Psych history taking Flashcards
What is the 3 purpose of history taking
- Content: gathering of information in order to make diagnosis.
○ Identify the condition
○ Aetiology and contributing factors
○ Identify illness phase and severity
○ Exclude other important diagnoses- Process: how you connect with the patient during the interview through verbal and non-verbal techniques.
○ Use open ended questions initially: what has brought you to clinic? How can I help you? sounds like things have been difficulty according to .. Can you tell me more about that?
○ Clarifying leads: noticing important bits and clarifying it - in what way? Showing that listening to patient.
○ Demeanour and posture: facing the patient, leaning towards them, maintaining eye contact as much as possible.
○ Framing the questions: normalising things by asking indirectly - suicide screening - have things ever gotten so bad that you didn’t feel like living anymore, has it reached the point where things are too overwhelming and in what way. Sometimes when people are overwhelmed they have thoughts of giving up on life. What about actually attempting to end your life, have you done anything like that? - Clinical reasoning - combine the gathered information to make a hypothesis - aim is to make an accurate diagnosis - every question used to justify and guide treatment plan
- Process: how you connect with the patient during the interview through verbal and non-verbal techniques.
What is the lose structure of hx taking in Psych
Obtain consent, explain purpose explain confidentiality limits
1. Establishing demographics -
2. HPC
3. Review of symptoms
4. Past psychiatric history
5. Medical hx
6. Medication
7. Developmental hx
8. social hx
9. Drug and alcohol
10. fam hx of psychiatric condition
11. Forensic hx
12. premorbid personality
What is involved in demographics section
- What do you like to be called
Age, sex, ethnic background, marital state, profession, supports in place, religion, employment
What is involved in HPC
why is the patient here, what complaints are others making?
- Time of onset
- Fluctuations
- Frequency
- Diurnal variation
- Severity
- Triggers or stressors - what makes them experience this?
- Alleviating and aggravating factors
- Impact on patient
- Their opinion of what is going on - what was that like for you
○ Collateral history is important especially for negative symptoms
Whats involved in roS
screening questions for ddx
Neuro vegetative signs & symptoms: suggest mood disorder - help to differentiate normal stressor - depression
- Quality of sleep
- Energy levels
- Concentration
- Appetite
Libido
Whats involved in past psychiatric hx
- (Previous contact with mental health services? any diagnosis, medications, psychotherapy
- Outpatient - community: Any past diagnoses of depression, anxiety, psychosis or past use of antidepressants
- Any past treatment - how did it work for them? SE? why is there a problem
- Hospitalizations: admission for how long, what treatment received
- Seen the mental health judge - treatment order
Past deliberate self-harm or suicide attempts
Whats involved in Medical History + Medication
- how does it relate to the psychiatric symptoms
Active or past medical and surgical conditions
○ Head injury, tumour, epilepsy: psychotic symptoms
○ Hypothyroidism: depressive symptoms, low mood, energy, weight gain
○ Hyperthyroidism: manic symptoms, high energy levels
○ Contraception, reproductive history (possibility for teratogenic interactions)
- (current medications & allergies). - OTC and herbal - St John's wort
Developmental hx?
Birth- childhood- adolescence- young adult- jaded adult- winding down-death
- (patient’s childhood experience, history of trauma and positive relationships).
- Relationships: parents, siblings and friends
- Current and past intimate relationships
- Where was patient born, pregnancy, birth, developmental milestones, schooling and social interactions
- How was childhood was and major life events growing up (parental separation, foster care)
Social hx ?
- Where does he live with and whom (relationships, family)
- ADLs : (Profession, hobbies, routines,
- Stressors and worries at work/school
- Aspirations
Drug and Alcohol hx including mnemonic alcohol
(important to rule out before committing to another diagnosis).
- Methamphetamine , cannabis, alcohol, tobacco
- Route and what does it do for you, when?
- Did use stay recreational or did it get out of hand
- Cause problems with you or others
- Severity of established alcohol abuse problem. Alcohol abuse: specify number of units per week.
- Specific questions to ask around alcohol abuse: C.A.G.E. =
○ Cut back; have you had thoughts of cutting down on drinking?
○ Anger; have you been angry when people talk about your drinking?
○ Guilt; have you felt guilty about the amount your drinking or how your drinking?
○ Eye-opening; has it reached a point where you have to drink in the morning to feel normal?
- Substance Abuse screen; outside of alcohol do you use recreational or “party” drugs?
what are specific questions for drug dependence (3)
○ Tolerance; have you noticed you need more to achieve the same effects?
○ Withdrawal; do you feel shaky, sweaty, palpitations, nauseous when you stop drinking?
○ Functional interference; have you had problems at work, at school, at home or with the police?
Fam hx of psychiatric condition
- When a family member is affected, other close relatives may be at increased risk
- Family history of mental illness
- Family history of suicide
- (psychosis, mood disorders, drug & alcohol, intergenerational abuse, etc.)
forensic hx + premorbid personality
Forensic History
- Any trouble with the law? What did they say you did?
- How did you plead ,and why If yes, any charges–> what are they–> did they serve a sentence
(Premorbid personality)
How would describe yourself in one sentence - differentiate between personality traits and disorder to avoid labelling)
