Psychiatry - History

Question 1

Steps of psychiatry history

Answer 1

1. Presenting complaint
2. History of presenting complaint
3. Past psychiatric history
4. Past medical history
5. Family history
6. Current social situation
7. Personal history
8. Substance use
9. Forensic history
10. Pre-morbid personality

Question 2

Presenting complaint

Answer 2

Problem in patients on words - ask open question

Question 3

History of presenting complaint

Answer 3

• Onset
  
  • How and when symptoms developed - come on suddenly/gradually, what precipitated (what were they doing at time)
• Associated symptoms
  
  • From beginning or development of new symptoms
• Time course
  
  • Changed over time
• Exacerbating or relieving factors
• Functional impairment
• Level of distress
• Treatments trialled

Question 4

Family history

Answer 4

• Parent
  
  • Age (now/death), illness, relationship
• Siblings
  
  • Age (now/death), illness, relationship
• Psychiatric illness in family members
  
  • Substance use and suicide too

Question 5

Personal history

Answer 5

• Mothers pregnancy and birth
  
  • Complications
• Early development
  
  • Milestones, early illnesses
• Childhood
  
  • Seperations, emotional/behavioural problems
• Relationships with family at home
• Schooling
  
  • Academic performance, peer relationshions, bullying, school refusal, shyness, conduct disorders
• Qualifications
  
  • Further education and performance
• Occupations
  
  • Work performance, relationship with others
• Sexual relationships
  
  • Casual, marriage, children
• History of abuse
  
  • Physical, sexual or emotional in childhood or adulthood

Question 6

Social history

Answer 6

• Whos at home, type of accomodation
• Finances
  
  • Mortgages and debt
• Gambling
• Employment
• Stressors
• Social support
• Struture of routine day

Question 7

Substance use

Answer 7

• For alcohol, smoking and drugs
  
  • Age of onset
  • Pattern of use/rationale
  • Dependence - psychological and physical
  • Previous detox, triggers for relapse
• Patients view and impact on their lives and relationships with others
• Explore cycle of change

Question 8

Forensic history

Answer 8

• Record of all offences
  
  • Convicted or not
  • Violence/sexual particularly important
• Persistent offending
• Probation
• Relationship to symptoms

Question 9

Past psychiatric history

Answer 9

• History of similar or other symptoms in past
• Previous diagnosis
• History of treatment
• Previous hospitalisation
• Recovery between episodes

Question 10

Past medical history

Answer 10

• Chronic conditions
• Past diseases and admissions

Question 11

Drug history

Answer 11

• Current medication
  
  • For each drug: name, dose, frequency, form, administration route
• Remember OTC
• Allergies

Question 12

Pre-morbid personality

Answer 12

• Ask patient how others see them/would describe them
• Useful to ask friends/family
• Prevailing mood, how they get on with people, deal with stress, hobbies, standards