A Guide to Psychiatric Examination, 1st Edition

"This practical book is the perfect guide for anyone who wishes to conduct a thorough psychiatric examination. It covers every possible area, including the patient’s perspective and how it can feel to be examined."

"Nothing provides a better foundation for good mental healthcare than access to a range of excellent supervisors and role models. This text is liking having a supervisor in your pocket"

"Provides detailed and practical guidance on the assessment of people with mental health problems. It takes a humane, person-centred approach whilst providing detailed technical advice. I strongly recommend it to students and established mental health workers alike"

"A valuable contribution to understanding the different manifestations of mental illness, harnessing the skills of examining the person experiencing mental health issues and the process of coming to a diagnosis. It… addresses the needs of psychiatrists and other health practitioners, including nurses and social workers, who collaborate to provide support and treatment to people living with mental illness…and also provides clear and practical advice to students and trainees, and to health education programs, with the hope that the approaches recommended will be adopted and bring continued progress in the movement towards humane mental health services".

"A book that will make a difference to readers in their everyday work… There are many books on psychiatry, but just a handful are essential purchases for trainees. This is one"

"An excellent resource for every mental health professional. The strength of this book lies in detailed description and numerous examples of ‘how to ask’ for information. There is an excellent synthesis of theoretical information and practicalities of interviewing. It makes everything so real and practical".

"This is a really great little book. It is a powerfully practical guide that provides the reader with all the information, advice and support needed to complete a psychiatric examination. Whatever your experience and expertise there is much to be gained by reference to this deep resource."

"An incredibly comprehensive and broad guide to psychiatry in various settings and contexts. Suitable for various levels of training and one to revisit time and time again."

"Understanding and application of the psychiatric interview is a must for any doctor or student, regardless of specialty. This textbook effortlessly connects both routine examination and therapeutic impact, allowing for meaningful conversations to take place that make a difference."

"Knowledge without skill does not allow us to make a difference. This book provides a tour de force with deep value for a range from student to trainee to skilled professional. It should not just sit on every psychiatric professional bookshelf but be a resource to go to, time and again."

"This book comes at the opposite end of my career to the time when I needed it most. Psychiatry was daunting at first, with a huge amount to learn about the nuts and bolts of how to do it. For quite a long time, I was far from certain what I was supposed to be doing. I was fortunate to be trained by some truly outstanding psychiatrists, but great clinicians do not necessarily convey a clear idea of how they do it, because it seems obvious to them; that is one of the things that makes them so good at what they do. Understanding what trainees need, and conveying it to them, is an unusual skill that Carmelo and Gavin manifestly possess. They have achieved something really special: they have written a book that will make a difference to readers in their everyday work.

Amongst this book’s many strengths, James Downs’s chapter on being interviewed is outstanding. It is a well-written, balanced account of the experience and the pitfalls of interacting with psychiatrists as a patient. It lends authenticity to the book, and it is a master stroke to have made it chapter 1. It creates the key contextual framework for what follows.

Although reductionism is an important scientific tool, it is also a key weakness of biomedicine. Contextualisation matters. One of my mentors was Dr Loïc Hemsi, a pioneering old age psychiatrist who died suddenly at the early age of 54. He introduced me to systems thinking and emphasised the importance of context in a broad and multifaceted sense. I can offer no higher praise than to say that, for me, strong echoes of Loïc’s teaching are evident in this book. The patient’s life circumstances, the settings where examination is carried out, the mixed blessings of operationalised diagnosis and many other contextual issues are woven into the text.

I have written some books myself. I work with co-authors, who struggle with my precious attitude to prose that I have carefully crafted. When Robert Higgo and I showed a draft of our first book to trusted friends and colleagues, one of them said that it was alright, but it needed more lists in it. I ignored this philistine feedback. It is ironic that, many years later, I find myself recommending a book that has copious lists, tables and bullet points. The device works very well. The text is succinct but includes discussion of important controversies. It is accessible and readable. Chapters stand alone and they can be read as the need arises in the workplace.

There are many books on psychiatry, but just a handful are essential purchases for trainees. This is one."

