History Questions

Question 1

Mood symptoms - Elation (Detailed)

Answer 1

• How have you been feeling lately? Have you been feeling extremely happy?

Grandiosity

• Do you feel particularly confident like you are on top of the world?
• How do you see yourself compared to others? Do you feel you have any special powers/purpose?
• Have you had any spiritual experiences recently or contact with a higher power?

Flight of Ideas/Pressured Speech

• Do you finds your thoughts racing?
• Are you talking more quickly than normal? Do people comment on this?

Increased Energy

• Do you have more energy than usual?
• Are you sleeping less than you usually would?
• Have you had any new projects or ideas recently?

Risk

• Have you been in trouble with the police or your family recently?
• Have you been doing risky things you would not usually?
• Who is at home with you? Any children?
• Have you been spending more money?

Psychotic Symptoms

• Have you been recieving any special messages?
• Have you had any unusual experiences lately?
• What happens when people annoy you?

Question 2

Mood symptoms - Depression (Detailed)

Answer 2

• Have you been feeling low or depressed in mood recently?
• Has this been every day for most of the day over the last two weeks?
• Can you tell me how this has been affecting you?
• Does your mood change as the day goes one?
• On a scale of 1-10 where would you rate your mood?

Anhedonia/Motivation/Libido

• Have you been able to enjoy things you usually would?
• What have you stopped doing?
• Has there been any change in your sex drive?

Anergia

• Have you been feeling more tired than you would usually?
• Has this stopped you doing things? Work/ADLs? Pleasure? Caring for others?

Concentration/Memory

• Have you had any difficulties concentrating on things?
• Are you abe to follow a film or book?
• How has your memory been?

Appetite

• Have you noticed any changes in your appetite since you’ve felt this way?
• Has this affected your weight?

Sleep

• Have you noticed any changes in your sleep?
• Is it difficult to fall asleep? Do you sleep through the night? Do you wake up early?

Hopelessness/Guilt/Helplessness

• How do you see the future?
• How do you feel about yourself as a person?
• Why do you think you’ve been having such a hard time lately?
• Do you feel guilty or to blame for anything?
• Is there anything you could do to improve the situation?

Suicidality/Risk

• It seems you have been having a difficult time recently, have you had any thoughts that your life is not worth living?
• What thoughts have you had?
• Have you taken any steps to prepare?
• What is stopping you?
• Have you found yourself using any substances to make you feel better? - ETOH/DRUGS

Question 3

Eating Disorders - Detailed Hx

Answer 3

• How do you feel about your current weight?
• Are you trying to lose weight at the moment? How?
• What are the rules to your weight loss plan?
• How do you feel about your body?
• Do you ever lose control and binge? How often? What do you eat?
• How do you manage the social side of eating?
• What do your friends/family think?

Physical problems

• How is your physical health at the moment?
• Have you had any: loss of libido, dizziness, weakness, sensitivity to cold, lack of periods, digestion issues?

Psychosocial screening

• What effect has this had on your life? education, career, relationships

Question 4

Suicidality - Screening

Answer 4

• How do you feel about the future?
• Have you ever thought that life is not worth living?
• Have you ever wishes you didn’t wake up in the morning?
• Have you had thoughts about ending your life?
  
  • Are these fleeting or more prolonged? Are they increasing?
• Have you thought about how you would do it?
• Have you made any preparations?
• What is stopping you from doing it?
• What might push you to act on it?
• Have you told anyone about these thoughts?
• Have you tried to take your own life in the past?

Question 5

Body Dysmorphic Disorder

Answer 5

• What is the problem?
• Are you convinced? Might it be normal
• What have you read/researched about it?
• How much time do you spend looking or worrying about it?
• What steps have you taken to hide it?
• What steps have you taken to fix it?
• What are you future plans?
• Hypochondriasis/somatization/bulimia screening

Question 6

Alcohol Use

Answer 6

• Could you please talk me through how much you’re drinking per day? (Ideally work out the units per week)
• Any more on the weekend?
• How long have you been drinking this much?

