Diagnosis of Psychiatric disorders
Psychiatric disorders Diagnosis: Book Excerpts
Diagnostic Tests for Psychiatric disorders: Online Medical Books
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Psychotic behavior:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Because the patient’s behavior can
make it difficult — or potentially dangerous — to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and circumstances that may have precipitated it. Obtain a drug history, noting especially the use of an antipsychotic, and explore his use of alcohol and other drugs, such as cocaine, indicating duration of use and amount. Ask about recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient’s family. Which family members does he seem closest to? How does the family describe the patient’s relationships, communication patterns, and role? Has a family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient’s compliance with his drug regimen.
Finally, evaluate the patient’s environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Violent behavior:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
During your evaluation, determine if the patient has a history of violent behavior. Is he intoxicated or suffering symptoms of alcohol or drug withdrawal? Does he have a history of family violence, including corporal punishment and child or spouse abuse? (See Understanding family violence.)
Watch for clues indicating that the patient is losing control and may become violent. Has he exhibited abrupt behavioral changes? Is he unable to sit still? Increased activity may indicate an attempt to discharge aggression. Does he suddenly cease activity (suggesting the calm before the storm)? Does he make verbal threats or angry gestures? Is he jumpy, extremely tense, or laughing? Such intensifying of emotion may herald loss of control.
If your patient’s violent behavior is a new development, he may have an organic disorder. Obtain a medical history, and perform a physical examination. Watch for a sudden change in his level of consciousness. Disorientation, failure to recall recent events, and display of tics, jerks, tremors, and asterixis all suggest an organic disorder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Psychiatric Disorders:
Patient history
(Professional Guide to Diseases (Eighth Edition))
A patient history establishes a baseline and provides clues to the underlying or precipitating cause of the current problem. Remember that the patient may not be a reliable source of information, particularly if he has a mental illness. If possible, verify his responses with family members, friends, or health care personnel. Also check facility records from previous admissions, if possible, and compare his past behavior, symptoms, and circumstances with the current situation.
Explore the patient’s chief complaint, current symptoms, psychiatric history, demographic data, socioeconomic data, cultural and religious beliefs, medication history, and physical illnesses.
❑ Chief complaint. The patient may not voice his chief complaint directly. Instead, you or others may note that he’s having difficulty coping or is exhibiting unusual behavior. If this occurs, determine whether the patient is aware of the problem. When documenting the patient’s response, write it verbatim and enclose it in quotation marks.
❑ Current symptoms. Find out about the onset of symptoms, their severity and persistence, and whether they occurred abruptly or insidiously. Compare the patient’s condition with his normal level of functioning.
❑ Psychiatric history. Discuss past psychiatric disturbances, such as episodes of delusions, violence, depression, attempted suicides, drug or alcohol abuse, and previous psychiatric treatment.
❑ Demographic data. Determine the patient’s age, sex, ethnic origin, primary language, birthplace, religion, and marital status. Use this information to establish a baseline and validate the patient’s record.
❑ Socioeconomic data. Obtain information about the patient’s educational level, housing conditions, income, current employment status, and family, because these data may provide clues to his current problem. Determine current stressors from a holistic perspective.
❑ Cultural and religious beliefs. A patient’s background and values affect his response to illness and his adaptation to care. Certain questions and behaviors considered acceptable in one culture may be inappropriate in another. Determine the extent to which the patient may utilize cultural rituals, treatments, and healing practices.
❑ Medication history. Certain drugs can cause symptoms of mental illness. Review any medications the patient may be taking, including over-the-counter drugs and herbal supplements or remedies, and check for interactions. If he’s taking an antipsychotic, antidepressant, anxiolytic, or antimanic drug, ask if his symptoms have improved, if he’s taking the medication as prescribed, and if he has had any adverse reactions.
❑ Physical illnesses. Find out if the patient has a history of medical disorders that may cause distorted thought processes, disorientation, depression, or other symptoms of mental illness. For instance, does he have a history of renal or hepatic failure, infection, thyroid disease, increased intracranial pressure, or a metabolic disorder? Additionally, has the patient suffered recent head trauma, infection, or physical illness?
