CMN 548 MODULE 1 STUDY GUIDE
Carlat, Chapter 14
ch 14
1. How is the history of present illness different from the past psychiatric history?
Why is it important to have an understanding of the history of present illness if
I'm going to obtain the psychiatric history anyway?
What time period should be covered in the history of present illness?
Often, psychiatric crises occur over a 1- to 4-week period.
What are some common mistakes made by beginners in obtaining the history of
present illness?
The most common pitfall for beginners is spending too much time on the HPI
What are some examples of questions that can be asked to obtain a history of
present illness when the patient is in a crisis?
What has been happening over the past week or two that has brought you into
the clinic?
Have there been any events that you think have caused your problem or made it
worse?
Have you sought any treatment for this problem?
,How would you approach a patient when obtaining a history of present illness
when you're simply trying to explore symptoms?
Many patients automatically jump into a chronologic narrative of their problems
when prompted by one of the preceding questions.
If this happens, it is a time to fall silent for a while and listen. Remember, this is
your "scouting period" (see Chapter 3), during which you are observing, listening,
and hypothesizing. However, if your patient begins to jump around into other
issues or time frames, you may want to refocus him.
What are some key points to remember in conducting a well executed interview?
At its best, a well-conducted interview resembles a dance in which the give and
take between clinician and patient flow effortlessly throughout the hour, giving
the patient the sense that he just participated in a fascinating conversation about
his life rather than a "psychiatric" interview.
One way to set the stage for this type of experience is to begin the interview by
showing genuine interest and curiosity about the patient's job, hobbies, or life
situation and to allow the patient to steer the discussion toward clinical topics.
Why is it important to obtain the history of present illness in a chronological
fashion?
Ensuing questions track the course of the illness through months or years, arriving
eventually at the present.
What are some examples of ways to keep patients on track when obtaining the
history of present illness?
,Patient: I felt so angry when my wife yelled at me. But she's always been that
way. Back when I was in law school, she nagged at me constantly. I'd have to
spend late nights at the law library, and she refused to understand.
Interviewer: I'd like to hear more about that period later, but right now let's focus
on what's been happening over the last 2 weeks or so. You said you got angry at
her. What happened then?
Why is it important to focus on symptoms as the patient mentions them during
the interview?
Here, the interviewer stays on the depression topic by cueing off what the patient
has said about work (see the discussion of the smooth transition in Chapter 6).
If the interviewer had not actively structured the interview this way, the patient
might have discussed details of his work environment that would be less relevant
to the diagnosis of major depression.
Later, when ascertaining the social history, the interviewer can refer to what the
patient said about work.
Why is it important to have an understanding of how the patient was functioning
prior to this exacerbation of their mental illness?
Asking about current versus baseline functioning is important diagnostically.
The classic example is the difference between schizophrenia and bipolar disorder.
In schizophrenia, the patient's level of functioning gradually decreases over
months or years, whereas in bipolar disorder, the patient may have been
functioning dramatically better within the past few weeks.
, Determining baseline functioning is also important in setting treatment goals. You
might aim to help the patient achieve his best level of functioning over the past
year.
Carlat Chapter 15
Chapter 15
What is the purpose of obtaining the past psychiatric history?
goals of establishing a diagnosis and formulating a treatment plan.
Why is it important to obtain a chronological view of the patient's past psychiatric
history?
Specific psychiatric disorders have specific natural histories, with characteristic
risk factors, prodromal signs, ages at onset, and prognoses.
Obtaining a detailed PPH for a particular patient allows you to compare the
course of her illness with the textbook's version of the course of illness, increasing
the likelihood that you will make a correct diagnosis.
What are some important points to cover in the past psychiatric history?
Include questions about the severity of episodes and exacerbations, as well as the
duration of episodes. Often, this information comes out when you are obtaining
the treatment history.
For example, episodes of mania or exacerbation of schizophrenia often
correspond with hospitalizations.
