THE PSYCHIATRIC EXAMINATION
A contrast to the psychotherapeutic interviews, is the heavily structured psychiatric examination. The psychiatric examination includes a thorough case history, and an examination of the physical and mental state of the client. The taking of the client’s history is an important part of the examination. It is the means by which the clinician or psychotherapist investigates the problem and establishes a treatment plan. The case history seeks to give the clinician a picture of the client from early childhood to adulthood and as a result of this picture provides a basis for informed and meaningful intervention.
What then are the areas of the client’s development and experience investigated in the case history?
1) Details of present problem
2) Family history
3) Personal history
Infancy and childhood
Experience at school
Experience at work
Menstrual functions
Sexual attitudes, experience
4) Marital history
5) Personal habits (smoking, alcohol, drugs, etc.)
6) Medical history
7) Appearance and behaviour
8) Communication
9) Mood
10) Nature of client’s thoughts (self esteem, attitude to others,
depressive, suspicious, etc.)
11) Disorders of perception
12) Orientation and memory
The psychiatric examination seeks to obtain as much information as possible about the client from the client and to supplement this where it is thought appropriate by information provided by other sources. It would be unfair, however, to suggest that such a fact gathering exercise inevitably leads to insensitive interviewing. Clearly it can do so but in the hands of an empathic clinician such a detailed enquiry can be made respectfully and with the minimum intrusion.
