Description of mental status Example. Description of mental status in medical records. Patients with suspicion of confused
Relevance.
Schizophrenia is an endogenous disease with a progradient flow, which is characterized by changes in personality (autism, emotional depletion) and may be accompanied by the advent of negative (the drop in energy potential) and productive (hallucinatory-delusional, catatonic and other syndromes) symptoms.
According to WHO, 1% of the total population of the globe is sick of shizophrenia. According to the prevalence and social consequences of schizophrenia ranks first among all psychosis.
In the diagnosis of schizophrenia, several groups of symptoms are distinguished. The main (mandatory) symptoms of schizophrenia include the so-called balloom symptoms, namely: autism, disorders of the flow of associations, impaired affect and ambivalence. The symptoms of the first rank include the symptoms of K. Schneider: a variety of manifestations of the discretion of the automation of the psyche (symptoms of mental automatism), they are very specific, but they are far from always. Additional symptoms include nonsense, hallucinations, senthenetics, dealealization and depersonalization, catatonic stupor, mental attacks (raptines). In order to identify the above symptoms and syndromes, it is necessary to assess the mental status of the patient. In this work, we were covered by a clinical case of a patient with schizophrenia, its mental status was rated and leading psychopathological syndromes were revealed.
The purpose of the work: to identify the main psychopathological syndromes of schizophrenia patient on the example of a clinical case.
Objectives of work: 1) Estimate the complaints of the patient, anamnesis of the disease and anamnesis of life; 2) assess the mental status of the patient; 3) reveal the leading psychopathological syndromes.
Work results.
CLINICAL Case Lighting: Patient I., 40 years old, entered the psychiatric clinic of Kaliningrad in November 2017.
Complaints of the patient at the time of receipt: at the time of arrival, the patient presented complaints about the "monster", which settled into it from space, talking to a loud man's voice in her head, sends some kind of "space energy" through her, performs actions for it (houses on house - cleaning, cooking, etc.), periodically talks instead of it (with the patient's voice changes, becomes more rude); on the "emptiness in the head", the lack of thoughts, the deterioration of memory and attention, the impossibility of reading ("letters are blurred before our eyes"), sleep disorder, lack of emotions; On the "cutting of the head", which is caused by the "presence of the monsters inside it."
Complaints of the patient at the time of inspection: at the time of inspection, the patient presented complaints about a bad mood, no thoughts in the head, violation of attention and memory.
Anamnesis of the disease: considers himself a patient for two years. For the first time signs of the disease appeared when the patient began to hear a male voice in her head, which I was interpreted as "Voice of Love". The patient did not feel the discomfort from his presence. Binds the emergence of this voice with the fact that the romantic relationship with a familiar man (whom was not really not), pursued him. Due to his "new love" divorced her husband. At home, he often spoke with themselves, it was alarming her mother, who turned to a psychiatrist. The patient was hospitalized in a psychiatric hospital No. 1 in December 2015, stayed in hospital treatment for about two months. Reports that after discharge, the voice disappeared. A month later, according to the patient, the "monster, alien from space" was settled in it, which seems to be sick as "big toad". He began to talk with her a male voice (who came out of her head), did his homework for her, "stole all thoughts." The patient began to feel the emptiness in the head, lost the ability to read ("letters began to break up before our eyes"), the memory and attention was sharply worsened, emotions were disappeared. In addition, the patient felt the "sawing of the head", which binds the "monsters" in his head. The listed symptoms caused the appeal to the psychiatrist, and the patient was hospitalized into a psychiatric hospital for inpatient treatment.
Life history: heredity is not burdened, in childhood mentally and physically developed normally, by education - an accountant, the last three years. Harmful habits (smoking, alcohol use) denies. Not married, has two children.
Mental status:
1) external features: hypomimic, the posture is flat, sitting on a chair, hands and legs crossed, condition of clothing and hairstyles - without features;
2) Consciousness: in time, place and self oriented, there is no disorientation;
3) the degree of accessibility to the contact: the initiative in the conversation does not show, it is not responding to questions, one is monitored;
4) perception: broken, syntedopathy ("cutting heads"), pseudogalucination (male voice in the head);
5) Memory: Standing events remembers well, some recent, current events periodically fall out of the memory (sometimes it can not remember what I have done earlier, what kind of houses did it), Square Lururia: I also remembered all the words from the fifth time, just once again reproduced two; pictograms: reproduced all the expressions except "delicious dinner" (called "delicious breakfast"), drawings - without features;
6) Thinking: Bradyphractions, Schperong, delusional ideas of impact, test "Fourth extra" - not by a significant sign, some proverbs understand literally;
7) Attention: distractions, test results on Tables Schulte: The first table - 31 seconds, then there is fatigue, the second table is 55 seconds, the third is 41 seconds, the fourth table is 1 minute;
8) Intellect: Preserved (the patient has a higher education);
9) Emotions: There is a decline in mood, longing, sadness, concerns, anxiety, fear (prevailing radicals - longing, sadness). The background of mood - depressive, often crying, wants home;
10) Volga activity: no hobby, does not read books, often watching TV, there is no favorite TV show, hygiene rules observe;
11) Increases: reduced;
12) Movement: adequate, slow down;
13) Three main desires: expressed one desire - return home to children;
14) The inner picture of the disease: it suffers, but there is no criticism for the disease, it believes that "alien" uses it to transmit "cosmic energy", does not believe that it may disappear. Volosses for cooperation and rehabilitation are present.
Clinical assessment of mental status:
A woman has 40 years old exacerbation of endogenous disease. The following psychopathological syndromes were identified:
Kandinsky-Clerambo syndrome (based on the identified pseudogalucinations, the delusional ideas of impact and automatism - associative (violation of thinking, shlerong), syntopathic and kinesthetic);
Depressive syndrome (the patient often crying (hypothymia), there is a brady attraction, the movements are slow down - "Depressive Triad");
Apatico-abutic syndrome (based on a pronounced emotionally volitional squeezing).
Evaluation of mental status helps to identify leading psychopathological syndromes. It must be remembered that the nosological diagnosis without specifying the leading syndromes is non-informative and is always questioned. In our work was presented approximate algorithm Estimates of the psychic status of the patient. A very important final stage in the assessment of mental status is to establish the presence or absence of criticism for its disease in the patient himself. It is quite obvious that the ability to realize their disease in different patients is very different (up to its complete denial) and it is it that it has a crucial impact on the treatment plan and subsequent medical and diagnostic measures.
List of references:
- Antipina A.V., Antipina T. V. The incidence of schizophrenia in different age groups // International Academic Bulletin. - 2016. - №. 4. - P. 32-34.
- Gurovich I. Ya., Shmukler A. B. Schizophrenia in Systematics mental disorders // Social and clinical psychiatry. - 2014. - T. 24. - No. 2.
- Ivana N. N. and others. Psychiatry and narcology // News of science and technology. Series: Medicine. Psychiatry. - 2007. - №. 2. - P. 6-6.
Anamnesis of life:
Anamnesis of the disease:He considers himself a patient within 3 months, when, for the first time, some changes in the character, expressed in the increased emotional lability, "crying often and without a special reason," irritability (in raising, conversation with her child). Notes that the mood was more often bad, he felt a constant concern for the child. At the same time noticed that it became quickly tired with mental tension, the dream became worse, became forgetful. Symptoms of the disease grew gradually. Binds the disease with stress by the husband after the death of her husband
Appearance of patients (frozen look, poverty of the Mimici, slow motion)
Feeling and perception(- hypshethesis, illusory, delaimal and depersonalizational phenomena;)
Consciousness-All
Thinking - slowdown in thinking (one-step speech, long-thinking answer), ultra-subject and delusional ideas of hypochondriac, self-evidence, self-priority, self-sharing; Slow
Emotional-volitional sphere: in the emotional sphere - the reaction of anxiety and fear; Deposit Suppression: Live Appetite, Libido Reduction, Contact Avoiding, Closed, Depreciation of Life, Suicide, Hypothymia, Depression, Depression, Sadness
Memory.violation of a sense of familiarity; in fact, they are due to the insufficient concentration of attention, and if they induce the patient to make special efforts to focus, then, as a rule, it turns out that the ability to memorize and reproduce information is not violated
Intellect is saved, in schizophrenia reducing
Motor disorders: stiffness, slowness, badness; Depressive stupor.
Describe the mental status of the patient with Corsakovsky syndrome
Anamnesis of life
It develops with: severe intoxications, infectious diseases, different types of hypoxia, brain tumors, violation of the blood circulation of the brain, in the preparation of cranial injuries. With thiamine deficiency (vitamin B1). Vitamin B1 deficiency is distributed to people suffering from alcohol addiction. Also common among people, with disturbed suction - Malabsorption syndrome.
Anamnesis of the disease.Denies the presence of the disease.
Appearance and behavior
Neat. Friendly. Mimica live. The addressed speech reacts quickly. Questions answers essentially. The tempo of speech is normal.
Feelings and perception
Of particular importance is the disorder of the perception of time, and the non-elementary sense of time is disturbed, but mostly the arrangement of events in time, i.e. the chronological order is lost.
Consciousness
Clearly. Prepared Orientation in time, and the patients often cannot call not only the numbers, day of the week, month and year, but also the time of year. He cannot imagine how long he is in the hospital, can not remember when this event occurred - now or a year ago. He does not consider patients.
Thinking
Sequential, tempo normal. The statements and conclusions are logical. Thinking them mostly caused not internal need, but by external impressions: they will start talking to him - he begins to say, it will see a thing - will make his remark, but he is not interested in anything.
Emotional-volitional sphere
Facial expression and facial paink adequate. Reducing the level of motivation, volitional activity, in connection with which they provided themselves can remain inaccessible for hours. There are no interests with a resolutely no, except for the interests of physical: eat, drink, sleep, smoke. They prevail the apathetic or apatico-euphoric background of mood.
