Psychiatric History Flashcards
What is the typical order of histories in a full psychiatric history?
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
What should you ask about in the demographic statement?
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?
What should we ask for in presenting complaint?
Short phrase in patients own words if possible.
What should you ask about in history of presenting complaint?
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
How perform a risk assessment?
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
What should you ask in past psychiatric history?
First presentation to psychiatry
List of past admissions (approx date)
Community follow-up
Previous diagnoses
What should you ask in past medical history?
Summarise medical problems
Accidents
Operations
What should you ask for in current medications?
Name, dose and preparation
Some estimation of adherence
What should you ask for in family history?
Ask about any family mental health problems
Drug/alcohol abuse
Suicide attempts
Ask some facts about parents and siblings
What should you ask about in personal history?
Early development and childhood
Schooling - in order
Employment history
Relationships/psychosexual history
What should you ask further in early development and childhood?
Problems in their own gestation/birth
Developmental milestones
Childhood illness
Overall happiness/stability
What should you ask further in schooling?
Relationships with other children Relationships with staff Any conduct problems Periods of absence/truancy Qualifications achieved
What should you ask further in employment history?
List of jobs
Reasons for leaving
Periods of unemployment
Relationships with work colleagues
What should you ask further in relationships/psychosexual history?
List of relationships
Sexuality
Children/terminations/miscarriages
What should you ask in social history?
Accommodation Finances/benefits Social supports Leisure interests and hobbies Illicit drugs. alcohol and smoking
What further questions should ask regarding drug and alcohol use?
How often? How much? Cost Method of use/safety of use Withdrawal symptoms Physical health complications CAGE questions
What should you ask in forensic history?
Convictions, cautions, court appearance
Periods of imprisonment/community service etc.
Consider this earlier in forensic patients.
What should you ask in premorbid personality?
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
