Psychiatry for Physicians- Interview, History, And MSE - Part-2
All areas of mental functioning of the patient are approached for description in mental status examination (MSE). For a psychiatrist it is like the physical examination done by the primary care physician. Nine areas are approached for this purpose. They are
1. General description that includes appearance, motor behavior, speech and attitude.
\r 2. Emotions that include mood, affective expression and appropriateness.
\r 3. Perceptual disturbances including hallucinations, illusions, depersonalization and derealization.
\r 4. Thought processes including stream of thought, thought content, abstract thinking, education, intelligence and concentration.
\r 5. Orientation of time, place, person and situation.
\r 6. Memory that includes remote, recent past and recent memory.
\r 7. Impulse control.
\r 8. Judgment.
\r 9. Insight.
Finally the reliability of the information obtained is assessed by the psychiatrist before any important decision is made.
After the interview, history taking, mental status examination is complete they are integrated and utilized for the psychodynamic formulation. It includes the patients personality structures, principal psychological conflicts and adaptive abilities. The psychiatrist assesses the patient for ego function, developmental history, origin of conflicts, and adaptive problems so that a total and brief picture of disease, treatment and possible prognosis is obtained.
Some important terms are used in relation to the above procedure that should be known to the physicians to understand a complete document of history of psychiatry. They are briefly presented below.
1) Abstract thinking Type of thinking that enables one to formulate concepts and generalize them.
\r 2) Affect Expressed internal feelings.
\r 3) Compulsions Repetitive stereotyped behavior with internal intense impulse to perform it.
\r 4) Concentration The ability to focus and maintain attention when needed.
\r 5) Concrete thought Inability to formulate concept.
\r 6) Countertransference Transference from the part of psychiatrist towards the patient.
\r 7) Delusions Unshakable false belief not amenable and not shared by others.
\r 8) Depersonalization Transient unusual or different feelings about ones own self.
\r 9) Derealization Transient unusual or different feelings about the environment around.
\r 10) Echolalia Meaningless repeatation of others word.
\r 11) Hallucinations Perceiving something in the absence of any perceivable stimulus.
\r 12) Illusion Misperception of a stimulus.
\r 13) Impulse control The ability to control self activity for the sake of rationality or adaptation.
\r 14) Insight The awareness of the patient concerning the prevailing illness.
\r 15) Interpretations The calculated decisions from a psychiatrist about behavior in analysis.
\r 16) Judgment The capacities to understand, make proper decision, and apply them acceptably when a subject matter is at hand in the environment.
\r 17) Mood The sustained internal feelings.
\r 18) Neologism Production of unintelligible words as new or meaningless combination of old words.
\r 19) Phobia Marked fear reflected by intense anxiety.
\r 20) Preoccupation Prevailing thoughts in one that detaches from external reality.
\r 21) Resistance Attitudes against the goal of a therapy.
\r 22) Therapeutic alliance Combination of patients willingness with capacity of the psychiatrist to proceed with the treatment.
\r 23) Word salad Incomprehensible mixing of meaningless words and phrases.
About the Author:
Dr. Mohammad Samir Hossain PhD is a researcher teacher of Psychiatry and a Psychotherapist in Bangladesh. He is renouned for his educational and research activity in mental health sector nationally and internationally. The Dictionary of International Biography cites his brief biography starting from its 33rd edition. One of the best educational institutions involved with his educational activity is the Harvard Medical School of USA. Visit his personal page at http://www.samirhossain.org .
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