Memory
Fixation amnesia - Memory disorders to current events, the patient can not remember, he took part or not, although just removed from the table. If the person with whom he told minutes from two minutes to this minute, will again go and asks if he saw him, the patient answers: "No, it seems, I have not seen." Memory is limited only to what was before the sickness, the same, that was after the start of the disease, the patient does not remember the patient.
Pseudoreminescence - Violation of chronology in memory, in which individual events that occurred in the past are transferred to the present, so, the patients who have long been in the hospital say that they have recently "came from work", "were visiting relatives."
Rafament - False memories, when questioning about current life, report fictional stories, often fantastic content ("Traveled by countries in Africa and Asia, met with Abyssinian Neubor," "flew on the spacecraft" and others).
Retrograde amnesia - Events directly preceding the disease, often covering weeks, months, and even years, can completely fall out of the memory of the patient.
Intelligence
The patient is characterized by one or another degree of intellectual insufficiency, which is expressed in the weakening of the productivity, stereotypes and monotony of judgments, pronounced dependence on their external impressions, inability to notice contradictions in their own statements, to detect incompatibility of false memories with reality. Arithmetic tasks solves without difficulty. It cannot formulate the meaning of proverbs.
Motor spherenot broken. Gestures and arbitrary movements natural.
Somatic status
Describes traditionally in all organism systems. Especially pay attention to the following indicators:
COMPRISTICONSTRUCTIONAL TYPE - may indicate a predisposition to some mental and somatic diseases;
Neurological status
Describes traditionally, special attention is paid to:
The reaction of pupils to the light is used to diagnose drug addiction, progressive paralysis and other organic diseases;
Coordination of movements, the presence of tremor - these violations are frequent signs of intoxication and abstinence in patients with drug addicts and alcoholism.
The presence of focal neurological symptoms.
Mental status
The definition of mental status is the most important part of the process of psychiatric diagnostics, that is, the process of the patient's knowledge, which, as a scientifically cognitive process, should be occurring not chaotic, and systematically, according to the scheme - on the phenomenon to the essence. Actively targeted and certainly organized living contemplating phenomenon, that is, the definition or qualification of the present status (syndrome) of the patient is the first stage of the recognition of the disease.
A poor-quality study and a description of the psychic status of the patient most often happens for the reason that the doctor did not master and does not adhere to a certain plan or the study scheme of the patient, and therefore it makes it chaotic.
Since mental illness is the essence of the personality disease (Korsakov S.S.), the mental status of the mentally ill will develop from personal characteristics and psychopathological manifestations that are conventionally divided into positive and negative symptoms (Jackson). By taking the conditional notation, it can be said that the mental status of the mentally ill consists of three "layers": positive disorders (P). Negative disorders (H) and personal features (L). PNL - according to the first letters.
In addition, the manifestations of mental activity can be conditionally divided into four main areas, PPPS - by first letters:
- 1. Cognitive (intellectual-insicuistic) sphere, which includes perception, thinking, memory and attention (P).
- 2. The emotional sphere in which the highest and lower emotions (E) are highlighted.
- 3. The behavioral (motor-volitional) sphere in which instinctive and volitional activity is distinguished (P).
- 4. The sphere of consciousness in which three types of orientation are distinguished: allopsis, outopsychic and somatopsychic (C).
Mental Status Research Method
With a clinical and psychopathological method of research, the main diagnostic technique or method of identifying painful manifestations is the questioned and observation in their inseparable unity.
A conversation with the sick is recommended to start with generally accepted questions about the health issues, which in a psychiatric clinic often serve only the reason for the beginning of the conversation, giving a doctor the opportunity to navigate in the future direction, according to which research should be conducted. Options are possible when, due to the condition of the patient, the questioned and the conversation is almost impossible. In such cases, exploring the status of the patient, the psychiatrist is forced to limit itself mainly by observation.
In the process of further, targeted conversation, after primary health issues, a psychiatrist determines the maximum level of mental impairment in the patient under study, so that later in this range find out the details of the individual characteristics of psychopathological manifestations that may have differential diagnostic importance.
In the structure of the syndrome, in addition to positive (pathologically productive), there are still negative (deficient) disorders. The latter most often attach the syndrome features of nosological specificity. They are more inertial, once arising, do not tend to disappear and, as if merging with the premature features of the individual, to one degree or another deform it depending on the severity of their manifestations.
The need to interpret personal features in the analysis of mental status arises in cases where the psychotic state is undercoined or chronic in connection with which psychopathological productive symptoms do not overlap completely personal manifestations. In addition, personal features should be assessed in remission states, in determining the premorbide and characteristic data of the relatives of the patient, as well as in assessing the mental statuses of patients with border violations (neurosis and psychopathy).
Mental status description method
The description of the mental status is carried out after compiling the idea of \u200b\u200bthe syndrome, which determines the state, its structure and individual characteristics. The status description is descriptive, if possible, without consuming psychiatric terms, so that another doctor who applied to the history of the disease under this clinical description could be able to give this state of its clinical interpretation, qualifications.
Adhering to the structural and logical scheme of the mental status, it is necessary to describe four spheres of mental activity. You can choose any sequence in describing these areas of mental activity, however, it is necessary to comply with the principle: without describing the pathology of one sphere without describing the pathology, do not move to the description of the other. With this approach, nothing will be missed, as the description is consistently and systematized.
It is advisable to start a description from those areas, information from which it turns out mainly through observation, that is, from the appearance: behavior and emotional manifestations. After that, it is necessary to move to the description of the cognitive sphere, the information about which is obtained mainly through the questioned and conversation.
Cognitive sphere
Disorders of perception
Violations of perception are determined when examining the patient, monitoring its behavior, questioning, studying drawings, writing products. The presence of hyperesthesia can be judged by the features of reactions to some stimuli: the patient sits down to the back window, asks the doctor to speak quietly, he tries to pronounce the words quietly, a semide, hends and wrinkles with a viper or flaming doors. Objective signs of the presence of illusions and hallucinations are able to set much less frequently than to obtain the relevant information from the patient himself.
The presence and character of hallucinations can be judged by observing the behavior of the patient, - he listens to something, boils his ears, nostrils, something whispers, and fears around, from someone, it makes something collecting on the floor, He shakes something like that, etc. In the history of the disease, it is necessary to describe a similar behavior of the patient. Such behavior gives grounds for the corresponding strokes.
In cases where there are no objective signs of hallucination, it is not always possible to ask a question - "see or hears" something patient. It is better if these questions are touched to encourage the patient to an active story about their experiences. It is not only important what tells the patient, but also as it says: willingly or reluctant, with the desire for dissimulation or without such aspiration, with interest, with the visible emotional color, an affect of fear or indifferent, indifferent.
Sennestopathy. The peculiarities of the behavior of patients experiencing sensenestopathy are primarily persistent appeals for help from a somatic profile specialists, and in the future - often to psychics and sorcerers. This surprisingly persistent, monotonous pains / unpleasant sensations are characteristic of the absence of objects of experiences, in contrast to visceral hallucinations, is often peculiar, even fuzzy tint and fuzzy, changing localization. Unusual, painful, no matter what the "roam" by the stomach, chestThe limbs and patients clearly oppose them to pain in the exacerbation of the diseases known to them.
Where do you feel it?
Are there any features of these pains / unpleasant sensations?
Is the area change where you feel them? Is it connected with the time of day?
Are they extremely physical in nature?
Is there any connection to their occurrence or gain with food reception, time of day, exercise, weather conditions?
Are these sensations take place when taking painkillers or soothing funds?
Illusions and hallucinations. Asking for illusions and hallucinations, a special tact should be shown. Before proceeding to this topic, it is advisable to prepare the patient, saying: "Some people have unusual sensations with nervous disorder." Then you can ask about whether the sickness did not hear any sounds or voices at the moment when no one was in the audition. If the history of the disease gives grounds to assume in this case the presence of visual, taste, olfactory, tactile or visceral hallucinations, appropriate questions should be asked.
If the patient describes hallucinations, then depending on the type of sensations, certain additional questions are formulated. It should be found out if he heard one voice or a few; In the latter case, it seemed to the patient that the voices were talking among themselves about him, mentioning it in the third person. These phenomena should be distinguished from the situation when the patient, hearing the voices of real people talking at a distance from him, is convinced that they are discussing it (delight relationship). If the patient claims that the voices turn to it (hallucinations from the second person), it is necessary to establish what exactly they say, and if the words are perceived as teams, it feels the sick that they must obey them. It is necessary to record examples of words pronounced by hallucinatory voices.
Spectative hallucinations should be differentiated from visual illusions. If the patient does not experience hallucinations directly during the inspection, it is difficult to carry out such distinction, since it depends on the presence or absence of a real visual irritant, which could be incorrectly interpreted.
Hearing hallucinations. The patient announces noise, sounds or voices that he hears. Voices can be male or female, familiar and unfamiliar, the patient can hear criticism or complements in their address.
Have you ever hear any sounds or voices when there is no one
next to you or you did not understand where they were from?
What they're saying?
Hallucinations in the form of a dialogue - this is a symptom in which the patient hears two or more votes discussing something relating to the patient.
What do they discuss?
Where do you hear them?
Hallucinations of commenting content. The content of such hallucinations is the current commentary of the patient's behaviors and thoughts.
Do you hear any estimates of your actions, thoughts?
Imperative hallucinations. Deceptions of perceptions that encourage patients to a certain action.
Tactile hallucinations. This group of disorders include complex deceptions, tactile and general feeling, in the form of a feeling of touch, cover with hands, some kind of matter, wind; Feelings of crawling insects under the skin, injections, bites.
