Psych history taking Flashcards
What is the acronym for history of presenting complaint?
N- Nature
O- Onset
T- triggers
E- exacerbating/relieving
P- progression
A- Associated symptoms
D- Disability
Then ask also about what caused them to contact the psychiatric services
Key symptoms for depression?
Low mood
Lack of pleasure
Low energy levels
What are the associated symptoms with depression?
Disturbed sleep
Change in appetite/weight
Poor concentration
Lack hope/feeling guilty
What are questions to ask for mania/hypomania?
Changes in mood/energy levels (describe the change)
Problems with job/relationship
Appetite
Increased self esteem
Reduced social inhibitions
Spending recklessly
Inappropriate sexual encounters
Delusions
What are the questions to ask for GAD?
- Worrying a lot
- What things have been worrying them
- When are they most anxious
- Anxiety attacks
- Avoid things because of worry
What are the physical symptoms of anxiety?
Palpitations
Chest tightness
Breathlessness
Sweating
Dizziness
Dry mouth
Screen for co-existing depression
What are the 3 main symptoms of psychosis?
- Hallucinations
- Thought abnormalities
- Delusions
What are the questions to ask for psychosis?
Auditory hallucinations
Do you ever seem to hear noises or voices even when there is nobody about?
Have you been hearing voices? What are they like?
Visual hallucinations
Do you ever seem to see things other people cannot?
Have you had any visions or seen things other people could not see?
Thought insertion
Do you ever have the feeling that thoughts are being put into your mind that are not your own?
Thought withdrawal
Do you ever feel that your thoughts are being taken out of your mind?
Thought broadcast
Do you ever feel that your thoughts are not private to yourself; as though they are being broadcast so others can know what you are thinking?
Thought echo
Does a thought in your mind ever seem to be repeated over again, like an echo?
Do you ever hear your thoughts echoed out aloud?
Also ask about delusions:
Do you have thoughts that others tell you are false
What are the objective questions to ask for in a suicidal patient?
Exactly what was taken?
Where and when was it taken?
Was anyone else present?
Were any precautions taken to avoid discovery?
Was there a suicide note?
Was there any other act in anticipation of death? (e.g. making a will)
Was action taken to alert possible helpers after taking the overdose?
What are the subjective questions to ask in a suicidal patient?
What was the patient’s stated intent?
What was the patient’s estimate of lethality of the substances taken?
Evidence of recent / psychiatric illness, notably symptoms of depression or psychosis.
Is there a past history of psychiatric illness or self harm?
Is there any evidence of drug or alcohol abuse?
Recent precipitating life event?
Any family history of mental illness
Social support at home?
After history of presenting complaint what should be asked next?
Personal History
- Developmental milestones
- Early childhood development
- School performance
- Qualifications
- Work record
What are the questions to ask in OCD?
“Do you get repeated unpleasant thoughts or images coming into your mind?”
“
Do you get these thoughts entering your mind despite trying to keep them out?”
“Do you ever feel that you need to repeatedly check things you have already done?”
“Do you ever feel that you need to arrange, touch, or count things repeatedly?”
“Do you try to resist the thoughts or the urge to respond to them?”
What question is asked after personal history?
Social history
- Current accommodation
- Job
- Relationships
- Formal and informal carers
What to ask after social history?
Family history
- Get details of any past psychiatric problems or relevant medical conditions
What should be asked after family history?
Past psychiatric and medication history
