Psychiatric History

Question 1

What is the typical order of histories in a full psychiatric history?

Answer 1

Demographic statement
Presenting complaint
History of presenting complaint 
Past psychiatric history
Past medical history
Current medications 
Family history
Personal history 
Social history 
Forensic history
Premorbid personality

Question 2

What should you ask about in the demographic statement?

Answer 2

Age, sex, occupation, where they're from
Where they live and who with
Where you saw them
Circumstances of admission (if admitted)
Informal or formal?

Question 3

What should we ask for in presenting complaint?

Answer 3

Short phrase in patients own words if possible.

Question 4

What should you ask about in history of presenting complaint?

Answer 4

Describe all psychiatric symptoms 
Duration
How it's affected functioning.
Precipitating factors
Relieving factors 
Why admitted to hospital, how long etc.
Assess risk here aswell

Question 5

How perform a risk assessment?

Answer 5

Thoughts, plans, intent of suicide or self-harm 
Recent overdoses or self injurious acts
Preventative factors (positive plans for future)
AND include assessment of ideas of harm to others too

Question 6

What should you ask in past psychiatric history?

Answer 6

First presentation to psychiatry
List of past admissions (approx date)
Community follow-up
Previous diagnoses

Question 7

What should you ask in past medical history?

Answer 7

Summarise medical problems
Accidents
Operations

Question 8

What should you ask for in current medications?

Answer 8

Name, dose and preparation

Some estimation of adherence

Question 9

What should you ask for in family history?

Answer 9

Ask about any family mental health problems
Drug/alcohol abuse
Suicide attempts
Ask some facts about parents and siblings

Question 10

What should you ask about in personal history?

Answer 10

Early development and childhood
Schooling - in order
Employment history
Relationships/psychosexual history

Question 11

What should you ask further in early development and childhood?

Answer 11

Problems in their own gestation/birth
Developmental milestones
Childhood illness
Overall happiness/stability

Question 12

What should you ask further in schooling?

Answer 12

Relationships with other children
Relationships with staff
Any conduct problems
Periods of absence/truancy
Qualifications achieved

Question 13

What should you ask further in employment history?

Answer 13

List of jobs
Reasons for leaving
Periods of unemployment
Relationships with work colleagues

Question 14

What should you ask further in relationships/psychosexual history?

Answer 14

List of relationships
Sexuality
Children/terminations/miscarriages

Question 15

What should you ask in social history?

Answer 15

Accommodation
Finances/benefits
Social supports
Leisure interests and hobbies
Illicit drugs. alcohol and smoking

Question 16

What further questions should ask regarding drug and alcohol use?

Answer 16

How often? How much? Cost
Method of use/safety of use
Withdrawal symptoms
Physical health complications
CAGE questions

Question 17

What should you ask in forensic history?

Answer 17

Convictions, cautions, court appearance
Periods of imprisonment/community service etc.
Consider this earlier in forensic patients.

Question 18

What should you ask in premorbid personality?

Answer 18

Overall description of predominant mood, character, attitudes and self-image.
Their view of their own personality
Their view of other people and the world
Coping mechanisms at times of stress
Ability to build and maintain relationships
What others would say about them