Carlat, Chapter 14
ch 14
1. How is the history of present illness different from the past psychiatric history?
Why is it important to have an understanding of the history of present illness if
I'm going to obtain the psychiatric history anyway?
What time period should be covered in the history of present illness?
Often, psychiatric crises occur over a 1- to 4-week period.
What are some common mistakes made by beginners in obtaining the history of
present illness?
The most common pitfall for beginners is spending too much time on the HPI
What are some examples of questions that can be asked to obtain a history of
present illness when the patient is in a crisis?
What has been happening over the past week or two that has brought you into
the clinic?
Have there been any events that you think have caused your problem or made it
worse?
Have you sought any treatment for this problem?
,How would you approach a patient when obtaining a history of present illness
when you're simply trying to explore symptoms?
Many patients automatically jump into a chronologic narrative of their problems
when prompted by one of the preceding questions.
If this happens, it is a time to fall silent for a while and listen. Remember, this is
your "scouting period" (see Chapter 3), during which you are observing, listening,
and hypothesizing. However, if your patient begins to jump around into other
issues or time frames, you may want to refocus him.
What are some key points to remember in conducting a well executed interview?
At its best, a well-conducted interview resembles a dance in which the give and
take between clinician and patient flow effortlessly throughout the hour, giving
the patient the sense that he just participated in a fascinating conversation about
his life rather than a "psychiatric" interview.
One way to set the stage for this type of experience is to begin the interview by
showing genuine interest and curiosity about the patient's job, hobbies, or life
situation and to allow the patient to steer the discussion toward clinical topics.
Why is it important to obtain the history of present illness in a chronological
fashion?
Ensuing questions track the course of the illness through months or years, arriving
eventually at the present.
What are some examples of ways to keep patients on track when obtaining the
history of present illness?
,Patient: I felt so angry when my wife yelled at me. But she's always been that
way. Back when I was in law school, she nagged at me constantly. I'd have to
spend late nights at the law library, and she refused to understand.
Interviewer: I'd like to hear more about that period later, but right now let's focus
on what's been happening over the last 2 weeks or so. You said you got angry at
her. What happened then?
Why is it important to focus on symptoms as the patient mentions them during
the interview?
Here, the interviewer stays on the depression topic by cueing off what the patient
has said about work (see the discussion of the smooth transition in Chapter 6).
If the interviewer had not actively structured the interview this way, the patient
might have discussed details of his work environment that would be less relevant
to the diagnosis of major depression.
Later, when ascertaining the social history, the interviewer can refer to what the
patient said about work.
Why is it important to have an understanding of how the patient was functioning
prior to this exacerbation of their mental illness?
Asking about current versus baseline functioning is important diagnostically.
The classic example is the difference between schizophrenia and bipolar disorder.
In schizophrenia, the patient's level of functioning gradually decreases over
months or years, whereas in bipolar disorder, the patient may have been
functioning dramatically better within the past few weeks.
, Determining baseline functioning is also important in setting treatment goals. You
might aim to help the patient achieve his best level of functioning over the past
year.
Carlat Chapter 15
Chapter 15
What is the purpose of obtaining the past psychiatric history?
goals of establishing a diagnosis and formulating a treatment plan.
Why is it important to obtain a chronological view of the patient's past psychiatric
history?
Specific psychiatric disorders have specific natural histories, with characteristic
risk factors, prodromal signs, ages at onset, and prognoses.
Obtaining a detailed PPH for a particular patient allows you to compare the
course of her illness with the textbook's version of the course of illness, increasing
the likelihood that you will make a correct diagnosis.
What are some important points to cover in the past psychiatric history?
Include questions about the severity of episodes and exacerbations, as well as the
duration of episodes. Often, this information comes out when you are obtaining
the treatment history.
For example, episodes of mania or exacerbation of schizophrenia often
correspond with hospitalizations.
