History taking principles

Question 1

In what order should you take a psychiatric history?

Answer 1

BASIC DEMOGRAPHICS - name, DOB, pronouns, occupation, housing, marital status
PRESENTING COMPLAINT - pt.’s own words
HISTORY OF PRESENTING COMPLAINT - expand on symptoms, screen for other symptoms, RISKS, effect of problem on work, relationships
PAST PSYCHIATRIC HISTORY - happened before? previous admissions / therapy? previous self-harm / suicide attempts?
PAST MEDICAL HISTORY - check for epilepsy, head injury, include DHx
FAMILY HISTORY - health, occupation, relationship
PERSONAL HISTORY - birth + childhood, education, employment, relationships
SOCIAL HISTORY - housing, typical day, relationships, finances, hobbies, driving
SUBSTANCE MISUSE - smoking, alcohol (CAGE), illicit drugs
FORENSIC HISTORY - convictions, Hx of violence, drink-driving
PRE-MORBID PERSONALITY - mood, character, stress reaction, hobbies
COLLATERAL HISTORY

Question 2

What are the 5 Ps?

Answer 2

Presenting problem - beyond diagnosis ie how it’s affecting the patient
Predisposing factors - biological, environmental, genetic, personality risk factors
Precipitating factors - significant preceding events
Perpetuating factors - maintaining current difficulties
Protective factors - positive support and strength systems