A psychiatric examination is a conversation that focuses on various potential symptoms of psychiatric illnesses and disorders. Visiting a psychiatrist is still probably, but should not be, a shameful matter and remains a taboo subject. A psychiatrist - like any other doctor - takes into account only the patient's well-being in order to properly diagnose the existing problem in the patient, and then propose appropriate treatment for him. What questions are asked during a psychiatric examination and why should patients not be afraid of it?

Psychiatric examinationis still a taboo subject, and some patients, just hearing this phrase, experience unpleasant feelings and associations. Where could this attitude come from? Most often, people fear what they simply do not know.Psychiatric examinationis in fact a mental functioning problem-oriented conversation. Basically every doctor can perform a basic mental state assessment, while a full psychiatric examination remains the domain of specialists in psychiatry and psychiatry of children and adolescents.

Psychiatric examination starts when the patient enters the office

The beginning of the psychiatric examination is the moment when the patient enters the doctor's office. Already then, one can pay attention to the different behaviors of the patient, which will bring the doctor closer to the diagnosis. For example, a depressed person may come to a doctor's office dressed in an extremely sloppy manner. Another patient - for example one who is in a mania - may have an exceptionally colorful and flashy style. The first associations that appear at the doctor are very important - they may affect the further course of the psychiatric examination.

Psychiatrists keep a close eye on their patients throughout the psychiatric examination. For example, aspects such as :

  • the way the patient sits;
  • the patient performs any restless movements, e.g. trembling legs or constant manipulations with hands;
  • eye contact with the doctor;
  • the pace of speaking.

Psychiatric examination: orientation assessment

During a psychiatric examination, two types of orientation are assessed: autopsychic orientationandallopsychic orientation . The first one concerns the patient himself - an autopsychic person knows who he is, what his name is and how old he is. Allopsychic orientation, in turn, concerns the patient's environment - to evaluate it, it is necessary to ask questions about the patient's place or the current date or day of the week.

Psychiatric screening: affect and mood assessment

Affectis the current emotional state presented by the patient (affect can also be defined as an expression of the patient's emotions that can be assessed by the doctor). During a psychiatric examination, a physician may find that a patient has an adapted, maladjusted, labile, rigid, or weakened affect.

Mood , in turn, is a broader concept than affect and covers longer-lasting emotional states. Mood can be elevated, depressed or even (euthymic). In order to assess the mood, the psychiatrist may ask the patient to describe his mood according to some scale (e.g. on a numerical scale, where 0 is the worst possible mood, and 10 is the best mood that the patient can imagine). The clinical picture presented by the examined person also influences the final assessment of mood. A person who is sad, distressed, and unable to rejoice may be in a low mood. Conversely, in another person who seems to be full of energy and agitated, unable to sit still in one place - such behavior may suggest an elevated mood in the patient.

Psychiatric examination: perception impairment assessment

In the course of a psychiatric examination, basically every patient is asked whether they have ever seen or heard something unusual, or experienced sensations from any other sense that other people have not experienced. In some of the respondents this causes indignation, but you should not get upset too quickly - the question about the occurrence of perceptual disturbances (mainly in the form of hallucinations) is a routine element of a psychiatric examination.

Hallucinations can involve any sense, therefore - especially if the psychiatrist suspects that the patient may be experiencing them - a number of different questions may arise focusing on perceptual disturbances. For this purpose, the patient may be asked, for example, if he hears any voices or if he has ever felt any unusual sensations that could come from inside his body.

Psychiatric examination: assessment of thinking disorders

Disturbances in thinking are divided into two groups:disturbances in the pace of thinkingand disturbed thinking content . Both information obtained from the patient and the manner in which the patient speaks are used in the assessment of disturbances in the pace of thinking. This group of disorders includes, inter alia, acceleration of the course of thinking or its slowing down. Psychiatrists often simply ask patients if they experience a slower or faster flow of thoughts. It is also taken into account how quickly the patient answers questions - e.g. after long reflection on the answer, one may suspect that the respondent's pace of thinking is slowing down.

The second group of psychopathological disorders related to thinking are disturbances in the content of thinking. These include delusions and obsessions. The psychiatrist may find out about the patient's delusions by carefully listening to what the patient tells about - for example, a patient with persecutory delusions may be convinced that everyone wants to hurt him, while the patient with delusions of influence may stubbornly claim that his behavior or thought processes are guided by some external force. When assessing delusions, the doctor must be especially tactful - because in order to be able to talk about a patient experiencing delusions, it must be stated that the patient is uncritically convinced of the truthfulness of his beliefs, even when he is presented with evidence that they are not true.

Obsessions in turn are called intrusive thoughts. To check if they are present in the patient, the psychiatrist asks the subject if he has ever experienced any intrusive, unpleasant thoughts that the patient has tried (unsuccessfully) to avoid. Obsessions are related to another problem - compulsions, i.e. the need to perform certain activities (e.g. obsessive washing of hands). In this case, the psychiatrist asks the patient if the patient experiences the necessity to perform any activities that may - even temporarily - alleviate the occurrence of obsessions.

Psychiatric examination: Insight Assessment

Insight is the patient's awareness of a disease. The assessment of insight is one of the basic elements of a psychiatric examination - in a patient with preserved insight, it will most likely be easier to implement therapeutic interventions than in a patient who - despite being burdened with the disease - feels completely he althy.

Psychiatric examination: assessment of cognitive functions

During a psychiatric examination, attention, memory and concentration are also assessed. The easiest way to infer about the state of these cognitive activities is by asking the patient whether he or she feels there is, for example, impaired attention or memory.Memory can also be assessed during the psychiatric examination itself, for example the psychiatrist may ask the respondent to remember a few words given to him and to recreate them at the moment chosen by the doctor.

