Psychiatric history

Introduction

• Wash hands
• Introduce self
• Ask Patient’s name, DOB and what they like to be called
• Explain and obtain consent

Presenting complaint

• Determine symptoms which brought patient in
• Did they come voluntarily or were they detained
• Who prompted it (patient, family, friend)

History of presenting complaint

• Explore every symptom
  • Timeframes – any triggers?
  • Symptom-specific questions (see exploring symptoms)
• Psychiatric system review
  • Psychosis screen (first rank symptoms): 3^rd person auditory hallucinations, running commentary auditory hallucinations, delusions of thought/control/perception
  • Depression screen: core (mood, anhedonia), biological (sleep, energy), future (hopelessness, suicidal thoughts)
  • Other: memory loss, anxiety, insight
  • RISK: to self (suicide/self-harm), to others

Past medical history

• Past psychiatric history
  • Diagnoses
  • First and last episodes
  • How many episodes and admissions (check if voluntary or involuntary and if any to psychiatric intensive care)
  • Previous self-harm/suicide attempts
  • Mental health worker/care co-ordinator
• Past medical history

Drug history

• As usual
• Check compliance

Family history

• Family psychiatric history
• Family history of suicide

Social history

• Alcohol and drug use (VERY IMPORTANT!)
• Social circumstances
  • Current situation
  • Relationships
  • Dependants and contact with children – determine if their children are safe (who are they with?)
  • Home (support, home state)
  • Finances (benefits, debts)
  • Education/work
  • Coping with activities of daily living
• Forensic history (especially important if there may be any risk to others), for example:
  • Ever been arrested or in prison?
  • Types of crimes?
  • Longest prison sentence?
  • Any domestic abuse?
• Personal upbringing history: include if any history of child abuse
• Pre-morbid personality

NEVER FORGET RISK!

Why don’t you test your knowledge?

Now it’s time for some stations…

1. Strange behaviour
2. Psychosis
3. Anxiety
4. Eating disorder
5. And there’s much, much more!