Table of Contents
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): 3rd 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?
What are the first rank symptoms of schizophrenia?
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What are the symptoms of depression?
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List some risk factors for suicide?
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