- - Do you know the unusual feelings of touch in the absence of anyone who could do it?
- - Have you ever experienced a sudden change in the weight of your body, the feeling of lightness or gravity, immersion or flight.
Olfress hallucinations. Patients feel unusual smells, more often unpleasant. Sometimes the patient seems that this smell comes from him.
Are you experiencing any unusual smells or smells that others do not feel? What are these odors?
Taste hallucinations appear more often in the form of unpleasant taste sensations.
- - Have you ever to feel that ordinary food changed your taste?
- - Do you feel any taste outside meals?
- - Spectator hallucinations. The patient sees the outlines, shadows or people who are in reality. Sometimes it is an outline or color spots, but more often - figures of people or eating creatures, animals. It can be the characters of religious origin.
- - Have you ever seen what other people see not able to?
- - Have you had a vision?
- - What did you saw?
- - What time of day it happened to you?
- - Is this connected with the moment of falling asleep or awakening?
Depersonalization and delinealization. Patients who experienced depersonalization and derautiation are usually difficult to describe them; Patients unfamiliar with the specified phenomena often incorrectly understand the question of them and give misleading answers. Therefore, it is especially important that the patient brought concrete examples of their experiences. It is rational to start with the following questions: "Have you ever felt that the objects around you are unreal?" And "Do you have a feeling of your own unreality? Did you seem that some part of your body is unreal? ". Patients experiencing meroalization often say that all objects of the environment are represented by unreal or lifeless, while in depurstalization patients may argue that they feel separated from the environment, unable to feel emotions or as if playing some role. Some of them, when describing their experiences, resort to figurative expressions (for example: "As if I am a robot"), which should be carefully differentiated from nonsense.
The phenomena was previously seen, heard, experienced, tested, told (Deja Vu, Deja Entendu, Deja Vecu, Deja Eprouve, Deja Raconte). The feeling of acquaintance is never tied to a certain event or period in the past, but refers to the past at all. The degree of confidence, with which patients assesses the likelihood that the experienced event occurred, can differ significantly for different diseases. In the absence of criticism, these paramnesia can support the mystical thinking of patients, participate in the formation of nonsense.
- - did you ever seem to ever seem to have an idea that could not arise before?
- - Have you experienced feelings that you have already heard once what you hear now for the first time?
- - Is there any sensations of the unreasonable familiarity of the text when reading?
- - Have you ever had to see something for the first time, feel that you have already seen it before?
The phenomena has never been seen, not heard, not experienced, etc. (Jamais Vu, Jamais Vecu, Jamais Entendu and others). The patient seems unfamiliar, new and incomprehensible familiar, well known. The sensations associated with the distortion of feeling of familiarity can be both paroxysmal and durable.
- - Have you had the feeling that the usual situation see you for the first time?
- - Did you ever feel a strange stranss of what they had to hear many times before?
Thinking disorders
When analyzing the nature of thinking, the tempo of the mental process is established (acceleration, slowing, inhibition, stopping), the tendency to detail, the "viscosity of thinking", the tendency to fruitlessness (resonance). It is important to describe the content of thinking, its productivity, logic, the establishment of the ability to concrete and abstract, abstract thinking, analyzes the ability of the patient to operate with ideas and concepts. The ability to analyze, synthesis, summarizing is studied.
For research, you can use texts with missed words (Ebbingauz sample). Reading this text, the subject must insert missing words, consistent with the content of the story. At the same time, it is possible to discover the criticality of thinking: the examined inserts random words, sometimes according to the association with close and missing, and the allowable ridiculous errors does not correct. Identifying the pathology of thinking contributes to the identification of understanding of the figurative meaning of proverbs and sayings.
Formal thinking disorders
The process of thinking cannot be estimated directly, so the main object of study is.
The speech of the patient allows you to identify some unusual disorders observed mainly in schizophrenia. It is necessary to establish whether non-socialism patients are used, that is, the words invented by them themselves often to describe pathological sensations. Before recognizing this or that word neologism, it is important to make sure that it is not just an error in pronunciation or borrowing from another language.
Next, violations of speech flow are recorded. Sudden stops may indicate a breakdown of thought, but more often it is simply a consequence of neuropsychiatric excitement. Fast switching from one topic to another suggests the assumption of a jump of ideas, while amorphosis and lack of logical communication may indicate the type of thinking disorder characteristic of schizophrenia.
Slowing the tempo of speech (depressive subcutter, catatonic umutism).
Some answers do not contain complete information, including additional questions;
The doctor notes that it is forced to often encourage the patient, in the order of encouragement, to develop or clarify the answers;
The answers may be single or very short ("Yes", "no", "maybe", "I don't know"), rare more than one sentence;
The patient says nothing and only occasionally trying to answer the question.
Circumstance. Reducing the ability to separate the main thing from the secondary leads to the chaoticness of associations. These features of thinking are inherent in people with organic lesion Central nervous system and epileptic identity changes.
Increased tendency to detail may be noticeable with free presentation, responses to open questions;
Patients cannot answer specifically set questions, deepening in details.
Resonance. The resonance is based on an increased tendency to "assessment judgments", a tendency to generalize with respect to the small object of judgment.
Patients are prone to expecting to argue about all well-known things, retelling and claiming banal truths;
The extremely verbose speech does not correspond to the poverty of the content. Speech can be defined as "empty philosophizing", "idling".
Paralochy (so-called "Curve Logic"). With such a frustration of thinking, facts and judgments are consolidated on a single logical basis, fit into the chain, ride each other with particular bias. Facts that contradict the initial false judgment or not consistent with it are not taken into account.
Paralohydicism underlies the interpretative forms of nonsense, in content this most often delusional ideas of persecution, reformity, invention, jealousy and others.
When conversation, such a violation of thinking can manifest itself in connection with the discussion of mental injuries transferred in the past, which became a "patient paragraph" in the psyche of patients. Such a "catall" The nature of paralohydrates may arise in the event of an emotional injury related to the experiences of a hypochondriac, family, sexual plan, severe personal offense.
In more severe cases, paralogical thinking manifests itself regardless of the subject of the conversation. At the same time, the conclusions are determined by not reality, not logical laws, but are ruled solely by the needs (more often painful) personality.
Crane thought, or shlerung. Manifested by a sudden speech stop before the thought is completed. After a pause, which can continue for a few seconds, less often minutes, the patient can not remember what he said or wanted to say.
Long silence only then can be qualified as a break of thought when the patient arbitrarily describes the delay of thinking or after the question of the doctor determines the cause of the pause in this way.
- - Have you ever experienced a sudden not related to external reasons, disappearance of thought?
- - What prevented you to finish the phrase?
- - What did you feel?
Mentism. Thoughts may acquire an arbitrary, uncontrollable current. More often there is an accelerated course of thinking processes, it is not possible to concentrate attention and only the "shadow" of the thoughts or the feeling of "Roy" of the piercing thoughts remains consciously.
- - Do you feel sometimes (lately) Sobbar in my head?
- - Have you ever seemed to you ever that you do not control the stream of your own thoughts?
- - Is there no feeling that thoughts flicken by?
It is necessary to pay attention to the appearance of the patient: the unusual of clothing, the expression of the face and the eye (sad, wary, shining, etc.). Unusual posture, gait, extra movements allow you to think about the presence of nonsense or motor intrusiveness (rituals). Oh super subsequent and obsessive ideas (unlike nonsense) patient usually readily tells himself. It is necessary to determine how these ideas are associated with the content of thinking at the moment, their influence on the course of thought processes and the connection of these ideas with the personality of the patient. So, if the dominant and utasive ideas are fully connected with the content of the patient's thinking, they define it, the obsessive thoughts (ideas) are not in connection with the content of the patient's thinking at this time and can contradict him. It is important to assess the degree of violence of various ideas in the consciousness of the patient, the degree of their alien to the opinion, the worldview and the degree of its critical attitude towards the specified ideas.
Observatory phenomena. First of all, obsessive thoughts are considered. It is advisable to start with such a question:
Do you always have any thoughts in mind, despite the fact that you are trying hard to prevent them?
If the patient gives an affirmative answer, it should be asked to bring it an example. Patients often shame intrusive thoughts, especially relating to violence or sex, so it may be necessary to persistently, but benevolently ask the patient. Before identifying similar phenomena as obsessive thoughts, the doctor must make sure that the patient takes such thoughts as its own (and not inspired by someone or something).
Combulsive rituals in some cases can be seen with attentive observation, but sometimes they take a hidden form from an extraneous eye (as, for example, a mental score) and are detected only because they violate the course of the conversation. If there are compulsive rituals, it is necessary to ask for a patient to bring specific examples. The following questions are used to identify such disorders:
- - Do you feel the need to constantly check the actions that you know, have you already completed?
- - Do you feel the need again and again do something that most people do only once?
- - Do you feel the need to repeated the same and the same actions in an equally the same way? If "yes" respond to any of these questions, the doctor must ask him to bring concrete examples.
Brad is the only symptom that cannot be asked directly because the patient does not realize the difference between him and other convictions. The doctor may assume the presence of nonsense, based on information received from other individuals or from the history of the disease.
If the task is set to identify the presence of delusional ideas, it is advisable to begin to ask the patient to explain other symptoms or the discomfort described by them. For example, if the patient says that it is not worth living, he can also consider himself deeply by vicious, and his career is destroyed, despite the lack of objective grounds for this opinion.
The psychiatrist should be prepared for the fact that many patients hide nonsense. However, if the topic of nonsense is already disclosed, the patient often continues to develop it without tip.
If ideas that may be delusted, but may not be such, it is necessary to find out how stable they are. It is necessary to find out if the patient's beliefs are rather cultural traditions rather than nonsense. It is difficult to judge this if the patient is raised in the traditions of another culture or belongs to an unusual religious sect. In such cases, you can resolve doubts, finding a psychic healthy compatriot of a patient or a person who confess the same religion.