Reviewer:

"With the average lifespan now expanding to the 90s, many people will likely experience one or more episodes of mental illness in themselves or in the lives of family, friends, colleagues and acquaintances. This means that whether healthcare professionals focus their practice on treating mental illness, or not, they will be involved in varying degrees with persons experiencing mental health issues. Unfortunately, many healthcare professionals seem to have little to offer those who present with a mental health issue, as evidenced by the growing numbers of people of all ages who express dissatisfaction with conventional health services. In large part this is because training of health care professionals primarily emphasises the treatment of acute physical disease, wherein each disease is viewed as an objective biomedical reality with a single cause and single treatment. This approach is entirely unsuited to mental health issues, which may have more than one cause and may require more than one management approach. Thus, the experience of mental illness may be quite variable, depending on biomedical, personality, coping, social and cultural factors.

A Guide to Psychiatric Examination is a valuable contribution to understanding the different manifestations of mental illness, harnessing the skills of examining the person experiencing mental health issues and the process of coming to a diagnosis. It is unique in its emphasis on the experience of mental illness from both the perspective of the person and the health professional. The Guide emphasises the need for, and clinical value of, a comprehensive, humane approach to biopsychosocial assessment and case conceptualisation. In doing so, the Guide stresses the value of tailoring the assessment and diagnostic process to personality dynamics, family, social and cultural dynamics, health dynamics, including illness presentation or explanatory models, and course and progression of illness. Several case studies are provided to clarify and illustrate significant points and issues.

The tenor of the Guide is established in the beginning with the story of one person’s unsuccessful encounters with a multitude of health practitioners and services for complex mental health issues. This authentic reflection provides readers with a feel for working with persons experiencing such issues in the treatment setting. The often-traumatic experiences faced by this person when seeking answers and mental health support, focuses our attention to the essential requirement that therapeutic support must be built around the needs of the individual and is contingent upon knowing the person through an interpersonal relationship. Achieving this fundamental goal requires a commitment by the practitioner to support the person’s selfhood in the process of building and nurturing the relationship, and in journeying together towards mutual understanding, skilled management and healing.

The Guide is divided in seven section. Section 1 outlines the importance of information gathering and provides detailed advice on the interview process, including the purpose, nature and circumstances for posing different questions, question wording, structure and probing techniques, ways in which to clarify and extend question responses. Section 2 gives comprehensive advice on conducting the interview, illustrated with plausible examples of question sequence and approach within different contexts. Clear instruction is provided on the most useful ways of administering and recording the Mental State Examination, and on best approaches to sharing mental health assessment data with colleagues. Specific mental illnesses are fully explored in Section 3, covering the range of conditions experienced by people across the lifespan and within different circumstances. Not only does this section provide detailed information on these illnesses, it provides evidence-based guidance on use of assessment instruments and procedures, and on coming to a mutual understanding in making a diagnosis. Practical points are provided to assist the health practitioner in undertaking these processes. Section 4 provides helpful advice on undertaking mental health assessments in specific contexts, such as in the accident and emergency department, while Section 5 gives insightful guidance on assessing for mental illness in specific spopulation groups, such as adolescents, and people living with an intellectual disability and/or dementia. In Section 6 there is more detailed information on undertaking mental health assessments in particular circumstances, including assessment of risk and bio-psychosocial health assessment. The Guide concludes with Section 7, which details the examination skills required for health practitioners. The appendices provide several examples of assessment instruments used in mental health practice.

In conclusion, this Guide addresses the needs of psychiatrists and other health practitioners, including nurses and social workers, who collaborate to provide support and treatment to people living with mental illness. Their collaboration as part of the medical team enables a more comprehensive assessment of mental health issues and is instrumental to the success of the bio-psychosocial model of mental health support. The Guide also provides clear and practical advice to students and trainees, and to health education programs, with the hope that the approaches recommended in the Guide will be adopted and bring continued progress in the movement towards humane mental health services."

Reviewer

"A remarkably comprehensive book on psychiatric assessment in all its complexity, and it will be invaluable for all those clinicians training in mental health, as well as a welcome resource for those who are well practiced in the discipline…It is excellent in reminding all of us about the approach to assessment and the need for a fundamental humanity and empathy, combined with the expertise of a professional, which cannot be overstated."