Assessment of the Psychological State
A psychiatric examination consists of four parts:
1. The psychiatric history
2. Examination of the Mental State
3. Evaluation of the personality
4. The diagnostic formulation
The clinical method for history-taking is the interview. The clinician sets out to obtain a comprehensive history in his first interview with the patient. A series of interviews may be necessary before he acquires all the information he needs to understand both how the psychiatric illness came about and why it took the course it did. In his first interview the goal of the clinician is to get at least a preliminary overall history; in doing so, he will also detect the prominent signs or illness comprising the mental state; moreover, he will have the information enabling him to reach a tentative assessment of the patient’s personality; and he will be able to arrive at a working diagnosis. A diagnosis is an hypothesis about the illness; and about the main aetiological factors operating. It is derived by the clinician from an informed synthesis of the facts elicited. Because diagnosis antecedes therapy, and the clinician will wish to begin the initial treatment after his first interview, he aims to reach his preliminary diagnosis where possible. A first interview takes an experienced practitioner half-an-hour. Subsequent interviews may be briefer, and can be arranged as required to get further information and to extend the psychiatric examination as necessary.
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