Psych History

Question 1

Preparation beforehand

Answer 1

Opening will depend on your setting
How are you
How are you feeling today

Ask how would they like you to address them
Set out your role, length of interview and your focus
Ask if you can take notes and explain what happens to your notes
Inform them that they are not obliged to talk about topics that they don’t feel comfortable to discuss
Mention that you are working with the team and will need to share important info with them

Question 2

Presenting complaint

Answer 2

Focuses on ICE

• demographic summary
• mode of presentation to headline PC

Question 3

History of presenting complaint

Answer 3

When did it start?
Chronology of symptoms and issues
-explore symptoms in the same way as a traditional history
Precipitating, perpetuating, protective factors
Impacts on functioning
Patient’s strengths and solutions attempted so far
Why presenting now?

Can use questions in PHQ9, GAD7 to guide questions

Question 4

Asking about suicidal thinking

Answer 4

Include a brief normalising statement (we ask everybody this)

Question funnel

• how do you feel about the future
• do you ever feel that life is not worth living
• do you ever feel completely hopeless
• do you ever feel that you would be better off dead and away from it all
• have you made any plans
• have you come close to ending your life? what stopped you?
• how likely is it in the immediate future that you may do something

Question 5

Asking about psychotic ideas

Answer 5

Brief normalising statement

Explore connections that the patient makes but you cannot follow - you said x => y, I can’t quite follow the connection, please help me understand

Gently reality test and measure conviction but do not confront

Don’t say ‘you think’ because this is what they know

Question 6

Past medical history and medication

Past psych history

Answer 6

Any medical conditions

• past hospital admissions, surgeries
• any history of epilepsy, head injury?

Past admission, duration, treatments
-what worked
Past diagnoses and episodes
Self harm - dates, patterns

Allergies?
Prescribed meds, compliance
OTCs
Recreational drugs?
Smoking
Alcohol - try to work out units
-AUDIT tool

Question 7

Family history (nature)

• genogram
• psychiatric

Answer 7

Establish who the family members are - genogram

• name, ages of children
• aunts, uncles, grandparent
• causes of death
• any MH issues

Early onset disorders = more likely to be genetic
-some disorders are likely to cluster

Question 8

Personal history

• childhood
• schooling

Answer 8

Place of birth, nationality
-did they move, why?

Family life

• ACEs?
• parent personalities and relationships
• adoption/fostering
• parental conflict/divorce

Ask in context

• atmosphere at home
• how was discipline at home
• did anyone do anything to harm or hurt you

Type of school/age of leaving/qualifications
Bullying, self behaviour

Question 9

Personal history

-psychosexual

Answer 9

Developmental milestones if relevant

Sexual experiences

• sexually active, frequency, sex of partner, no of partners
• sexual trauma, rape, FGM,

Marital status

• marriage, civil partnerships, divorce, cohabitation?
• voluntary/forced?

Question 10

Personal history

-social

Answer 10

Accommodation

• type
• who they live with

ADLs
-do they require help with housework, shopping, cooking, cleaning, self care?

Social networks/hobbies and interests
-do they have a network of support

Type of work, duration, reason for leaving
If unemployed, why?
Financial situation
-source of income?

Question 11

Personal history

-forensic history

Answer 11

Any past interactions with the polic

• date and type of offence
• court, prison, probation?

Question 12

Premorbid history - lifelong persisting characteristics and coping styles prior to current illness

Answer 12

How would others describe you?
What are your strengths, what do you struggle with?

Possible traits

• glass half empty/full
• worrier, anxious
• ruminative, obsessional, perfectionism, self critic
• can master situations/prone to feeling helpless
• prone to anger and conflict?
• coping strategies

Question 13

Collateral history

Answer 13

Provide insights into psychiatric problems
Depression
-undisclosed risk behaviours, solutions
Anxiety
-undisclosed safety behaviours and compuslsions
Psychosis
-past illness and risks
Dementia
-extent of short term memory issues
Personality disorders
-impact of behaviours on others, emotional states, difficulties interacting with others

Question 14

Pressure of speech

Answer 14

Patient talks very fast, cannot interrupt

-flight of ideas

Question 15

Feeling sad

Answer 15

Depression
Trauma
Impacts of a physical condition

Question 16

Somatic symptoms of mood disorder

Psychotic symptoms - your experience on reality is very different from others

What are their thoughts like

Narrative

What is their support system like?

Suicidal thoughts?

Answer 16

Poor quality of sleep
Appetite
Weight
Enjoyment - anhedonia
Energy levels

False beliefs
2nd person voices?
Depersonalisation derealisation?
Feel like a failure, burden,
'Some people people feel like they've failed, have you had this experience?'

Timeline associated with symptoms

Would they be safe to go home after discharge?
-coping strategies (alcohol/drug use?)

Can frame it as a ‘this is a question we ask everyone’ or slowly build up to the question
Have you ever thought of hurting yourself?
Have you ever had suicidal thoughts?

Question 17

Past medical history

Answer 17

Mental impacts of physical conditions

• hypothyroidism
• dementia, PD
• head trauma
• post partum depression (can be 2-3months post birth)
• post partum psychosis (can be within 1wk post birth)

Medications

• sedatives
• steroids
• lithium and kidney function

Question 18

Personal history

• FHx
• pregnancy and birth
• school
• occupations
• relationships

Answer 18

FHx of psychiatric history (bipolar, schizophrenia)
Relationship/structure of family => genogram
-parent occupations

Pregnancy, birth - any complications?

• developmental milestones? (autism?
• was their childhood a happy or difficult time? => ask them to elaborate but give them an out if this is too difficult for them
• has anyone touched you in a way that made you uncomfortable? => how old were you, was it someone you knew?

Relationships with other people
Academic attainment - any changes over time? Expectations of others?
Self identity, esteem
Disrupted schooling due to family logistics

What was their best job - what are they like at their best, when was this?
What was their longest job - has their condition affected their functioning

Stability in relationships - protective factors?

Question 19

Social

• environment, housing
• finances
• support network
• day to day life
• drugs and alcohol
• forensic

Answer 19

Who’s at home with them
-do they have children, caring responsibilities - would they like additional support for their child

Forensic
-any trouble with the police?

Question 20

Premorbid personality

Answer 20

What were they like before they were unwell?