Taking a Psych History Flashcards
Before you even start a Psychiatric Interview how should you arrange the setting?
Note* - A psych interview covers all the same areas as any medical history, i will only be referring to the extra bits here
1) In a private space
2) Ensure no interruptions
3) Keep it informal by arranging the seats informally etc
4) Make sure you have an easy exit
What should you do at the start of the interview before you start asking questions?
Patient’s in a psych interview may be confused, suspicious or nervous etc so make sure to ORIENTATE AND CHECK:
- Explain the reason for the interview
- Explain why you’re taking notes
- Reassure about confidentiality
- Explain the duration of the interview
How might you open a psych history
A nice open question e.g. Can you tell me in your own words why you’re here?
It’s helpful to know if the patient is an informal (voluntary) patient or has been referred under order
When doing HoPC you want to cover it just like any other. An important extra to remember
Ask about the complaint’s response to any other treatments
In term’s of exploring psychoses in the systemic enquiry, how might you ask about hallucinations?
Avoid the phrase “Do you hear voices”
Try something clear but diplomatic like:
- Have you ever seen or heard something others weren’t aware of?
- Have you ever heard someone speaking with no one around?
Be concerned about anyone hearing commands
Also exploring Psychoses, what else might you ask
You want to know if they feel anyone is controlling their mind in some way e.g.:
- Is there anything particular playing on your mind?
- Does anyone else ever have access to your thoughts?
What areas would you want to cover when asking a the psych part of the PMH?
- When/duration of episodes
- Treatments they received
- Any admissions or detentions
- Inter-episode functioning
- any suicide or self harm
What none-psych PMH is particularly important?
- Developmental problems
- Head Injuries
- Endocrine abnormalities (particularly thyroid)
- Vascular Risk factors
- Liver damage, peptic ulcers or oesophageal varices
What’s different about a psych FH?
with relative with a psych problem you want to know about their:
- Circumstances
- Relationships
- Age
- employment
- Health etc
In major mental illness distant relatives are more important than closer ones
What’s different about a psych med history?
Make sure to see if any drugs have been started or discontinued in the last 6 months as this may cause symptoms
what areas are particularly important in a psych social history?
Think about anything that could trigger or worsen mental illness:
- Employment/finance
- Relationships
- Substance abuse
- Parent or carer
- Other stressors
What do we want to know about any substance abuse?
- Amount
- Reg vs Intermittent and -Pattern
- Any dependance or symptoms on withdrawal
- Impact on work, relationships etc
- Police involvement
Can use screening questions e.g. CAGE
During a psych social history we would also ask a personal history, what does this include?
- Developmental milestones (mainly in younger patients)
- Early life/ Schooling
- Relationships/friendships
- Education &Occupation
- Financial history
In a psych history we also ask a forensic history, how do we do this?
Be sensitive, open with:
- “Have you ever had any contact with the police?” And go from there
Why is it particularly helpful to ask about sentences during a forensic history?
- Gives you a more objective measure of any crime the patient was convicted of
- Can give you an idea of how likely a patient is to commit a crime again