psychiatric history taking Flashcards
2 fundamental components in psychiatric hx
collection of clinical data
intuitive understanding of the patient as an individual - empathy, descriptive psychopatholohy
how do we collect clinical data
taking a clinical hx
examining the mental state
the setting for psychiatric hx taking
importance of privacy
avoid interruption - phones etc
informal setting, avoid barriers, respect personal space
easy exit - interviewer should have immediate access if only one exit
safety/risk assessment
speak to treating team/ 1y nurse
violence is unusual
inform staff who you are going to interview and where
look out for warning signs - posture, verbal aggression, signs of aggression
sections of psychiatric hx
PC HPC Past psychiatric Hx PMH current and recent medication SHx - alcohol and drug use, smoking, social circumstances, occupation Fhx forensic hx - contact w/ police etc personal hx - developmental milestones, schooling/education, occupational hx, relationships, pre-morbid personality
introduction
greet verbally and introduce yourself look for non-verbal cues orientate and check - purpose of interview - likely duration - note taking, confidentiality, part of a team
important general skills
eye contact helps rapport
adopt relaxed non-threatening posture and appear unhurried
use facilitative noises
pick up on non-verbal cues and acknowledge
control any over-talkativeness (polite authority and at the right time)
don’t offer advice or opinion too early
clarification and summary
advantages of open questions
allows patients to start talking about themselves and puts them at ease
allows you time to think and plan areas of questioning as you assess their style and content of their response
allows a period of non-verbal response from the interviewer - listening and facilitating
how to start off the consultation - what types of questions
open
however closed questions can be useful for very paranoid/depressed patients
what is an informal referral
not subject to any legislation
HPC
clarify each complaint from the PC in turn
onset, precipitants, course, severity
associated symptoms, effects on daily living
is it getting worse/better
has it responded to any treatment
asking about related symptoms
after patient has finished volunteering symptoms
what other changes have partner/family/friends noticed in you
ask about specific symptoms - may be closed questions
systematic enquiry to screen for other symptoms
exploring psychotic symptoms - percepts
have you seen/heard anything that other people haven’t been aware of
have you heard any people talking when there was nobody around
what do they think is causing them
does it seem possible
beware commands - are the voices telling people to do things (red flag symptom)
exploring psychotic symptoms - beliefs/thoughts
has anything particular been playing on your mind
do you know why this is happening
have you noticed any change in your thoughts
has anyone interfered with your thoughts
does anyone else have access to your thoughts
past psychiatric hx
past episodes/diagnoses/contacts
previous treatments (psychological, drug and physical)
inter-episode functioning
previous admissions to hospital
attempted suicide/repeated DSH
previous detentions under mental health legislation
PMH
developmental problems head injuries endocrine abnormalities liver damage, oesophageal varices, peptic ulcers vascular risk factors
medical problems can sometimes present with psychiatric symptoms
person might have been out of contact with medical services for a while
current and recent medication
tablets and injections
medication recently
drugs discontinued (within past 6mths) - why was it stopped (i.e. by doctor or did you stop taking it)
how long medication has been taken for and at what dose
adverse reactions and allergies
FHx
parents, siblings, grandparents etc
age, employment, circumstances, health problems, quality of relationship
major mental illness in more distant relatives is important
genogram can be helpful
SHx
social circumstances incl occupation current financial situation/stressors smoking, alcohol, illicit drug use current relationship, stressors children - contact, where are children
alcohol, illicit drug hx
regular or intermittent amount - units pattern dependence, withdrawal symptoms impact on work, relationships, money, police screening questionnaires e.g. CAGE
forensic hx
have you ever been in contact w/ police ever charged with any crime offences incl sentences recidivism particular attention to violent or sexual crimes
