Important role in the formulation of clinical and psychological diagnosis is correctly collected psychological anamnestic information about the patient (anamnesis - memories). They are compiled in the course of psychobiographical and clinical-psychological methods of research.
Detailed inquiry - the basis of rationally collected psychological history - often allows you to find out objective data about the origin and development of the disease, the life of the patient in the conditions of the disease, determine the internal model of the disease and, having analyzed the data obtained, outline psychodiagnostic methods of studying mental processes, states, properties .
Clinical psychologist should carefully, delicately, but without excessive shyness to collect the necessary information. During the interview, he must achieve the patient's location to himself, win his confidence. Feeling a sympathetic attitude towards his destiny, a desire to help him, the patient sets forth in more detail his complaints and various aspects of his life. Here it is necessary to warn the beginning clinical psychologists - first of all, it is impossible to share with sick fragments from own life and from the life of your relatives, relatives, acquaintances, from the read literature, the viewed movie, etc. For the patient, his condition is unique and unique, as a rule, he has a thousand reservations that the heroes the psychologist talked about are different, "and still better than I have."
It should be strictly monitored that the collection of necessary information does not turn into spying "in the keyhole". Also, the psychologist should resist the patient's attempts to "recruit" him in his allies against doctors, according to the patient, who do not understand and underestimate his condition.
Carefully collected history gives good information about the cause of the disease, the peculiarities of its symptoms, reflecting the development of the mechanisms of the disease, the internal model of the disease, the psychological discomfort of the patient in a state of illness.
Quite often the basis for the clinical diagnosis is psychological. Let us give an example from practice. S. V. Kharchenko, 1970. Education - secondary special. Profession is a nurse.
Diagnosis: impaired vision functions of grade III-VI, diabetes after psychotrauma. During the collection of psychodiagnostic anamnestic information, it was possible to find out that the visual impairment is a consequence of diabetes mellitus, which appeared in 1983 as a result of a psychotrauma - the death of a brother (drowned at the age of four). Psychological history includes:
- complaints of the patient;
- subjective and objective data on the cause of the onset and development of the disease;
- information on the order of occurrence and development of the disease;
- data on the development of the individual before the disease (biological, psychological and social);
- information about a family history;
- detailed information about the patient's condition in the situation of the disease (biological, psychological and social);
- data on the nature of work and various circumstances of life (social, personal).
It is necessary to find out: changes in the patient's place of residence in a geographical aspect, revealing the presence of a regional pathology; participation in hostilities; participation in the elimination of accidents at nuclear power plants, in areas of natural disasters, etc.
Information about the initial symptoms, as well as the cause of the neurosis, is obtained mainly from the patients themselves, about the behavior and experiences of the researcher in the immediate environment - from relatives living with the patient. This information, in spite of their value, is only additional information. Often, additional psychodiagnostic information is collected after an objective examination: they supplement missing information on the causes and conditions of the onset of the disease (especially often additional information is collected in trauma to the nervous system, craniocerebral trauma, after a stroke).
However, you should not get involved in collecting a lot of additional information. The better the psychological history is collected at the first meeting, the less the additional information is needed and the more their psychodiagnostic value. Undoubtedly, the details of psychological and anamnestic information are justified in connection with the emergence of a diagnostic hypothesis: it is usually conducted after the comparison of psychological and anamnestic information with the results of an objective examination of the patient.
It is better to start the interview with a patient, where the psychologist not only learns the name, patronymic, age, profession, family status and position of the patient, but also names his name and patronymic, and also explains the reason for staying in this room patient. Having received the passport data of the patient, the psychologist in the course of the study refers to him only on behalf of the patronymic, and ns by last name. In order to establish contact with the patient, you can ask him about the present and past residence, about where he spent his vacation, etc.
There are two ways to obtain information about complaints: the patient himself tells about them or answers the leading questions. More often, these methods are used together.