There are specific forms of nonsense, recognizing that are especially difficult. Drain ideas of openness should be differentiated from the opinion that those surrounding may guide the thoughts of a person to express his face or behavior. To identify the specified form of nonsense, you can ask:
Do you believe that other people know what you think, although you did not express your thoughts out loud?
In order to identify nonsense "Investigations of Thoughts" use the relevant question:
Have you ever felt that some thoughts do not actually belong to you, but are embedded in your consciousness from the outside?
Brad "Taking Thoughts" can be diagnosed with the help of the question:
· Do you sometimes feel that thoughts are withdrawn from your head?
During the diagnosis of delirium control, the doctor faces similar difficulties. In this case, you can ask:
- · Do you feel that some external force is trying to manage you?
- · Do you have the feeling that your actions are controlled by some person or something out of you?
Since the experiences of this kind are far from normal, some patients incorrectly understand the issue and respond to the affirmative, meaning the religious or philosophical conviction that the human activity is sent by God or the Devil. Others think this is a sensation of loss of self-control at extreme anxiety. Patients with schizophrenia can declare their specified sensations if they heard "voices" that give commands. Therefore, to receive positive responses should follow further questions to eliminate such misunderstandings.
Brad of jealousy. Its content is the conviction in treason of spouse / spouse. Any facts are perceived as evidence of this treason. Usually patients make great efforts to find confirmation of the extramarital lovelines in the form of hair on bedding, the smell of spirits or cologne from clothes, gifts from the lover. Plans are produced and attempts are made to catch lovers together.
- · Do you have any thoughts that your spouse (a) / friend can be incorrect to you?
- · What confirmation do you have?
Brad guilt. The patient is confident that he made some terrible sin or did something intimate. Sometimes the patient is over and inadequately absorbed (covered) with experiences about that "bad" what he did in childhood. Sometimes the patient feels responsible for some tragic events, such as a fire or car accident, which in reality it is not relevant.
- · Do you have a feeling that you did something terrible?
- · Is there something like that for what conscience torments you?
- · Can you tell about it?
- · Do you think that you deserve punishment for it?
- · Do you sometimes think about punishing yourself?
Megalomanian nonsense. The patient believes that it has special abilities and power. He can be sure that he is a famous person, for example, some rock star, Napoleon or Christ; It is considered that he wrote great books, composed ingenious musical works or made revolutionary scientific discoveries. Often there are suspicions that someone tries to steal his ideas, the slightest doubts from its special abilities cause irritation.
- · Doesn't the thoughts arise that you can achieve something great?
- · If you compare yourself with a middle person, how would you rate yourself: a little better, a little worse or the same?
- · If worse; So what? Does something special in you?
- · Do you have any special abilities, diving or opportunities, do you have an extrasensory perception or some way to influence people?
- · Do you think yourself with a bright person?
- · Can you describe what you are famous?
Religious detention. The patient is covered by false religious representations. Sometimes they arise in the framework of traditional religious systems, let's say, ideas about the second coming, antichrist or mastering the devil. It can be completely new religious systems or a mixture of representations from various religions, in particular oriental, for example, the ideas of reincarnation or nirvana.
Religious nonsense can be combined with Megalomanian delusions of greatness (if the patient considers himself a religious leader); deliriousness if an imaginary crime is, by conviction of the patient, a sin, for which he must bear the eternal Kara of the Lord, or delirium impact, for example, with conviction in the devil's obsession.
Religious detention must go beyond the framework of the ideas adopted in the culture and religious environment of the patient.
- · Are you a religious person?
- · What do you understand by this?
- · Have you had any unusual religious experience (impressions)?
- · Have you brought up in a religious family or came to faith later? How long ago?
- · Are you close to God? Did God mean a special role or purpose for you?
- · Do you have a special mission in life?
The hypochondrial nonsense is manifested by painful conviction in the presence of a severe, incurable disease. Any statement of a doctor in this case is interpreted as an attempt to deceive, hide the true danger, and the refusal of the operation or another radical treatment of treatment convinces the patient that the disease reached the terminal stage.
These disorders should be distinguished from the dysmorphomonic (dysmorphophobic) syndrome, when the basic experiences of the patient are focused on a possible physical disadvantage or deformity in addition to the ideas of the physical disadvantage, the ideas of the relationship are observed (the feeling that everyone surrounding their defect is laughing at with them), dreamed background of mood. They describe the constant desire of patients unnoticed from others to consider themselves in the mirror ("symptom of the mirror"), persistent rejection of participation in photography, appeals to cosmetology salons with requests for operations to correct the "shortcomings". For example, the patient may assume that its stomach or brain has rotted; His hands stretched out or changed features of the face (dysmorfomania).
- · Are there any violations in your body?
- · Have you noticed any changes to your appearance?
Relief relationship. Patients believe that nothing significant comments, statements or events relate to them or are intended to them specifically. Seeing laughing people, the patient is convinced that they laugh at him. Reading the newspaper, listening to the radio or watching TV, patients tend to perceive certain phrases as special messages addressed to them. The firm conviction is that events or statements are not related to the patient relate to him, it should be considered delirium relations.
- · Entering the room where people are located, don't you think that they talk about you and maybe laugh at you?
- · It happens on television, in radio programs and newspapers some information related to you personally?
- · How do strangers in public places react to you, on the street, in transport?
Nonsense influences. The patient is experiencing a distinct effect on feelings, thoughts and actions on the part or a sense of management of them by some external force. The main feature of this form of nonsense is a pronounced sense of impact.
The most characteristic of the descriptions of the alien forces settled in the patient's body and forcing it to move in a special way or any telepathic messages causing feelings that are perceived as strangers.
- · Some people believe in the ability to transfer thoughts to the distance. What is your opinion?
- · Have you ever had to experience a feeling of non-volatility not related to external circumstances?
- · Was there ever the impressions that your thoughts or feelings do not belong to you?
- · Have you ever to feel that some power manages your movements?
- · Have you ever unusual impact?
- · Was it an impact on the part of a person?
- · Is there an unusual way caused by unpleasant or pleasant sensations in the body?
Openness of thoughts. The patient is convinced that people can read his thoughts on the basis of subjective perception and features of the behavior of others.
Investment of thoughts. The patient believes that thoughts that are not his own are invested in his head.
Withdrawing thoughts. Patients can describe the subjective sensations of sudden removal or interruption of thought from some external force.
Subjective, perceptual, component of the influence, called mental automatism (ideator, sensory and motor versions), is detected using the same questions:
- · Do you happen to feel that people can know what you think, or even read your thoughts?
- · How can they do it?
- · Why do they need it?
- · Can you say who controls your thoughts?
The symptoms described above are included in the structure of ideator automatism observed in the Candine-Clerambo syndrome.
Memory disorders
In the process of collecting anamnesis, questions should be asked about the presence of constant difficulties at memorization. During the mental status survey, patients offer tests to assess the memory for current, recent and remote events. Short-term memory is assessed as follows. The patient is asked to reproduce a number of unambiguous numbers, pronounced slowly, in order to enable the patient to fix them.
To begin with, it is easy to memorize a short number of numbers, in order to make sure that the task understood the patient. Call five different numbers. If the patient can repeat them correctly, offer a series of six, and then from seven numbers. If the patient did not cope with the memorization of the five numbers, the test is repeated, but already with a number of other five numbers.
Normal indicator for healthy man It is considered to reproduce the seven numbers. To perform this test, a sufficient concentration of attention is also needed, so it cannot be used to assess the memory if the results of the concentration tests are explicitly abnormal.
Then the ability to perceive new information and its immediate reproduction is estimated, and then to her memorization. For five minutes, the doctor continues to talk with the patient to other topics, after which the memorization results are checked. A healthy person will admit only insignificant errors.
The memory for recent events is assessed by asking about the news over the past one or two days or about events in the life of a patient known to the doctor. The news that questions are asked must comply with the interests of the patient and are widely covered by the media.
Memory to remote events can be assessed, asking the patient to recall certain moments from his biography or well famous facts Public life over the past few years, such as the date of birth of his children or grandchildren, or the names of political leaders. A clear idea of \u200b\u200bthe sequence of events is also important as the presence of memories of individual events.
When the patient is in the hospital, certain conclusions about its memory can be made on the basis of information provided by the Middle Medical Personnel. Their observations relate to how quickly the patient is assimbing the mobular routine of the day, the names of the clinic staff and other patients; Whether he does not forget where it puts things where his bed is located, how to go to a living room.
Standardized psychological tests for assimilation and memory can help with diagnostics and provide a quantitative assessment of the increase in memory disorders. Among them, one of the most effective is the test of a loack of a logical memory, in which you want to reproduce the content of the short paragraph immediately and after 45 minutes. Counting points is made on the basis of the number of properly reproduced items.
Memory disorders are often found, and in the second half of life, most people have a place in one degree or another. Qualification of the specifics of memory disorders can help the doctor make a holistic idea of \u200b\u200bthe leading syndrome, the nosological affiliation of the disease, the flow stage, and sometimes on the localization of the pathological process.
There may be a different pathology for the "memory loss" complaints. The actual slowness of thinking is aggravated by the uncertainty or inattention associated with anxiety of depressive patients, and the reduced self-esteem framed these real cognitive violations in the framework of the experimentalness experiences. At the initial stages of the development of depression, this may be complaints about memory violation.
With reactive hysterical states, active forgetting or displacement of painful psychotrauming experiences is possible. Outside the time frame of the pathogenic situation, memory remains saved.
Fragmental fallouts from the memory of individual (often significant) details of the events that occurred in a state of intoxication - the paletmpuses are a reliable sign of the initial stage of alcoholism.
