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PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: CLINICAL
ASSESSMENT-PATIENT’S PSYCHIATRIC HISTORY AND PREMORBID PERSONALITY
A personal history of psychiatric disorder can be assessed either in the review of systems or in the past medical history. Here, too, there is a smooth transition from questions about neurological symptoms to questions about psychiatric ones. In the review of systems, for example, “Do you get frequent headaches?” and “Have you been depressed or anxious?” will be regarded as parallel inquiries.
Patients sometimes report having had a “nervous breakdown.” Because the meaning of this term is so uncertain, the physician should obtain a description of symptoms at the time of the illness. Just as in the medical and surgical histories, additional informants may be needed for an accurate understanding of past diagnoses and treatments.
Premorbid personality-The goal of assessing premorbid personality is not only to learn more about the patient as an individual but also to discover traits that may shape her response to illness and her relationship to physicians and others involved in her care. A good time to evaluate the premorbid personality is following the review of systems or the past medical history: “You’ve told me a lot about your health. Now I’d like you to tell me about yourself. What kind of person would you say you are?not when you’re ill, but when you’re well?” Depending on the response, the physician may wish to inquire about traits of particular interest in the medical setting. Thus, after a patient describes herself as “a good person … a kind person … a hard worker,” the physician should ask her whether she tends to be optimistic or pessimistic; carefree or worried; trusting or suspicious; calm or irritable. Someone who knows the patient well might also be asked to characterize her, if only because we often lack the gift to see ourselves as others see us.
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