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Psychotic behavior:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Because the patient’s behavior can make it difficult—or potentially dangerous—to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and any circumstances that may have precipitated it. Obtain a drug history, noting especially use of an antipsychotic, and explore his use of alcohol and other drugs such as cocaine, indicating duration of use and amount. Ask about any recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient’s family. Which family members does he seem closest to? How does the family describe the patient’s relationships, communication patterns, and role? Has any family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient’s compliance with his drug regimen.
Finally, evaluate the patient’s environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Violent behavior:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
During your evaluation, determine if the patient has a history of violent behavior. Is he intoxicated or suffering symptoms of alcohol or drug withdrawal? Does he have a history of family violence, including corporal punishment and child or spouse abuse? (See Understanding family violence, page 800.)
Watch for clues indicating that the patient is losing control and may become violent. Has he exhibited abrupt behavioral changes? Is he unable to sit still? Increased activity may indicate an attempt to discharge aggression. Does he suddenly cease activity (suggesting the calm before the storm)? Does he make verbal threats or angry gestures? Is he jumpy, extremely tense, or laughing? Such intensifying of emotion may herald loss of control.
If your patient’s violent behavior is a new development, he may have an organic disorder. Obtain a medical history, and perform a physical examination. Watch for a sudden change in his level of consciousness. Disorientation, failure to recall recent events, and a display of tics, jerks, tremors, and asterixis all suggest an organic disorder.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Psychotic behavior:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Because the patient’s behavior can make it difficult — or potentially dangerous — to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and any circumstances that may have precipitated it. Obtain a drug history, noting especially use of an antipsychotic, and explore his use of alcohol and other drugs such as cocaine, indicating duration of use and amount. Ask about recent illnesses or accidents.
Interview the patient’s family. Which family member does he seem closest to? How does the family describe the patient’s relationships, communication patterns, and role? Has any family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient’s compliance with his drug regimen.
Finally, evaluate the patient’s environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Psychotic behavior:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Because the patient's behavior can make it difficult—or potentially dangerous—to obtain pertinent information, conduct the interview in a calm, safe, and well-lit room. Provide enough personal space to avoid threatening or agitating the patient. Ask him to describe his problem and circumstances that may have precipitated it. Obtain a drug history, noting especially the use of an antipsychotic, and explore his use of alcohol and other drugs, such as cocaine, indicating duration of use and amount and when it was last taken. Ask about recent illnesses or accidents.
As the patient talks, watch for cognitive, linguistic, or perceptual abnormalities such as delusions. Do thoughts and actions seem to match? Look for unusual gestures, posture, gait, tone of voice, and mannerisms. Does the patient appear to be responding to stimuli? For example, is he looking around the room?
Interview the patient's family. Which family members does he seem closest to? How does the family describe the patient's relationships, communication patterns, and role? Has a family member ever been hospitalized for psychiatric or emotional illness? Ask about the patient's compliance with his drug regimen.
Finally, evaluate the patient's environment, educational and employment history, and socioeconomic status. Are community services available? How does the patient spend his leisure time? Does he have friends? Has he ever had a close emotional relationship?
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Violent behavior:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
During your evaluation, determine whether the patient has a history of violent behavior. Is he intoxicated or suffering symptoms of alcohol or drug intoxication or withdrawal? Does he have a history of family violence, including corporal punishment and child or spouse abuse? (See Understanding family violence.)
Watch for clues indicating that the patient is losing control and may become violent. Has he exhibited abrupt behavioral changes? Is he unable to sit still? Increased activity may indicate an attempt to discharge aggression. Does he suddenly cease activity (suggesting the calm before the storm)? Does he make verbal threats or angry gestures? Is he jumpy, extremely tense, or laughing? Such intensifying of emotion may herald loss of control.
If your patient's violent behavior is a new development, he may have an organic disorder. Obtain a medical history and perform a physical examination. Watch for a sudden change in his level of consciousness. Disorientation, failure to recall recent events, and display of tics, jerks, tremors, and asterixis all suggest an organic disorder.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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