To identify the pathology of memory, samples are used to memorize artificial phrases and ten words.
Elective, electoral dismesecia is the segments of specific information that occurs in situations of psycho-emotional tension, a time limit characteristic of vascular cerebral pathology. Forgetting dates, names, addresses or phone numbers with excitement can attract attention already when collecting anamnesis. In this case, it is especially appropriate to clarify:
- · Have you noticed that you can't remember something well known when you need to remember urgently, for example, with an unexpected telephone conversation, or when did you promote?
- · Dynamic memory violations. With vascular diseases of the brain in patients undergoing cranopy and brain injuries, with some intoxications, the epistic activity can be intermittent. Such violations rarely perform in the form of an isolated monosimptom, and manifest themselves in combination with the intermittentness of all mental processes. Memory in this case is an indicator of instability, the depletion of the mental performance of patients in general.
One of the indicators of a dynamic memory violation is the possibility of its improvement in the use of mediation media, which patients resort to everyday life. About such a device is appropriate to ask:
- · Do you make yourself any notes for memory (nodules on a nose scarf)?
- · Do you leave any items in a prominent place that would remind you of something?
Fixing amnesia is in violation of the storage of current events, while the memory is saved to the past. This amnesia is the leading symptom of Corsakov syndrome with toxic, traumatic and vascular psychosis flowing both acutely and chronically. I introduced to the patient, it is appropriate to warn that in the interests of the examination, you ask you to call you by name after some time.
The following questions are usually asked:
- · What did you do this morning?
- · What is your heading doctor?
- · Name the names of patients from your chamber.
Retrograde amnesia is a loss of the events preceding the period of disturbed consciousness.
At an anterograde amnesia, events for the period of time, immediately following the period of disturbed consciousness, fall out of the patient's memory.
CONGRADY amnesia represents the lack of memory for events that occurred during the disturbed consciousness.
Since these amnesia features a deritment to a certain state or the action of the pathogenic factor, then, asking the patient, you should delay the boundaries of this period, within which the patients cannot be restored in memory.
Progressive hymometry. The emptying of memory increases gradually and occurs in a certain sequence: from private to a common, from later acquired skills and knowledge to what they were obtained earlier, from less emotionally significant to more significant. Such a dynamics comply with the law of Rib. The severity of progressive amnesia can identify questions about life eventsDecisible in sequences - from current to remote. Could you call:
- · The latest most famous events in the world;
- · Approximate population of the city (village), where you live;
- · Opening hours of your nearest grocery store;
- · Days of your usual receipt of a pension (salaries);
- · How much do you pay for an apartment?
PseudoMemminiscence - the deception of memory, consisting in the displacement of the events that really visited in the life of the patient. The events of the past are issued for the present. The content of them is usually monotonous, ordinary, plausible. Usually both pseudoamminiscence and feedback spontaneously outlines patients in the story. Questions aimed at identifying these disorders are not defined.
Rafament. Memories that do not have any real foundation in the past, temporary causal connection with it. Fantastic feedbacks are isolated, which are fiction about the extraordinary events that have occurred with patients in different periods of life, including in a danger period. Rappable can be fraction, changeable, with repeated stories, new incredible details are reported.
Disorders of attention
Attention is the ability to focus on any object. Concentration - the ability to keep this concentration. During the collection of anamnesis, the doctor must follow the attention and its concentration in the patient. Thus, he will already be able to form a judgment about the appropriate abilities until the end of the mental status survey. Formal tests allow you to expand this information and make it possible to express changes in quantitative indicators to develop as a disease progressing. Usually begin with an attachment account: the patient is asked to take 7 from 100, then subtract 7 from the residue and repeat the specified action until the residue is less than seven. Register the test time of the test, as well as the number of errors. If the impression is created that the patient did not cope with the test due to the weak knowledge of arithmetic, it should be suggested to perform a simpler similar task or list the names of months in the reverse order.
The study of the orientation and concentration of mental activities of patients is very important in different areas clinical medicineSince many mental and somatic painful processes begin with attention off attention. Violations of attention are often notified by the patients themselves, and almost everyday nature of these disorders allows patients to tell the doctors of various specialties. However, in some mental illness, patients may not notice their problems in the field of attention.
The main characteristics of attention include volume, selectivity, stability, concentration, distribution and switching.
The amount of attention is understood by the number of objects that can be clearly perceived in a relatively short period of time.
The limited amount of attention requires constant allocation by the subject of any of the most significant objects of surrounding. This choice from a variety of incentives is only some of the election name.
- · The patient discovers scattered, periodically asks the interlocutor (doctor), especially often by the end of the conversation.
- · The nature of communication affects noticeable distractions, difficulty in maintaining and arbitrary switching attention to a new topic.
- · The patient's attention is held on one thought, the topic of conversation, the object is quite short
Stability of attention is the ability of a subject to not deviate from targeted mental activity and maintain focus on the object of attention.
The patient distracts any internal (thoughts, sensations) or external stimuli (foreign conversation, street noiseAny item in sight). Productive contact can be practically impossible.
The concentration of attention is the ability to focus on the presence of interference.
- · Do you notice that it is difficult for you to focus when performing mental work, especially at the end of the working day?
- · Do you notice that you began to make more mistakes in carelessness?
The distribution of attention indicates the possibility of a subject to direct and focus its mental activity on several independent variables at the same time.
Switching attention is the movement of its orientation and concentration from one object or the type of activity to others.
- · Are you sensitive to external interference when performing mental work?
- · Do you manage to switch attention from one lesson to another?
- · Do you always manage to keep track of the plot of the film you are interested in, TV shows?
- · Do you often distract when reading?
- · Do you often have to notice that you are mechanically running the text with a look, without catching his meaning?
Study of attention is also carried out using Tables of Shulte and Correct Sample.
Emotion disorders
Mood assessment starts with observation of behavior and continue through direct questions:
- · What is your mood?
- · How do you feel in the sense of mental condition?
If depression is revealed, it is necessary to ask the patient in more detail about whether it sometimes feels that it is close to tears (the existing tears is often denied), whether his pessimistic thoughts are visited about the present, about the future; Does he have a feeling of guilt towards the past. Questions can be formulated as follows:
- · What do you think with you will be in the future?
- · Do you blame yourself in anything?
With an in-depth study, the patient's alarm state ask about somatic symptoms and about thoughts accompanying this affect:
· Do you notice any changes in your body when you feel the alarm?
Then go to the consideration of specific moments, aware of the rapid heartbeat, dryness in the mouth, sweating, trembling and other signs of the activity of the vegetative nervous system and muscle tension. To identify the presence of alarming thoughts, it is recommended to ask:
· What comes to your mind when you are alarming?
Probable answers are associated with thoughts of possible fainting, loss of control over themselves and about the hopeless madness. Many of these issues inevitably coincide with the information collapsed when collecting information for the disease.
Questions about high spirits are related to the depressed attributed; So, for the general question ("How mood?") follows, if necessary, relevant direct issues, for example:
· Do you feel extraordinary vigor?
The raised mood is often accompanied by thoughts reflecting excessive self-confidence, an overestimated assessment of their abilities and crazy plans.
Along with the assessment of the dominant mood, the doctor should find out how the mood changes and does it correspond to the situation. With sudden mood changes, it is said that it is laby. It is also necessary to note any persistent absence of emotional reactions, usually denoted as dulling or placing emotions. In a mentally healthy person, the mood changes in accordance with the main topics discussed; He looks sad, speaking of sad events, manifests anger, telling about what he got angry, etc. If the mood does not coincide with the situation (for example, the patient giggles, describing the death of his mother), it is noted as inadequate. This symptom is often diagnosed without sufficient grounds, so it is necessary to write characteristic examples in the history of the disease. More close acquaintance with the patient may later prompt another explanation for his behavior; For example, a smile when talking about sad events may be a consequence of embarrassment.
The state of the emotional sphere is determined and evaluated in the process of the entire survey. In the study of the sphere of thinking, memory, intelligence, perception is recorded by the nature of the emotional background, the solve reactions of the patient. The peculiarity of the emotional relationship of the patient to relatives, colleagues, neighbors on the ward, medical personnel, their own state is estimated. At the same time, it is important to take into account not only the self-lifting of the patient, but also the data of objective observation of psychomotor activity, facial and pantomimic, for the indicators of the tone and the directivity of the growing and exchange processes. The patient should be interviewed and observing the duration and quality of sleep, appetite (reduced during depression and increased during mania), physiological sections (constipation during depression). In case of inspection, pay attention to the magnitude of pupils (expanded during depression), on the humidity of the skin and mucous membranes (dryness when depressed), measure arterial pressure And to count the pulse (increase the blood pressure and the increase in the pulse with emotional tension), find out the self-esteem of the patient (reassessment during manicocal state and self-depression).
Depressive symptoms
Depressed mood (hypothymia). Patients experience feelings of sadness, despondency, hopelessness, discourability, feel unhappy; Anxiety, tension or irritability should also be assessed as a dysphoric mood. The estimate is carried out without reference to the duration of the mood.
- · Have you experienced tensions (anxiety, irritability)?
- · How long did it last?
- · Have you been experiencing periods of depression, sadness, hopelessness?
- · Do you know the condition when nothing pleases you when you are all indifferent?
Psychomotor inhibition. The patient feels inhibition and experiences difficulties in movements. Objective signs of injury, such as slow motion, pauses between words should be noticeable.
· Do you feel inhibition?
Deterioration of cognitive abilities. Patients complain about deterioration of the ability to concentrate attention and generally deterioration in mental abilities. For example, helplessness when thinking, the inability to make a decision. Violations of thinking are more subjective to a greater degree and differ from such coarse disorders such as torn or incoherence of thinking.
