History Taking Flashcards
What are the 2 fundamental components of psychiatric interviewing?
Collection of clinical data
- Taking a clinical history
- Examining the mental state
Intuitive understanding of the patient as an individual
- Empathy
- Descriptive psychopathology
What is important to ensure about the setting of the interview?
- Privacy
- Minimise chance of interruptions
- Informal setting, avoid barriers
- Easy exit for the physician
What safety/risk assessment can be done for the interview?
- Inform staff who you are going to interview and where
- Identify change in behaviour throughout interview
What sections should you cover when taking a history?
- Presenting complaint
- History of presenting complaint
- Past psychiatric history
- Past medical history
- Current and recent medications
- Social history
- Family history
- Personal history
What is important to cover in the introductions during a psychiatric interview?
- Greet verbally and introduce yourself
- Orientate and check the purpose and likely duration of the interview
- Let them know you wlll be taking notes but you will respect confidentiality
What general skills can be adopted for the interview?
-Eye contact
-Relaxed, non-threatening posture
-Use facilitative noises
-Pick up on non-verbal cues
-Control over talkativeness
-Do not offer advice or opinion too early
Clarify and summarise
What are the advantages of asking open questions?
- Allows patients to start talking about themselves and puts them at ease as they have the floor
- Allows you time to think and plan areas of questioning as you assess their style and content of their response
- Allows a period of non-verbal response from interviewer, listening and facilitating
What are the main objectives of the psychiatric interview?
- Form rapport and gather information
- Establish and explore symptoms in context of personality and circumstances
- Explore possible biological and social factors related to the symptoms
- Inform and motivate patient
- Examine mental state
- Begin formulation
How should you deal with a patient’s presenting complaint?
- Record each presenting complaint in their own words
- List the main ones and then deal with each individually
What should you enquire about with presenting complaint?
- Clarify each complaint in turn
- Onset, precipitants, course, severity
- Associated symptoms, effects on daily living
- Is it getting worse or better?
- Has it responded to any treatment?
How should you explore psychotic symptoms: percepts?
- “Have you seen or heard anything that other people have not been aware of?”
- “Have you heard any people talking when there was nobody around?”
- What do they think is causing them?
- Does it seem possible?
- Beware of commands
How should you explore psychotic symptoms: beliefs/thoughts?
- “Has anything particular been playing on your mind?”
- “Do you know why is this happening?”
- “Have you noticed any change in your thoughts?”
- “Has anyone interfered with your thoughts?”
- “Does anyone else have access to your thoughts?”
What should be explored in the past psychiatric history?
- Past episodes/ diagnoses / contacts
- Previous treatments (psychological, drug and physical)
- Inter-episode functioning
- Previous admissions to hospital
- Attempted suicide/ repeated DSH
- Previous detentions under Mental Health Legislation
What should be explored in the family history?
- 1st degree relatives mental health
- Age, employment, circumstances, health problems, quality of relationship
- Major mental illness in more distant relatives is important
What should you explore in past medical history?
- Developmental problems
- Head injuries
- Endocrine abnormalities
- Liver damage, oesophageal varices, peptic ulcers
- Vascular risk factors
What should you explore in current and recent medications?
- Tablet and injections
- Recent medications
- Any discontinued drugs (within past 6 months)
- Duration and dosage
- Adverse reactions and allergies
What should you explore in social history?
- Social circumstances including occupation
- Current financial situation
- Smoking/ alcohol/ illicit drug use
- Current relationship
- Children (contact)
What must you try to find out if there is alcohol or illicit drug misuse?
- Regular or intermittent
- Amount (know the units)
- Pattern
- Dependence/ withdrawal symptoms
- Impact on work, relationships, money, police
- Screening questionnaires eg CAGE
What should you explore in personal history?
- Developmental milestones
- Early life
- Schooling
- Occupational
- Relationships (sexual & marital history)
- Finances
- Friendships, hobbies and interests
What is important to explore if asking about a forensic history?
- “Have you ever been in contact with the police? Charged with any crime?”
- Offences including sentences
- Recidivism
- Particular attention to violent or sexual crimes
What is important to know about pre-morbid personality?
- Emphasis on consistent patterns of behaviour, interaction and mood
- Importance of corroboration
What are the components of a mental state examination?
- Appearance
- Behaviour
- Mood
- Speech
- (Abnormal) thoughts
- (Abnormal) beliefs
- (Abnormal) percepts
- Suicide/homicide
- Cognitive function
- Insight
What can be noted about a patient’s appearance?
- Height/Build
- Clothing - appropriate/inappropriate, kempt, bizarre
- Personal hygiene - clean/unshaven/malodorous
- Make up, jewellery, accessories
