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

• Exploreevery 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

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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!

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