· Are you experiencing any problems when thinking about; making decisions; performing arithmetic actions in everyday life; If necessary, concentrate on something?
Loss of interest and / or aspirations for pleasures. Patients lose interest, the need to obtain pleasure in various spheres of life is reduced by sexual attraction.
Do you notice changes in your interest in the surrounding?
- · What usually gives you pleasure?
- · Does it make you now?
Ideas of low value (self-esteem), guilt. Patients humiliantly evaluate their identity and ability, detraining or denying everything positive, talking about the feeling of guilt and express unreasonable ideas of guilt.
- · Do you have no feelings of discontent yourself lately?
- · What is it connected with?
- · What can I regard your personal achievement in your life?
- · Are you feeling guilty?
- · Could you tell me what you blame yourself?
Thoughts about death, suicide. Almost all depressive patients are often returned to the thoughts of death or suicide. The usual statements about the desire to go into oblivion so that it happened suddenly, without the participation of the patient, "fall asleep and not wake up." Characterized by thinking of suicide methods. But sometimes patients are prone to specific suicidal actions.
The so-called "antisuicidal barrier", one or more circumstances holding a patient from suicide is of great importance. The identification and strengthening of this barrier is one of the few ways to prevent suicide.
- · Is there no sense of hopelessness, life deadlock?
- · Did you have a feeling that your life is not worth going to continue it?
- · Do you think about death about death?
- · Do you have a desire to deprive yourself of life?
- · Have you thought about specific ways of suicide?
- · What kept you from this?
- · Have an attempt to do this?
- · Could you tell us more about it?
Reduced appetite and / or weight. Depression is usually accompanied by a change, more often than decrease, appetite and body weight. The increase in appetite is found in some atypical depressions, in particular, with a seasonal affective disorder (winter depression).
- · Have your appetite changed?
- · Do not lose weight / Have you recently recently?
Insomnia or increased drowsiness. Among the violations of the night's sleep is made to allocate the insomnia of the falling period, insomnia of the middle of the night (frequent awakening, superficial sleep) and premature awakening from 2 to 5 hours.
Pulling disorders are more characteristic of the insomnia of neurotic genesis, early premature awakens are more common in endogenous depressions with distinct dust and / or alarming components.
- · Do you have any problems with sleep?
- · Do you easily fall asleep?
- · If not, what prevents you from falling asleep?
- · Are there any awakening among the night?
- · Do you worry hard dreams?
- · Is there any premature pre-weary awakens? (Do you manage to fall asleep again?)
- · What mood do you wake up?
Daily fluctuations in mood. Clarification of the rhythmic peculiarities of patients mood is an important differential sign of endo and exogenous depression. The most typical endogenous rhythm is a gradual decrease in longing or anxiety, especially pronounced in the morning during the day.
- · What time of day is the hardest for you?
- · Do you feel harder in the morning or in the evening?
The decrease in the emotional response is manifested by the poverty of the Mimici, the range of senses, voice monotony. The basis for evaluation is motor manifestations and an emotional response, recorded during the abstract. It should be borne in mind that the assessment of some symptoms can be distorted by the reception of psychotropic drugs.
Monthly facial expression
- · Mimic expression may be incomplete.
- · The expression of the patient's face does not change or the mimic response is less than expected in accordance with the emotional conversation.
- · Mimica frozen, indifferent, the reaction to the appeal is sluggish.
Reducing spontaneity of movements
- · The patient looks very cured during the conversation.
- · Movement slowed down.
- · The patient is sitting motionless throughout the conversation.
Insufficient gesticulation or its absence
- · The patient detects a slight decrease in gesture expressiveness.
- · The patient does not use for the expression of his ideas and feelings of the movement with his hands, tilting forward when a confidential confidence is reported, etc.
No emotional response
- · The insufficiency of emotional resonance can be tested by a smile or joke, which usually causes a response smile or laughter.
- · The patient can skip some of these incentives.
- · The patient does not respond to a joke, no matter how provoked it.
- · During the conversation, the patient detects a slight decrease in voice modulation.
- · In the patient's speech, words are not highlighted by height or tone strength.
- · The patient does not change the timbre or voice volume when discussing purely personal those capable of indignant. Speech is constantly monotonous.
Aerygy. This symptom includes a sense of energy loss, fast fatigue or feeling of rapid fatigue. Asking these violations, they should be compared with the usual level of patient activity:
- · Do you feel more than usual fatigue, fulfilling ordinary cases?
- · Do you have to feel physical and / or mental exhaustion?
Alarm disorders
Panic disorders. These include unexpected and unfortunate attacks of anxiety. Such somategative symptoms of anxiety, such as tachycardia, shortness of breath, sweating, nausea or discomfort in the abdomen, pain or unpleasant feeling in the chest, can be more pronounced than mental manifestations: depersonalization (drama), fear of death, paresthesia.
- · Have you ever experience sudden attacks of panic or fear, in which you were very hard physically?
- · How long have they continued?
- · What unpleasant feelings were accompanied by?
- · Have these attacks accompanied by death fear?
Manic states
Manic symptoms. Increased mood. The patient's condition is characterized by excessive cheerfulness, optimistic, sometimes irritability that is not associated with alcohol or other intoxication. Patients rarely regard the increased mood as a manifestation of the disease. At the same time, the diagnosis of the actual manic state does not cause much difficulties, therefore, ask more often about the manic episodes suffered in the past.
- · Have you had to feel a special sentiment of the mood in some period of your life?
- · Did he differ from your behavior rate?
- · Have your relatives have friends to think that your condition goes beyond just a good mood?
- · Have you experienced irritability?
- · How long did this condition last?
Hyperactivity. Patients detect increased activity in work, family matters, the sexual sphere, in building plans and projects.
- · Is it true that you (were then) are active and busy more than usual?
- · How about work, communication with friends?
- · How are your hobbies are now passionate about or other interests?
- · Can you (could you sit quietly or do you want (I wanted) all the time to move?
Acceleration of thinking / jumping ideas. Patients may experience a distinct acceleration of thoughts, note that thoughts are ahead of speech.
- · Do you notice the ease of thoughts, associations?
- · We can say that your head is full of ideas?
Increased self-esteem. Assessment of merits, connections, influence on people and events, strength and knowledge is clearly increased compared to the usual level.
- · Do you feel great self-confidence than usual?
- · Do you have any special plans?
- · Do you feel any special abilities or new opportunities?
- · Do not you think that you are a special person?
Reducing sleep duration. When evaluating, it is necessary to consider the average in the last few days.
- · Do you need less hours to sleep to feel rested than usual?
- · How many hours of sleep you usually have enough and how much now?
Threshiflight. The patient's attention is very easily switched to insignificant or not related to the topic of conversation external stimuli.
· Do you notice that the surrounding distracts you from the main topic of conversation?
Behavioral sphere
Instinctive activity, volitional activity
The appearance of the patient, its manner dressing allows to conclude about the volitional qualities. The disregard for oneself, manifested in a slurry form and naked clothes, suggests several possible diagnoses, including alcoholism, drug addiction, depression, dementia or schizophrenia. Patients with manic syndrome often prefer bright colors, choose a ridiculous style dress or may seem poorly well-keeled. You should also pay attention to the physique of the patient. If there is reason to assume that lately it has lost weight in weight, it should alert the doctor and bring it to the idea of \u200b\u200ba possible somatic disease or nervous anorexia, depressive disorder.
The facial expression gives information about the mood. When depressed, the most characteristic features are the lowered corners of the mouth, vertical wrinkles on the forehead and a slightly raised middle part of the eyebrows. In patients who are in a state of anxiety, usually horizontal folds on the forehead, raised eyebrows, eyes wide open, pupils are expanded. Although depression and anxiety is especially important, the observer should look for signs of a number of emotions, including euphoria, irritation and anger. "Stone", the frozen expression of a person can be in patients with Parkinsonism phenomena due to taking neuroleptics. A person may also indicate such somatic states as thyrotoxicosis and myxedema.
Pose and movement also reflect the mood. Patients in the state of depression are usually sitting in a characteristic posture: leaning forward, having embarrassed, lowering his head and looking at the floor. Anxious patients sit straightening with his head raised, often on the edge of the chair, tightly holding his hands behind the seat. They, like patients with an accredited depression, are almost always restless, all the time they touch their decorations, straighten clothes or pecking nails; They beats a shiver. Maniacal patients hyperactive and restless.
Social behavior is of great importance. Patients with maniacal syndrome often violate the conventions adopted in society and excessively familiar with unfamiliar people. Demantic patients sometimes react inadequately to the order of medical interview or continue to engage in their affairs, as if there is no interview. Schizophrenia patients are often weirdly behave during a survey; Some of them are hyperactive and divided in behavior, others are closed and are absorbed by their thoughts, some are aggressive. Patients with asocial personality disorder can also seem aggressive. By registering violations of social behavior, a psychiatrist must give a clear description of the patient's specific actions.
Finally, the doctor must carefully trace, if the patient has unusual motor disorders, which are observed mainly in schizophrenia. These include stereotypes, frosting in poses, echopraxia, ambitfence and wax flexibility. It should also be borne in mind the possibility of the development of late dyskinesia - impaired motor functions observed mainly in the elderly patients (especially in women), for a long time of taking antipsychotic drugs. This disorder is characterized by chewing and sucking movements, grimacing and choreatethety movements, exciting face, limbs and respiratory muscles.
Pathology of consciousness
Allo-, auto and somatopsychic orientation.