Psychiatric examination: suicidal thoughts

Some people not related to psychiatry believe that questions about suicidal thoughts or attempts to kill oneself should not be asked - this is a definite mistake. They will not make the patient think about taking his own life, but rather make the patient think that someone has decided to really assess his mental state as a whole. In a psychiatric examination, it is important to identify both present and past suicidal thoughts or attempts. Psychiatrists also ask respondents about committing acts of self-harm.

Psychiatric examination: medical history

The patient may see a psychiatrist both for the first time, and it may be his next visit to such a specialist. In the case of people who have already received psychiatric treatment, information on the current course of their disease is of great importance. The doctor is interested in all already implemented methods of treatment, hospitalizations (especially those that took place without the patient's consent), as well as the length of remission periods.

The psyche is unquestionably related to organic diseases, therefore, during a psychiatric examination, questions are asked whether the patient suffers from any chronic diseases. This is very important for several different reasons. First, some organic entities can lead to mental disorders (such as hypercortisolemia, which can cause psychotic disorders). Another aspect is the one related to the planning of psychiatric treatment - the presence of certain diseases in a patient may preclude the use of certain medications (e.g. in people with cardiological problems who do not use tricyclic antidepressants). Information on medications already used by the patient is also important - a psychiatrist who knows what medications his patient is taking will be able to offer him psychotropic medications that will not interact with other medications.

Psychiatric examination: all events in human life have an impact on the psyche

A complete psychiatric examination is a very comprehensive assessment. This is due to the fact that the occurrence of mental disorders and diseases, e.g. in a 40-year-old person, may be influenced by events that occurred in their early youth. This is why psychiatrists ask about the patient's education process,relationships with parents during adolescence or first relationships. Theoretically, even information on the course of pregnancy in the patient's mother could be of significant importance - after all, one of the potential factors that may be related to the etiology of, for example, schizophrenia, are infections experienced during the intrauterine life. It is also important to know about the patient's various accidents (especially if they were accompanied by head injuries), as well as the history of neurological disorders such as seizures in the past.

Psychiatric examination: addictions

The standard question that is asked in a psychiatric examination is about psychoactive substances. Most often, patients are asked about the use of alcohol, drugs and nicotine products, in fact they should also be asked about possible drug abuse and other addictions (even such as shopaholism or pathological gambling).

Psychiatric examination: conflicts with the law

Psychiatrists are also interested in whether the patient has ever come into any conflict with the law. Such events may indicate, for example, the patient's excessive impulsiveness, breaking the law may also occur when patients experience, for example, manic episodes.

Psychiatric examination: what else do psychiatrists ask about?

Patients visiting a psychiatric office will probably also be asked about how they sleep (after all, psychiatric problems may result in both insomnia and excessive sleepiness), and about their appetite (the questions here are to exclude or confirm various eating disorders, such as bulimia and anorexia).

Worth knowing

Child psychiatric examination: similar but different

The course of a psychiatric examination in children is in some respects similar to that in adults, but it is also characterized by certain differences. First of all, the diagnosis of mental problems in children is carried out on the basis of both the conversation with the child and its caregivers. It is understandable that when a behavioral disorder or an autism spectrum disorder is suspected, it is not from a child, but from parents that the psychiatrist will obtain information that is crucial for making a diagnosis.

In child psychiatry, the development period of a child is of great importance. The first steps, the first words, the way in which the child interacted with peers and with strangers - all these matters in the psychiatric examination of children. This study is also specific to theDue to some difficulties - these may occur, for example, in the case of perception disorders in children. Pediatric patients usually have an extremely rich imagination, and it can be difficult for a layman to tell whether the stories about the sighted dragons or ghosts are related to the child's creativity, or whether the child is actually experiencing hallucinations. However, experienced specialists in child psychiatry are able to distinguish the norm from pathology. Yet another feature that makes a psychiatric examination in children different is the fact that, for example, drawings made by a child may be used during this examination.

Psychiatric examination - in the overall assessment it is not only the conversation with the patient that matters

Basic conclusions from the psychiatric examination are definitely drawn on the basis of the information obtained from the respondent. However, the data provided by the psychiatrist's family to the psychiatrist is also important in the overall assessment of the patient. Conversation with the relatives may be of particular importance, e.g. when a patient comes to a psychiatric hospital due to emergency indications during an acute episode of a mental illness (e.g. in the phase of severe mania). In such a situation, the patient's family can provide the physician with information about his functioning in the premorbid period, as well as provide the specialist with data on the current course of treatment or on the medications taken by the patient.

Psychiatric examination as a test that may look completely different in different patients

As you can see, the psychiatric examination is very extensive - it can take up to an hour or more to complete. However, not all patients hear the same questions from the doctor - it is understandable that the psychiatrist will talk to a patient with a suspected delusional syndrome mainly about his incorrect beliefs, and in turn, the conversation with a patient in a depressive episode will focus primarily on mood disorders.

Can you be concerned about a psychiatric examination?

An examination by psychiatrists is simply an interview. Honesty and openness in contact with a doctor can certainly bring benefits - a professional psychiatrist does not assess the patient, because his task is to systematize the information provided to him by the patient and make a diagnosis, and then offer him the appropriate treatment. It is worth emphasizing that you hardly ever find couches known from cinematography in psychiatric offices - if anything, they are rather the equipment of a psychologist's or psychotherapist's office. A patient visiting a psychiatrist will be offeredprobably a comfortable chair, and the conversation itself will take place in such conditions that the respondent would not feel any discomfort.

Category:

Psychiatry