History taking, in all clinical settings, is a process that allows clinicians to test out hypotheses to try and understand the nature and impact of the patient’s experiences. Many students when starting their psychiatric attachment feel intimidated by this process, feeling it to be alien to their previous history taking experiences. It is, however, simply a variant of all medical history taking but with a greater emphasis on exploring the meaning behind what the patient reports. In patients presenting with psychiatric symptoms it is vital that the student takes into consideration their physical health too as physical illnesses can presnt with psychiatric symptoms. Of course the converse holds true.
The psychiatric interview is the opportunity for the clinician to make an assessment of the patient’s mental state and establish a therapeutic relationship. The ability to do this well requires the use of nondirective (open) questioning followed up by systematic probe (closed) questions. Ambiguities and inconsistencies require clarification by sensitive enquiry or recapitulation. Ensure that you establish a timeline of the patients problems. Make sure you allow the patient time to talk and be empathic in your response to their experiences.
Common errors made in this process include failure to seek precise clarification, failure to pick up on nonverbal cues and a willingness to rely on patient’s use of jargon.
Mental state examination seems to be the one aspect of psychiatric assessment that intimidates students the most. It begins as soon as you see the patient, if not before i.e. when they are shouting, or when you turn up to their house and see windows covered in tin foil etc. It may seem obvious, but it is worth stressing, that this is an examination of the patient’s mental state at the time you see them. It is not the history of their morbid experiences. So, if you see a patient that was hallucinating the day before you saw them, their morbid experiences would be described in their history not the MSE.
Link to Blog posts featuring psychopathology
Internal video resources
History taking – a fairly long video of a challenging interview
Mini Mental State Examination (cognition)