The orientation is evaluated using issues aimed at identifying the awareness of the sick time, place and subject. The study begins with questions about the day, month, year and season. When evaluating the answers, it is necessary to remember that many healthy people do not know the exact date, and it is quite understandable that patients who are in the clinic may not be sure of the day of the week, especially if the same regime is constantly respected in the ward. Finding out the orientation in the place, ask the patient about where it is (for example, in the hospital ward or in a nursing home). Then ask questions about other people - let's say, about the patient's wife or service personnel, it is aware of who they are and what they have to do with the patient. If the latter is not able to answer these questions correctly, you should ask him to identify yourself.
Changes in consciousness may arise due to a variety of causes: somatic diseases leading to psychosis, intoxication, cranial injuries, schizophrenic process, reactive states. Therefore, the disorders of consciousness are heterogeneous.
In the quality of the typical symptom components of the changed consciousness, delirium, aimenia, oneroid, twilight permanent of consciousness is distinguished. For all these symptom complexes are characterized by expressed in varying degrees:
- · Disorder of memorization of occurring events and subjective experiences leading to the subsequent amnesia, the inadequity of perception of the surrounding, its fragmentation, difficulty fixing images of perception;
- · This or other disorientation in time, in a place, immediate environment, itself;
- · Disruption of connectedness, consistency of thinking in combination with the weakening of judgment;
- · Amnesia of the period of the permanent consciousness
Disorientation. Orientation disorder is manifested in various acute psychosis, chronic conditions and is easy to check with respect to the current real situation, the surrounding situation and the personality of the patient.
- · What is your name?
- · What is your occupation?
Holistic environmental perception can be replaced by volatile experiences of the upset consciousness.
The ability to perceive the surrounding and self-personality through illusory, hallucinatory and delusional experiences becomes impossible or limited to the items.
Insulated time orientation violations in time may not be associated with a disturbance of consciousness, but a memory violation (amnetic disorientation).
To begin the inspection of the patient follows from observing his behavior, not attracting the patient's attention. Asking questions, the doctor distracts the attention of the patient from the deceptions of perception, as a result of which they can weaken or temporarily disappear. In addition, the patient may begin to hide them (dissimulate).
- · What time is the time of day?
- · What day of the week, the number of month?
- · What season?
For diagnosis thin disorders Consciousness It is necessary to pay attention to the patient's response to questions. So, the patient can correctly navigate in the place, but the asked question takes it by surprise, the patient is scattered around, responds after a pause.
- · Where are you at?
- · What does the situation around you look like?
- · Who is around you?
Detachment. The revenue from the real external world is manifested by a weak understanding of patients of what is happening around, they cannot focus their attention and act, despite the situation.
In pathological conditions, such a characteristic of consciousness as a degree of attention is weakened. In this regard, the selection of the most important information is violated.
The violation of "energy of attention" leads to a decrease in the ability to focus on any task, to incomplete coverage, up to the full impossibility of perception of reality. Usually ask questions aimed at finding out the patient's ability to realize what is happening with him and around it:
- · What happened to you?
- · Why are you in the hospital?
- · Do you need help?
Incoherence of thinking. Patients discover different in the degree of impairment of thinking - from weakness of judgment until complete inability to associate objects and phenomena. The failure of such thinking operations, as an analysis, synthesis, a generalization, especially characteristic of aimation and is manifested by incoherent speech. The patient may meanlessly repeating the doctrine's questions, random meaningful elements of thinking can randomly invade consciousness, consistent with the same random ideas.
Patients can answer the question when repeated repeated loud or, on the contrary, a quiet voice. Typically, patients cannot respond to more complex issues related to the content of their thoughts.
- · What worries you?
- · What do you think about?
- · What do you have in the shower?
You can try to check the ability to establish the relationship between external circumstances and relevant events:
- · Around you people in white coats. Why?
- · You make injections. What for?
- · Does you prevent anything to go home?
- · Do you consider yourself sick?
Amnesia. For all symptom components of the altered consciousness, a complete or partial loss of memories after the end of the psychosis is characteristic.
The mental life flowing in the conditions of coarse permanent of consciousness may not be available (or almost unavailable) with a phenomenological study. Therefore, very important diagnostic importance is identified both by the presence and features of amnesia. In the absence of memories of real events during psychosis, painful experiences are often stored in memory.
It is best to have experienced patients who have suffered from the psychosis. This applies mainly to the content of dream-like representations, pseudogalucinations and, to a lesser extent, memories of the real environment (with an oriented onairoid). When leaving the Deliization, the memories are more fragmented and relate to almost solely painful experiences. The states of aimation and twilight consciousness are characterized most often by the complete amnesia of the suffered psychosis.
- · Have you ever had any states similar to the "dreams" in reality?
- · What did you saw?
- · What is the feature of these "dreams"?
- · How long did this state last?
- · Have you been a member of these dreams or have it seen from the side?
- · How did you come to yourself - immediately or gradually?
- · Do you remember what happened around while you were in this state?
Criticism
When evaluating the awareness of the patient of its mental state, it is necessary to remember the complexity of this concept. By the end of the mental status examination, the doctor must compile a preliminary opinion about the extent to which the patient is aware of the painful nature of its experiences. Then you should ask direct questions in order to deeper to appreciate this awareness. These questions relate to the opinions of the patient about the nature of its individual symptoms; For example, he believes that his hypertrophied guilt feel is justified, or not. The doctor should also find out if the patient considers himself to patients (and not, let's say, pursued by its enemies); If so, whether he binds his unhealthy with physical or with a mental illness; Whether he finds what needs treatment. The answers to these questions are also important because they, in particular, determine how patient is inclined to take part in the treatment process. An entry that only fixes the presence or absence of an appropriate phenomenon ("There is awareness of the mental illness" or "no awareness of the mental illness") is not of great value.
Attention - This is the ability to focus on any object. Concentration - the ability to keep this concentration. During the collection of anamnesis, the doctor must follow the attention and its concentration in the patient. Thus, he will already be able to form a judgment about the appropriate abilities until the end of the mental status survey. Formal tests allow you to expand this information and make it possible to express changes in quantitative indicators to develop as a disease progressing. Usually begin with an attachment account: the patient is asked to take 7 from 100, then subtract 7 from the residue and repeat the specified action until the residue is less than seven. Register the test time of the test, as well as the number of errors. If the impression is created that the patient did not cope with the test due to the weak knowledge of arithmetic, should offer it to perform a simpler similar task or list the names of the months in reverse order. The study of the orientation and concentration of mental activity of patients is very important in various areas of clinical medicine, since many mental and somatic painful processes begin with attention. Violations of attention are often notified by the patients themselves, and almost everyday nature of these disorders allows patients to tell the doctors of various specialties. However, in some mental illness, patients may not notice their problems in the field of attention. The main characteristics of attention include volume, selectivity, stability, concentration, distribution and switching. Under volume
attention is understood by the number of objects that can be clearly perceived in a relatively short period of time. The limited amount of attention requires constant allocation by the subject of any of the most significant objects of surrounding. This choice from a variety of incentives only some is called selectivity attention.
·
The patient reveals scattered, periodically asks the interlocutor (doctor), especially often by the end of the conversation. ·
The nature of communication affects noticeable distractions, difficulty in maintaining and randomly switching attention to a new topic. ·
The patient's attention is held on one thought, the topic of conversation, the object is quite short Stability of attention
- This is the ability of a subject to not deviate from targeted mental activity and maintain focus on the object of attention. The patient distracts any internal (thoughts, sensations) or exterior stimuli (foreign conversation, street noise, some item in sight). Productive contact can be practically impossible. Concentration of attention
It is the ability to focus on the presence of interference. ·
Do you notice that it is difficult for you to focus when performing mental work, especially at the end of the working day? ·
Do you notice that you began to make more mistakes in carelessness? Distribution of attention
it indicates the possibility of a subject to direct and focus its mental activity on several independent variables at the same time. Switching attention
It is the movement of its orientation and concentration from one object or the type of activity to others. ·
Are you sensitive to external interference when performing mental work? ·
Do you manage to switch from one lesson to another? ·
Do you always manage to keep track of the plot of the film you are interested in, TV shows? ·
Do you often get distracted when reading? ·
Do you often have to notice that you are mechanically running the text with a look, without catching his meaning? Study of attention is also carried out using Tables of Shulte and Correct Sample. Disorders of attention
Emotion disorders
Mood assessment starts with observation of behavior and continue through direct questions:
· What is your mood?
· How do you feel in the sense of mental condition?
If depression is revealed, it is necessary to ask the patient in more detail about whether it sometimes feels that it is close to tears (the existing tears is often denied), whether his pessimistic thoughts are visited about the present, about the future; Does he have a feeling of guilt towards the past. Questions can be formulated as follows:
· What do you think with you will be in the future?
· Do you blame yourself in anything?
With an in-depth study of the state anxiety The patient is asked about somatic symptoms and about thoughts accompanying this affect:
· Do you notice any changes in your body when you feel the alarm?
Then go to the consideration of specific moments, aware of the rapid heartbeat, dryness in the mouth, sweating, trembling and other signs of the activity of the vegetative nervous system and muscle tension. To identify the presence of alarming thoughts, it is recommended to ask:
· What comes to your mind when you are alarming?
Probable answers are associated with thoughts of possible fainting, loss of control over themselves and about the hopeless madness. Many of these issues inevitably coincide with the information collapsed when collecting information for the disease.
Questions O. raised mood correlate with the depressed attributed; So, for the general question ("How mood?") follows, if necessary, relevant direct issues, for example:
· Do you feel extraordinary vigor?
The raised mood is often accompanied by thoughts reflecting excessive self-confidence, an overestimated assessment of their abilities and crazy plans.
