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
What else should be asked in a psychiatric history?
Forensic history/contact with criminal justice
Brief description of factors that can cause conditions
What are the screening questions in an alcohol history?
C- Have you ever thought you should cut down your drinking
A- Have people annoyed you by asking you to cut down
G- Have you ever felt guilty about drinking
E- Have you ever had a drink first thing or to get rid of your hangover (eye opener)
What to ask in a drinking history?
Start by asking the patient to describe a typical drinking day (begin with the morning
and proceed through the day) establishing what is drunk and when:
Establish if the first drink of the day is taken to combat withdrawal symptoms
Does the patient drink without getting drunk, or in bouts – usually at lunchtime
and the evening?
How much is drunk at each session?
Does a single drink always lead to many more, and the person generally become
drunk? If so, has this led to blackouts or falls?
Establish whether drinking takes place alone, and whether the person drinks
What are the questions to screen for alcohol dependence syndrome?
Primacy
Has alcohol become the most important thing in your life?
Would you say you devote more time to drinking than to other things in life?
Tolerance
Do you find that you have to drink more alcohol now to get the same level of
satisfaction that you used to get with fewer drinks?
Have you noticed any change in the effect that alcohol has?
Withdrawal
What happens if you don’t have a drink?
Sometimes, if people don’t drink for a while, they start feeling shaky, sweaty
and anxious. Does this ever happen to you?
Relief Drinking
If this does happen, do you find a drink will calm you down?
Craving
Do you ever find yourself craving alcohol?
Narrowing of Repertoire
What do you drink?
Do you find that you always drink the same things?
Stereotyped Drinking Pattern
Do you tend to drink at a set time / place / alone or with others? Does it vary?
Reinstatement after Abstinence
Have you ever managed to stay off alcohol?
What has been your longest period of abstinence?
Describe the outline of a psych history?
- HOPC use NOTEPAD to go through the presenting complaint
- Go through childhood development and how they found school
- Talk about their social history, job, where they live etc
- Talk about their family history, touch on relationship with family and any psychiatric problems
- Ask about previous contact with psych
- Medication history
- Alcohol and elicit drug use
- MSE
- Aetiology- predisposing, precipitating
- Risk assessment