Dependency

• Difficult to control the amount you drink after you have started?
• Craving drinks in between sessions?
• Needing to drink more over time to get the same effects?
• Get sweats and shakes if you miss a drink or first thing in the morning?
• Does it worry you that Alcohol may be causing you some harm?
• Is alcohol taking increasing priority over other things in your life like leisure activities/friends etc.?

Impact

• Who is at home with you? Does it affect your relationship with your wife/children? (DV)
• Does it affect work?
• How are finances?
• Trouble with police?
• Driving?
• Physical health consequences?

Question 7

Anxiety (GAD/Phobias) - (detailed)

Answer 7

• Have you been feeling particularly anxious recently?
• Would you describe yourself as an anxious person?
• Any clear precipitating event/cause?
• Do you worry about things you should not worry about?
• How long have you been feeling like this? (>6 months for GAD)
• Do specific situations or thoughts trigger anxiety?
  
  • Social - centre of attention? doing something embarassing? fear of public speaking?
  • Agoraphobia - not being able to escape from a situation? Crowds? Specific environments?
  • Specific phobias?
• Are there situations you avoid due to anxiety?
• Do you feel anxious all the time or does it vary?
• What symptoms do you have when you are anxious? How does it feel?
• Do you feel jittery/irritable/on edge?
• Do you have panic attacks (sudden onset, 30-60mins, impending doom and +++ physical symptsoms)
• Do you use alcohol or drugs to manage your anxiety?
• What impact is it having on your life?
• What is your sleep like?
• Do you have difficulty concentrating?
• Screen for depression/suicidal thoughts/trauma/OCD

Question 8

Anxiety - OCD

Answer 8

Obsessions

• Do you have thoughts or worries that keep bothering you?
• Do they keep coming into your mind even if you try not to think about them?
• How much of your time is occupied with obsessive thoughts?
• How do they make you feel? Do they distress you?
• How much control do you have over them? Can you resist them or distract yourself?
• Where do these thoughts come from?
• Are they true?
• What do you do to manage the anxiety they cause?
• How much does this interfere with your ability to get on with your life?
• Do you avoid any situations because of them?

Compulsions

• Do you every spend time doing the same thing over and over again?
• Do you have any mental rituals to neutralise bad thoughts?
• How frequently and for how much time?
• What purpose does it serve? Does it make you feel less anxious? Is it linked to a specific thought?
• Do you try to resist doing these rituals? Can you control doing them?
• What happens if you do not do them?
• How much do these interfere with your ability to get on with your life?
• Would you say you have always been an obsessive person?
• Are you a superstitious person?
• Hoarding? Lucky numbers?
• Screen for substance use/depression/suicidality

Question 9

Anxiety - PTSD

Answer 9

Intrusion symptoms:

• Could you describe the event? (ask first if this is okay or too difficult)
• How often do you think about it?
• Do thoughts about it come into your mind intrusively when you don’t want to be thinking about it?
• Do you have nightmares about the event?
• Do you have flashbacks of the event?
• Do you ever relive the event?
• Do you have difficulties remembering the event?

Avoidance:

• Do you find yourself avoiding places/people/activities associated with that memory?
• Have you been back to the place where the event took place?
• How hard is it to talk about the event?

Alterations in arousal:

• Since the event do you feel more on edge much of the time?
• Are you easily startled?
• Have you been feeling irritable?
• How is your sleep?
• How is your concentration?

Cognition and mood:

• How has this affected your life?
• How does it affect how you feel? Do you ever feel numb?
• How have your relationships been effects?
• How do you see the future?
• Do you feel guilty for what happened?
• Has your interest in activities been affected?