Along with the assessment of the dominant mood, the doctor must figure out how mood changes And whether it matches the situation. With sudden mood changes, it is said that it is laby. It is also necessary to note any persistent absence of emotional reactions, usually denoted as dulling or placing emotions. In a mentally healthy person, the mood changes in accordance with the main topics discussed; He looks sad, speaking of sad events, manifests anger, telling about what he got angry, etc. If the mood does not coincide with the situation (for example, the patient giggles, describing the death of his mother), it is noted as inadequate. This symptom is often diagnosed without sufficient grounds, so it is necessary to write characteristic examples in the history of the disease. More close acquaintance with the patient may later prompt another explanation for his behavior; For example, a smile when talking about sad events may be a consequence of embarrassment.
The state of the emotional sphere is determined and evaluated in the process of the entire survey. In the study of the sphere of thinking, memory, intelligence, perception is recorded by the nature of the emotional background, the solve reactions of the patient. The peculiarity of the emotional relationship of the patient to relatives, colleagues, neighbors on the ward, medical personnel, their own state is estimated. At the same time, it is important to take into account not only the self-lifting of the patient, but also the data of objective observation of psychomotor activity, facial and pantomimic, for the indicators of the tone and the directivity of the growing and exchange processes. The patient should be interviewed and observing the duration and quality of sleep, appetite (reduced during depression and increased during mania), physiological sections (constipation during depression). When inspected, pay attention to the magnitude of the pupils (expanded during depression), on the humidity of the skin and mucous membranes (dryness during depression), measure blood pressure and claims the pulse (increase the blood pressure and the increase in the pulse during emotional voltage), find out the patient's self-esteem (revaluation during manic state and Self-satisfaction with depression).
Depressive symptoms
Depressed mood (hypothymia). Patients experience feelings of sadness, despondency, hopelessness, discourability, feel unhappy; Anxiety, tension or irritability should also be assessed as a dysphoric mood. The estimate is carried out without reference to the duration of the mood.
· Have you experienced tensions (anxiety, irritability)?
· How long did it last?
· Have you been experienced periods of depression, sadness, hopelessness?
· Do you know the condition when nothing pleases you when everything is indifferent to you?
Psychomotor inhibition. The patient feels inhibition and experiences difficulties in movements. Objective signs of injury, such as slow motion, pauses between words should be noticeable.
· Do you feel inhibition?
Deterioration of cognitive abilities. Patients complain about deterioration of the ability to concentrate attention and generally deterioration in mental abilities. For example, helplessness when thinking, the inability to make a decision. Violations of thinking are more subjective to a greater degree and differ from such coarse disorders such as torn or incoherence of thinking.
· Are you experiencing any problems when thinking; making decisions; performing arithmetic actions in everyday life; If necessary, concentrate on something?
Loss of interest and / or desire for pleasures . Patients lose interest, the need to obtain pleasure in various spheres of life is reduced by sexual attraction.
Do you notice changes in your interest in the surrounding?
· What usually gives you pleasure?
· Does it please you now?
Ideas of low value (self-esteem), guilt. Patients humiliantly evaluate their identity and ability, detraining or denying everything positive, talking about the feeling of guilt and express unreasonable ideas of guilt.
· Do you have no feelings of discontent with yourself lately?
· What is it connected with?
· What can you regard your personal achievement in your life?
· Are you feeling guilty?
· Could you tell me what you blame yourself?
Thoughts of death, suicide. Almost all depressive patients are often returned to the thoughts of death or suicide. The usual statements about the desire to go into oblivion so that it happened suddenly, without the participation of the patient, "fall asleep and not wake up." Characterized by thinking of suicide methods. But sometimes patients are prone to specific suicidal actions.
The so-called "antisuicidal barrier", one or more circumstances holding a patient from suicide is of great importance. The identification and strengthening of this barrier is one of the few ways to prevent suicide.
· Is there a sense of hopelessness, life deadlock?
· Did you have a feeling that your life is not worth going to continue it?
· Do the thoughts about death come to mind?
· Did you have a desire to deprive yourself?
· Did you think about specific ways of suicide?
· What kept you from this?
· Were there any attempt to do it?
· Could you tell us more about it?
Reduced appetite and / or weight. Depression is usually accompanied by a change, more often than decrease, appetite and body weight. The increase in appetite is found in some atypical depressions, in particular, with a seasonal affective disorder (winter depression).
· Did your appetite changed?
· Do not lose weight / Have you recently recently?
Insomnia or high drowsiness. Among the violations of the night's sleep is made to allocate the insomnia of the falling period, insomnia of the middle of the night (frequent awakening, superficial sleep) and premature awakening from 2 to 5 hours.
Pulling disorders are more characteristic of the insomnia of neurotic genesis, early premature awakens are more common in endogenous depressions with distinct dust and / or alarming components.
· Do you have any problems with sleep?
· Do you easily fall asleep?
· If not, what prevents you from falling asleep?
· Are there anywhere awakening among the night?
· Do you worry hard dreams?
· Is there any premature pre-weary awakens? (Do you manage to fall asleep again?)
· What mood you wake up?
Daily fluctuations in mood. Clarification of the rhythmic peculiarities of patients mood is an important differential sign of endo and exogenous depression. The most typical endogenous rhythm is a gradual decrease in longing or anxiety, especially pronounced in the morning during the day.
· What time of day is the hardest for you?
· Do you feel harder in the morning or evening?
Reducing emotional response the poverty is manifested by the poverty of the Mimic, the range of senses, voice monotony. The basis for evaluation is motor manifestations and an emotional response, recorded during the abstract. It should be borne in mind that the assessment of some symptoms can be distorted by the reception of psychotropic drugs.
Monthly facial expression
· Mimic expression may be incomplete.
· The expression of the patient's face does not change or the mimic response is less than expected in accordance with the emotional content of the conversation.
· Mimica frozen, indifferent, the reaction to the appeal is sluggish.
Reducing spontaneity of movements
· The patient looks very compound during the conversation.
· Motion slowed down.
· The patient is sitting motionless throughout the conversation.
Insufficient gesticulation or its absence
· The patient detects a slight decrease in expressiveness of gestures.
· The patient does not use for the expression of his ideas and feelings of the movement with hands, tilting forward when communicating something trustful, etc.
No emotional response
· The insufficiency of emotional resonance can be tested by a smile or joke, which usually causes a response smile or laughter.
· The patient can skip some of these incentives.
· The patient does not respond to a joke, no matter how provoked it.
· During the conversation, the patient detects a slight decrease in voice modulation.
· In the speech of the patient, the words are few highlighted with a tone height or power.
· The patient does not change the timbre or voice volume when discussing purely personal those who can cause indignation. Speech is constantly monotonous.
Aerygy. This symptom includes a sense of energy loss, fast fatigue or feeling of rapid fatigue. Asking these violations, they should be compared with the usual level of patient activity:
· Do you have more than usual fatigue, fulfilling ordinary cases?
· Do you have to feel physical and / or mental exhaustion?
Alarm disorders
Panic disorders. These include unexpected and unfortunate attacks of anxiety. Such somategative symptoms of anxiety, such as tachycardia, shortness of breath, sweating, nausea or discomfort in the abdomen, pain or unpleasant feeling in the chest, can be more pronounced than mental manifestations: depersonalization (drama), fear of death, paresthesia.
· Have you ever experience sudden attacks of panic or fear, in which you were very hard physically?
· How long have they continued?
· What unpleasant feelings were accompanied by?
· Did these attacks be accompanied by the fear of death?
Manic states
Manic symptoms . Increased mood. The patient's condition is characterized by excessive cheerfulness, optimistic, sometimes irritability that is not associated with alcohol or other intoxication. Patients rarely regard the increased mood as a manifestation of the disease. At the same time, the diagnosis of the actual manic state does not cause much difficulties, therefore, ask more often about the manic episodes suffered in the past.
· Have you ever sense a special lift of the mood in a period of your life?
· Did he differ from your behavior rate?
· Have your relatives have friends to think that your condition goes beyond just a good mood?
· Have you experienced irritability?
· How long did this state last?
Hyperactivity . Patients detect increased activity in work, family matters, the sexual sphere, in building plans and projects.
· Is it true that you (were then) are active and busy more than usual?
· What about work, communication with friends?
· How passable are your hobbies now or other interests?
· Can you (could you sit quietly or do you want to move all the time?
Acceleration of thinking / jumping ideas. Patients may experience a distinct acceleration of thoughts, note that thoughts are ahead of speech.
· Do you notice the ease of thoughts, associations?
· We can say that your head is full of ideas?
Increased self-esteem . Assessment of merits, connections, influence on people and events, strength and knowledge is clearly increased compared to the usual level.
· Do you feel great confidence in yourself than usual?
· Do you have any special plans?
· Do you feel any special abilities or new opportunities?
· Don't you think that you are a special person?
Reducing sleep duration. When evaluating, it is necessary to consider the average in the last few days.
· Do you need less hours to sleep to feel rested than usual?
· How many hours do you usually have enough for sleep and how much now?
Threshiflight. The patient's attention is very easily switched to insignificant or not related to the topic of conversation external stimuli.
· Do you notice that the surrounding distracts you from the main topic of conversation?
Criticism
When evaluating the awareness of the patient of its mental state, it is necessary to remember the complexity of this concept. By the end of the mental status examination, the doctor must compile a preliminary opinion about the extent to which the patient is aware of the painful nature of its experiences. Then you should ask direct questions in order to deeper to appreciate this awareness. These questions relate to the opinions of the patient about the nature of its individual symptoms; For example, he believes that his hypertrophied guilt feel is justified, or not. The doctor should also find out if the patient considers himself to patients (and not, let's say, pursued by its enemies); If so, whether he binds his unhealthy with physical or with a mental illness; Whether he finds what needs treatment. The answers to these questions are also important because they, in particular, determine how patient is inclined to take part in the treatment process. An entry that only fixes the presence or absence of an appropriate phenomenon ("There is awareness of the mental illness" or "no awareness of the mental illness") is not of great value.
