History Taking Flashcards
Mental illness causes disturbances in what 4 areas?
Thoughts
- Preoccupations
- May be based on perceptual changes
Perception
- Hallucinations
Feelings
- Emotions/mood/affect
Behaviours
- Avoidant
- Compensatory
- Overactive
- Bizarre
What is used as diagnostic tool for patients in the UK?
ICD 10
Apart from PC and HPC (Including ICE), what else do you need to ask in a psych history? - 9
Past Psych History
PMH
Medication
Family history
Personal history
Social circumstances
Drug and Alcohol History
Forensic History
Pre-morbid personality
Q’s to ask someone you suspect has depression using the list of S+S:
- Low mood
- Appetite/weight
- Sleep disturbance
- Poor concentration
- Diurnal mood variation
- Loss of energy
- Loss of libido
- Psychomotor agitation/retardation
- Loss of interest/pleasure
- Worthlessness/guilt/hopelessness (COGNITIVE TRIAD)
- Recurrent thoughts of death/ suicide
Have you been feeling low and depressed?
How is your appetite?
How is your sleep? Do you have problems getting to sleep and wake up early?
Are you able to concentrate like you used to (at work for example)?
Do you feel worse at any particular time of day?
Do you feel more tired than usual?
Have you lost some of your libido?
Have you been more irritable or crying more?
Has anyone else around you noticed you slow down?
Do you still enjoy the things you usually do?
Do you have feelings of worthlessness/guilt/hopelessness?
Do you have any thoughts of commiting suicide?
Q’s to ask someone who could be suicidal?
What are your thoughts about the future?
Do you ever feel that life is not worth living?
Do you ever feel like acting on these thoughts? Ending your life?
Have you thought about how you would go about it? Have you taken any steps yet (e.g. bought tablets/rope, depending on plans)
? suicide note
? Steps taken to put affairs in order, e.g. will/ funeral
What factors would protect you/keep you from acting on these thoughts
Q’s to ask someone who could be manic?
Do you feel you have more energy than normal?
Are you having less sleep than normal?
Can you concentrate on things?
Are you having difficulty settling?
Are you spending more than usual?
Are you more interested in sex (with different, inappropriate people)
Q’s to ask someone who could be psychotic:
How can you ask about persecutory beliefs?
How can you ask about thoughts?
How can you ask about hallucinations?
Has anything odd/unusual been happening recently?
What actions do you feel you need to take?
Do you feel your thoughts are being interfered with?
Do you feel anyone is controlled you?
Do you feel anyone is putting thoughts into your head?
Do you hear voices when there is no one there?
What do they say?
Do you see things that others cannot?
Q’s to ask someone who could have obsessions?
Any odd thoughts?
Recurring intrusive worries
Note behaviour - e.g. excessive hand-washing
Q’s to ask someone who could have anxiety?
Any worries/anxieties?
Are you always worried or does it happen in discrete attacks?
What causes this?
What physical symptoms do you get?
How do you manage your anxiety?
Q’s to ask someone who could have an eating disorder?
What are you currently eating?
How do you feel about your weight?
Are you dieting?
Q’s to ask someone to assess risk?
Are you wanting to harm anyone?
Yourself?
have you stopped caring about yourself? (dressing, washing, eating, drinking
Past psych history - Q’s to ask?
What other part of their history do you need to ask about?
Previous diagnoses/symptoms
Has the patient ever been in
hospital/SECTIONED before?
How many times?
What happened?
Was it useful?
Does the patient get any community support?
What treatments have they tried in the past? – Were these helpful?
Their medical Hx
Drug Hx - Q’s to ask?
What is another thing to ask the patient especially if they have a history of schizophrenia?
Allergies and intolerances?
What medications is the patient prescribed?
Medication side effects
Are they taking their media - medication compliance
FH - Q’s to ask?
It’s also a good idea to ask about physical health problems that run in the family too. Why?
What do you ask apart from mental health that runs in the family?
What can be used to track back FH?
Antipsychotics increases your risk of CVD so it is important to ask about CVD Hx in the family.
Dementia
Drug and alcohol problems
Suicide
Genetic/neurological disorders - Huntington’s)
Genogram
Personal Hx:
Q’s to ask about childhood -5
Q about later in life? - 3
Birth and development - any difficulties in pregnancy/labour? - did anybody say you were slow to walk/talk?
Anything particularly traumatic or significant happen to you as a child?
Were you at home with parents and siblings?
Any trouble at school including making friends/bullying/suspension?
Relationships and sex - status, sexual orientation, the impact of mental illness.
Any major stressful events in your life?
Children - names, age, and any social service contact
Social History:
Q’s to ask? - 3
(1) Housing - where, what type (private/social)
Who do you live with?
(2) Work
(3) Finances
Drug and alcohol Hx:
Q’s for alcohol
What tool can you use to assess further risk?
How much alcohol do they drink?
What type of alcohol?
When did they start drinking?
How is their alcohol use affecting their life?
AUDIT C tool - used to work out how much alcohol they are drinking
Drug and alcohol Hx:
Q’s for illicit drugs
Do they take any illicit drugs?
Do they abuse any prescription drugs?
What do they take and by what route?
How often?
Have they taken anything else in the past?
How is their drug use affecting their life?
Are they using safe practices? (e.g. needle exchange schemes)
Are they interested in stopping?
Drug and alcohol Hx:
Q’s for smoking
What do they smoke?
How many per day?
When did they start?
Do they want to quit?
What is forensic history?
Why is it done?
Has the patient ever been in trouble with the police?
Have they ever committed a crime?
Useful to assess risk of violence towards others?
Premorbid personality Q’s
How else could this be obtained?
What was the person’s personality like before they were unwell?
How would they describe themselves?
How would their family and friends describe them?
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Through a collateral Hx
