![]() ![]() When this is done, the examination needs to be introduced carefully to the patient, with some explanation as to why it is being done, in order to enlist patient cooperation rather than resistance. When there is history or evidence of clinically significant psychiatric illness, such as aberrant behavior or thinking, abnormalities on neurologic examination, or difficulties in day-to-day performance on the job or in social situations, then a formal dissecting of specific cognitive abilities should be performed near the close of the physician–patient encounter. A primary technique, then, in mental status testing is the imposition of some structure on these observations and raising them from the level of subliminal impressions to clinically useful descriptions of behavior. The way in which the patient relates the history of the present illness will reveal much about general appearance and behavior, alertness, speech, activity, affect, and attitude. ![]() The successful clinician must develop a style in which much of the mental status examination is performed through relatively unstructured observations made during the routine history and physical. On the other hand, the mental state of the patient colors the accuracy and sensitivity of the entire medical history, and from this standpoint, the physician wishes he or she could perform a mental status examination as a prelude to the rest of the medical history in order to have the assessment as a template against which to measure the accuracy of the rest of the history. On the one hand, because mental status testing can be threatening to the patient and requires much cooperation on the part of the patient, it is desirable to leave the mental status testing to the end of the overall evaluation when the patient can be placed most at ease and when some degree of rapport has been established between the examiner and the patient. The mental status examination, in many respects, lends itself less well to a systematic and structured approach than other portions of the examination of the patient. Nevertheless, the observational skills and subtle discriminations that constitute "great discernment," and the traits of professional and scientific integrity that are likewise required, must be cultivated afresh in each generation of physicians. The knowledge that the modern physician can bring to bear on this task is certainly much more extensive than in 1801. One could scarcely improve on this advice in the present-day approach to mental status evaluation. To seize the true character of mental derangement in a given case, and to pronounce an infallible prognosis of the event, is often a task of particular delicacy, and requires the united exertion of great discernment, of extensive knowledge and of incorruptible integrity. In his Treatise on Insanity, published in 1801, Pinel, one of the fathers of modern psychiatry, gave some advice to his contemporary colleagues. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |