1995, The main part of the symptoms of mental illness can only be found from the patient's words. Such violations are the phenomena of mental automatism, delusional ideas, obsessive thoughts and fears, deceptions of feelings, depersonalization and derealization. Other disorders of the psyche can only be suspected on the basis of monitoring the behavior of the patient. These disorders include auditory hallucinations (the patient listens to something), delusions of persecution (the patient has a strained and frightened appearance). In the case of a sharp excitement, a stupor, a disturbed consciousness, the patient should be questioned only after these conditions have passed. With a patient who is in a psychotic state, it is better to talk beforehand about
information from relatives and friends. In nonpsychotic disorders, it is better to ask the patient first, which increases his confidence in the doctor.
Interviewing a patient requires special skills from a psychiatrist. A single scheme for conducting a survey is simply impossible, because, on the one hand, the patient must be given a say, and on the other hand, the initiative should always be in the hands of the doctor. To begin a conversation with a patient you need from what served as the basis for applying to a psychiatrist. The doctor always needs patience, endurance, benevolence, as well as sympathy for the patient even with a clearly hostile
his attitude towards a psychiatrist. It is necessary to avoid familiarity and keep distance. In no case should one hide from the patient the purpose of the inquiry, be presented by someone else, not a psychiatrist. In case of refusal to answer the questions posed, the most important of them should still be given to the patient. In this case, the doctor must note the patient's reaction to these questions.
The task of the questioning is to find out how much the patient understands what is happening around him, how he is oriented in place and time, whether the memory is stored for the most important events in his life, as well as for events that occurred before calling a doctor. The psychiatrist should ask the patient to give an explanation to his actions or statements that others around him could suggest to a mental disorder. If the patient does not express himself about his painful experiences, the doctor should ask suggestive questions about hallucinations, delirium and other disorders. It is useful to ask a question about the presence in the mind of a patient of suicidal thoughts not only in the present tense, but also in the past. In addition, it is necessary to find out the attitude of the patient to all the revealed painful experiences and behavioral features, such as complete absence of criticism, partial, unstable or sufficient critical attitude towards them.
The patient is questioned only if his relatives and relatives are not present.
The psychiatric history is subdivided into subjective and objective.
Subjective anamnesis. In this case, the information is collected from the patient himself in the course of his interview. Anamnesis of the disease consists in elucidating the time of the first appearance and characterization of the signs of the disease, what events preceded it, how the manifestations changed when they disappeared. The anamnesis of life includes the patient's memories of which family he grew up in, who his parents were, how the training was conducted, what behavioral disorders (for example, runaways from home) were in childhood and adolescence. It is necessary to find out whether there was an abuse of alcohol, drugs or other intoxicants, at what age it began, as far as it was expressed. Important are the data on the assessment of the patient's social status - labor and family. The psychiatrist should find out whether the patient is satisfied with his status, what is burdensome and what he lacks. Also important are the information about those events of a past life that the patient himself considers the most difficult, how he experienced them, whether at such times suicidal thoughts and attempts were made. The somatic anamnesis takes into account the transmitted diseases, information about craniocerebral trauma, even with a short-term loss of consciousness, brain infections, neuro-intoxication, a tendency to allergic reactions. The subjective anamnesis reflects information obtained from relatives and close psychiatric patients. This information is recommended to be received from each person separately. The psychiatrist should lead the conversation, learning only the facts. At the same time, it is necessary to suppress any attempts to impose another's opinion on oneself. In addition, they collect an anamnesis of the disease itself. In the process of collecting this anamnesis find out when and what manifestations of the disease arose, what reason could contribute to this. They also collect an anamnesis of the patient's life, emphasizing his attention to information about hereditary burden.
28 фев 2018
