Psychiatric history

Question 1

What to ask as part of the history of presenting complaint.

Answer 1

When did the problem begin
- relapsing, remitting illness
- when was the last time they were ill
Precipitating factors (real or perceived)
Effect on personal relationships and capacity to work
What does the patient think has caused the illness as a whole (or causing any relapses)
What makes it better/worse
Collateral sources
Questions related to diagnostic criteria for individual disorders

Question 2

What to ask as part of previous psychiatric history?

Answer 2

Dates of illnesses, symptoms, diagnoses, treatments and hospitalisations
Whether they have have treated under compulsory admission or treatment

Question 3

What to ask as part of past medical history?

Answer 3

Any medical/surgical problems
Drug history
- include psychotropic medications which that have previously received, dosage and duration, and whether or not they helped
Drug allergies

Question 4

What to ask as part of family history?

Answer 4

Parents and siblings ages, occupations, physical and mental health
Quality of relationship with the parents
Decreased - cause of death, age at time of death and reactions to their deaths
Family history of psychiatric illness, suicide, drug and alcohol abuse, forensic encounters and medical illnesses

Question 5

What aspects of personal history need to be asked about?

Answer 5

Early life and development
Educational history
Occupation history
Relationship history

Question 6

What aspects of early life and development need to be asked about?

Answer 6

Pregnancy and birth (any complications)
Serious illness, bereavements, physical or sexual abuse, separations in childhood or development delays
Describe childhood home environments

Question 7

What aspects of educational history need to be asked about?

Answer 7

Details of school, academic achievements, relationships with peers (friends at that age) and conduct
School refusal or truancy important

Question 8

What aspects of occupation history need to be asked about?

Answer 8

Job titles and duration
Reasons for change, work satisfaction and relationships with colleagues
Longest duration of continuous employment is an indicator or pre-morbid functioning

Question 9

What aspects of relationship history need to be asked about?

Answer 9

Relationships and marriages (duration, children, any abuse)
Sexual practices, difficulties and orientations (menstruation pattern, contraception, miscarriages/still-births and any abortions)
Support and quality of the relationship (communication, infidelity)

Question 10

What aspects of substance abuse need to be asked about?

Answer 10

Alcohol
Drug (prescribed and recreational)
Smoking

Question 11

What aspects of forensic history need to be asked about?

Answer 11

Any arrests/convictions for violent offences

Periods of imprisonment (what for and length of time served)

Question 12

What aspects of social history need to be asked about?

Answer 12

Current accommodation, occupations, financial details and daily activities

Question 13

What aspects of pre-morbid personality need to be asked about?

Answer 13

Character and attitudes before they became unwell
- how they would describe themselves and then how their friends would have described them
What they enjoy doing
Coping with adversity
Religion