappear: ‘my mind goes blank’). 3- Circumstantiality : over inclusive of details Psychiatry Course for 5th Year Medical 45 Saturday, May 18, 2024 Students  The Mental State Examination 4- Tangentially : linkage between ideas remains tight yet not directly address the point. 5- Flights of ideas : frequent shifts in topic and rapid rate of speech. 6-Derailment: syntax intact , if it resumes ,the topic changes. 7-Incoherance : Words are unintelligible. Psychiatry Course for 5th Year Medical 46 Saturday, May 18, 2024 Students  The Mental State Examination Content of thinking Delusions Obsessions Overvalued ideas preoccupations Thought Control Thought broadcasting Thought insertion Thought withdrawal Thought reading No abnormality Psychiatry Course for 5th Year Medical 47 Saturday, May 18, 2024 Students  The Mental State Examination Perception Abnormalities Definition How To Examine Illusions Misinterpretations of Ask whether visual, normal perceptions auditory; occur in clear consciousness or not. Hallucinations Perceptions, in the Ask ‘Have you seen or absence of an external heard things that other stimulus, that are people can’t see or hear? experienced as true and Can you tell me more as coming from the about that?’ 48 outside world. Psychiatry Course for 5th Year Medical Saturday, May 18, 2024 Students  The Mental State Examination Hallucinations Auditory Visual Olfactory Tactile Gustatory Psychiatry Course for 5th Year Medical 49 Saturday, May 18, 2024 Students  The Mental State Examination Judgment Is the ability to assess a situation correctly and act appropriately within that situation. -Fair -Poor Insight Is the degree of awareness and understanding of the patient with regards to his illness , symptoms , need for treatment and admission. -Insightful - Insightless Psychiatry Course for 5th Year Medical 50 Saturday, May 18, 2024 Students  The Mental State Examination ❑Insight How to ask? Ask about the patient’s: Attitude towards his present state; whether there is an illness or not? If yes, which kind of illness (physical, psychiatric or both)? Is any treatment needed? Is there hope for recovery? What is the cause of illness? Psychiatry Course for 5th Year Medical 51 Saturday, May 18, 2024 Students  The Mental State Examination Abstraction : means displaying only essential information and hiding the details – Ask patient if he/she can grasp the hidden meaning of 3 to 5 proverbs – Or examine the ability to give similarity between two items -Fair -Concrete - partially improved Psychiatry Course for 5th Year Medical 52 Saturday, May 18, 2024 Students  The Mental State Examination Cognitive functions Consciousness Fully conscious confused stupor Attention Attentive inattentive N.B. any disturbed consciousness or attention is mostly secondary organic or other medical causes Orientation to time , place and person Orientated disorientated Psychiatry Course for 5th Year Medical 53 Saturday, May 18, 2024 Students  The Mental State Examination Memory: Our library of knowledge and experience A) Immediate/ Working memory and attention : ask patient to recall 3 wards immediately OR ask patient to recall 5 to 7 digit ( digit span backward and forward) B) Recent: ask patient to recall pervious 3 wards before or ask about recent situation occur within few hours as his breakfast today C) Remote: ask patient about old history as his address or history about counties Psychiatry Course for 5th Year Medical 54 Saturday, May 18, 2024 Students  The Mental State Examination Concentration is the ability to maintain attention for a period To examine concentration ask patient to subtract 7 for 100 serially for 7 times Or ask him to recall days of the week serially forward and backward General knowledge This can be something that is estimated by incidental factors during the interview Psychiatry Course for 5th Year Medical 55 Saturday, May 18, 2024 Students  Formative Assessment A 22-year-old woman is seen by a psychiatrist in the emergency room after she is found walking in the middle of a busy street with no shoes on. During her interview she is asked to count backwards from 100 by 7’s. Which of the following best describes the cognitive functions being tested by this request? A. Orientation B. Immediate memory C. Fund of knowledge D. Concentration E. Abstract reasoning Psychiatry Course for 5th Year Medical 56 Saturday, May 18, 2024 Students  Formative Assessment A 22-year-old woman is seen by a psychiatrist in the emergency room after she is found walking in the middle of a busy street with no shoes on. During her interview she is asked to count backwards from 100 by 7’s. Which of the following best describes the cognitive functions being tested by this request? A. Orientation B. Immediate memory C. Fund of knowledge D. Concentration E. Abstract reasoning Psychiatry Course for 5th Year Medical 57 Saturday, May 18, 2024 Students  Formative Assessment A 32-year-old woman is seen in an outpatient psychiatric clinic for the chief complaint of a depressed mood for 4 months. During the interview, she gives very long, complicated explanations and many unnecessary details before finally answering the original questions. Which of the following psychiatric findings best describes this style of train of thought? A. Loose association B. Circumstantiality C. Neologism D. Perseveration E. Flight of ideas Psychiatry Course for 5th Year Medical 58 Saturday, May 18, 2024 Students  Formative Assessment A 32-year-old woman is seen in an outpatient psychiatric clinic for the chief complaint of a depressed mood for 4 months. During the interview, she gives very long, complicated explanations and many unnecessary details before finally answering the original questions. Which of the following psychiatric findings best describes this style of train of thought? A. Loose association B. Circumstantiality C. Neologism D. Perseveration E. Flight of ideas Psychiatry Course for 5th Year Medical 59 Saturday, May 18, 2024 Students  References Kaplan & Sadock's Concise Textbook of Clinical Psychiatry. Publication Year: 2017 Edition: 4th Ed. Authors/Editor: Sadock, Benjamin; Sadock, Virginia A.; Ruiz, Pedro Publisher: Lippincott Williams & Wilkins (LWW) ISBN: 978-1-49-634525-7 Doody's Star Rating®: Score: 87 Psychiatry Course for 5th Year Medical 60 Saturday, May 18, 2024 Students  Psychiatry Course for 5th Year Medical 61 Saturday, May 18, 2024 Students