[1] Psychiatric History Taking

Question 1

What are the major differences between taking a psychiatric history and a medical history?

Answer 1

The social history, past psychiatric history, and developmental history are covered in more depth

Question 2

What areas need to be covered in a psychiatric history

Answer 2

1. Reason for referral
2. Presenting complaint
3. ICE
4. Past psychiatric history
5. Past medical history
6. Drug history
7. Family history
8. Personal history
9. Social history
10. Pre-morbid personality

Question 3

What are the important components of the introduction in psychatric history taking?

Answer 3

• Introduce yourself in full, including name and role
• Explain the purpose of the consultation, and how long you have to interview the patient
• Gain consent to take the history, and ask permission to take notes

Question 4

What information about the reason for referral should you obtain?

Answer 4

• When was the patient admitted?
• Why was the patient admitted
• Who was involved in the patients admission, e.g. GP, A&E, police, social worker
• Is the patient in hospital voluntarily, or detained under the mental health act

Question 5

What information about the presenting complaint should be obtained?

Answer 5

• Onset
• Seveirty
• Duration
• Progression/fluctuations
• Precipitating events
• Aggravating and relieving factors
• Associated symptoms

Question 6

What associated conditions should be screened for when taking a psychiatric history?

Answer 6

• Depression
• Psychosis
• Suicidal ideation

Question 7

What specific symptoms should be asked about in suspected depression?

Answer 7

• Low mood
• Anhedonia
• Anergia

Question 8

What specific symptoms should be asked about in suspected psychosis?

Answer 8

• Delusions
• Hallucinatinos
• Auditory hallucinations

Question 9

What should you ask about auditory hallucinations when taking a psychiatric history?

Answer 9

Are they talking too the patient (second person), about the patient (third person), or commenting on what the patient is doing (running commentary).

Need to know if there are any command hallucinations, and if so, if they can resist them

Question 10

What specific symptoms should be asked about in suspected anxiety?

Answer 10

• Generalised anxiety
• Panic attacks
• Phobias
• Obsessions

Question 11

What information about the past psychiatric history do you need to obtain?

Answer 11

• Have their been any problems similar to the presenting complaint in the past?
• Previous or ongoing psychiatric diagnoses
• Dates and duration of previous episodes of mental illness
• Whether or not the Mental Health Act was ever implemented
• Details of previous hospitalisation and treatment, including medications, psychotherapy, and ECT. Ask about response to treatment and side effects

Question 12

What information about the past medical history do you need to obtain?

Answer 12

Any current or previous medical illnesses, or any past surgical procedures. Ask particularly about head injuries and previous cranial surgery, neurological conditions e.g. epilepsy, and endocrine abnormalities e.g. thyroid disease

Question 13

What information about the drug history do you need to obtain?

Answer 13

Any medication that patient is using, both prescription and over the counter. Ask specifically about psychotropic medication, and whether the reported medication helped symptoms or caused side effects

Enquire abour allergies, and the nature of any allergies

Question 14

What information about the family history do you need to obtain?

Answer 14

• Presence of psychiatric illness in family members
• Quality of family relationships, including parents, siblings, and other significant relatives
• Brief medical history of the family

Question 15

What are the aspects in the personal history?

Answer 15

• Early childhood
• Education
• Employment
• Relationships
• Forensic history

Question 16

What information about the early childhood should be obtained?

Answer 16

• Antenatal and intrapartum complications
• Developmental milestones
• Childhood illness
• Childhood psychiatric illness - were they unusually aggressive, or struggled with social interaction
• Family dynamics - were their parents married, do they have any siblings
• Home atmosphere
• Childhood abuse

Question 17

What information about education should you obtain?

Answer 17

• Did they attend mainstream or specialist school
• Did they enjoy school
• Were they ever bullied at school
• Were they ever told they had behavioural problems at school
• Did they finish school
• Did they attend higher education, and what qualifications did they achieve

Question 18

What information about employment should you obtain?

Answer 18

• Chronological list of jobs
• Duration of work
• Redundancy, or personal choice to leave
• Work environment - relationship with boss and co-workers

Question 19

What information about relationships should you obtain?

Answer 19

• Sexual orientation
• Chronological account of major relationships
• Current relationships
• Any children? Relationships with children

Question 20

What information about forensic history should be obtained?

Answer 20

• Have they ever been charged with, or convicted of, any offences. If yes, what sentence
• Do they have any outstanding charges or convictions at present

Question 21

What information about the social history should be obtained?

Answer 21

• Current accommodation - state of housing, heating, living conditions
• Social support - friends and family
• Financial circumstances - any debts or benefits
• Hobbies or leisure activites
• Alcohol and substance misuse

Question 22

What information about alcohol and substance misuse should you obtain?

Answer 22

• How much alcohol in a day (units consumed) and type of alcohol
• Use of illicit drugs
• Drug names, routes of administration, and years/frequency of use
• Smoking status

Question 23

What is meant by premorbid personality?

Answer 23

An assessment of the patient’s personality and character before the onset of mental illness