When collecting a psychological history, you should start with leading questions: "What made you turn to a psychologist?" (if the coming to the psychologist is the patient's own desire) or "Why do you think your doctor referred you to a psychologist?" (if coming to a psychologist is dictated by the requirement of doctors). Most often the patient talks about his poor or worsened state of health, and the psychologist should explain to him that he "does not cure and does not prescribe drugs". The position of the psychologist in this case must be unambiguous: the problem with which the patient turned, has a psychological character, and its solution depends, first of all, on the patient's desire to solve it. To clarify the direction of the problem is the task of the psychologist. If after this the patient independently, consistently and clearly states his complaints, then he should not be interrupted. Questions should be asked only if the patient is confused, his confused story and inability to find the right words: the psychologist should tactfully ask several questions that are professional from the professional point of view.
It is important for a psychologist to develop the ability to quickly find questions that specify the data of a psychological anamnesis. In such matters there should be no certainty in a certain answer, for example: "Do you have a bad memory?" Are you dizzy? "Do you often feel bad, feel weak?" etc. Only after receiving the answer can you ask clarifying questions: for example, with a positive answer about bad memory, the psychologist should specify in what and how often it manifests itself, reveal the depth and frequency of forgetfulness, etc.
When describing neurosis-like and psychic stress conditions, it is necessary to delicately reveal their cause, taking into account the individual reactions of patients to this information. It must be remembered that prolonged emotional overstrain (worries, insecurities in oneself or in ones close to oneself, sick self-esteem, unsuccessful family life, dissatisfaction with work, etc.), as well as intellectual and emotional stress (for example, work as a driver) various neuroses.
The greatest caution should be shown with patients who participated in wars and liquidation of extreme situations and natural disasters. Such people are most vulnerable if it comes to memories that can lead a patient out of balance and make the situation of communication frustrating for him.
You should not avoid contact with the patient, even if, according to relatives, he is not sociable, hardly responds to others, he can talk, etc. You can not substitute information gathered during a conversation with such patients, information obtained from those who accompany the patient to a commission. You can always find a way to communicate: the patient can answer movement of the head, writing on paper, moving the eyes, etc. The psychologist should find an approach to each patient.
Let's give an example. V. V. Fomin, born in 1964. Education is an unfinished secondary. Unemployed. Diagnosis: partial atrophy of the optic nerves, hypertonic symptomatology of the retina of both eyes. Social anamnesis: the patient does not work since 1995; considers himself incapacitated; lives with his wife, but is divorced; has two children (9 and 14 years old) who help him; from the words of the patient, the wife wants to get rid of him, but he has nowhere to go: his mother died, his father lives very far away, in a small apartment; Friends are visiting; drinks. Psychodiagnostic anamnesis: in the course of the study behaved aggressively; there is a sharp change in mood; on any psychodiagnostic research reacts negatively; the examination of the patient was hampered by the inability to use visual techniques, so only verbal versions of the work were used: "Comparison of concepts", "Simple analogies", "Identification of common concepts", "Character traits and temperament (CHT)", Extroverts etc. In addition, the patient refused to investigate the letter. For additional psychodiagnostic anamnesis, a statement written by the patient was used.
Information relating to anamnesis of life is an important part of the preparation of the hypothesis of diagnosis. They should be fixed in the psychological map purposefully, from the point of view of revealing the pathogenic role of living conditions, especially those that are important for establishing the etiology of the disease.
Of great importance are the information on the professional specifics of the work for at least the last 10 years. At the same time, it is necessary to evaluate the nature of the work, all the tension, and the frequency of switching from one task to another. Disturbances in the rhythm of rest, overexertion of attention, the need for frequent inhibition of emotions, prolonged intellectual tension are revealed. It should be noted whether work is related to occupational hazards.
Analysis of biographical information and observation of the patient's behavior (facial expressions, gestures, manners, speech culture) allow the psychologist to make a definite idea of his intelligence, character and mental state.
The methodology of collecting a psychological history is improved with the growth of psychological experience, with the development of logical thinking. The business and professional qualities of a psychologist, his operational skills are the result, first of all, of his own integrity, his growth and, last but not least, his ability to expand a person's sense of belonging to a sick person. Thanks to this, a dialectical balance between belonging to another and a sense of one's own individuality becomes possible.
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