Question 10

Personality Disorder - Screening

Answer 10

• In general, do you have difficulty making and keeping friends?
• Would you normally describe yourself as a loner?
• In general do you trust other people?
• Do you normally lose your temper easily?
• Are you normally an impulsive sort of person?
• Are you normally a worrier?
• In general do you depend on others a lot?
• In general are you a perfectionist?

Question 11

Psychosis - Detailed

Answer 11

• Have you had any unusual experiences recently?
  
  • Can you give me some examples?

Hallucinations

• Have you had any unusual sensations recently?
• Have you hears any strange noises or voices?
  
  • Do they sound like someone speaking to you from outside your head?
  • Who is speaking? One or more?
  • What do they say?
  • Do they talk directly to you or about you?
  • Do they describe what you are doing or thinking?
  • Do they ever tell you do things?
  • How much do you hear them?
  • How does it affect you?
• Have you seen anything thats hard to explain? Animals/figures?
• Have you had any strange sensations in you body, smells or tastes recently?
• When did these start?

Delusions

• Do you feel that anyone has been making life difficult for you or trying to harm you?
• Do you feel like anyone is spying on you or following you?
• Who are they and why are they doing this?
• Do you feel you have any special purpose in life?
• Have you been getting any special messages for you in T.V./radio or out in the world?
• Do you feel in control of your thoughts? Can anyone put thoughts in or take them out of your mind?
• Do you ever feel that other people can know what you are thinking?
• Do you ever feel like your actions or feelings are being controlled by comeone else?
  
  • What do they make you do?
  • Can you resist them or do you have to do what they want?
  • Do they ever make you doing anything to harm yourself or others?
• When did these thoughts start?

Conviction

• Why do you think this is happening to you?
• Do you know for sure these events are real or could there be something else going on?
• What you your friends/family think?

Risk

• Do you ever get angry? What might you do to the people making your life difficult?
• Is this situation so difficult that you ever think about ending your life
• Are you ever told or made to do things that are dangerous to yourself or others?

Question 12

History Following Self-Harm Attempt

Answer 12

• Can you tell me what happened?

Before

• How long have you been planning this?
• What preparations did you make? Did you buy things for the act? Did you put your affairs in order?
• Did you tell anyone about these thoughts?
• Were you alone at the time? Did you do anything to make sure you wouldn’t be interrupted?

During

• What did you do?
• If tablets - how many? of what? everything they had?
• Did you take any alcohol or drugs before or during the event?
• What did you think would happen? Did you expect to die?
• Did any part of you want to live
• How were you discovered? Did you seek help youself?

Now/Future

• How do you feel about what happened?
• Do you regret anything?
• Has anything changed for you between now and then?
• How do you see the future?
• Do you plan on doing something like this again?
• If not what will happen if x trigger occurs again?

Risk

• Have you ever tried to harm or kill yourself before?
• Have you ever been seen for a mental health problem by a professional?
  
  • History of depression?
• Do you have anyone who you can talk to about your worries? Who is at home with you?
• Is there anything going on in your life that is causing you a lot of stress/worry? Relationships/finances/work/health?
• Screen for depression/substance misuse

Question 13

Frontal Lobe Assessment

Answer 13

Verbal fluency

• Can you say as many words beginning with the letter F in 1 minute?

Abstract thinking

• Can you explain the proverb ‘a stitch in time saves nine’
• Can you explain the similarities between an apple and an orange?
• Can you tell me the approximate distance between London and Manchester?

Judgement

• If you found a letter on the floor with a stamp on it what would you do?

Coordinated movements

• Please have a look at this diagram (alternating sequence of squares and triangles) and then copy for me
• I am going to show you a sequence of hand movements (fist, then edge of palm then hand flat on table, please could you follow and repeat after me.

Response inhibition

• Please place your index finger on the table, raise it once when I click once but do not if I click twice.
  
  • Now the opposite

Reflexes

• I would like to test your reflexes - tap between eyebrows, stroke palm, tap on lips