Psychiatric History Flashcards
What is important when taking a psychiatric history?
Be inquisitive
Ask for more information
Ask about the patient’s reasons for their beliefs
Don’t collude with the patient
Be open to the possibility of the patient telling the truth
How should a psychiatric history be structured?
Introductory questions
HPC
Past psychiatric history
PMH
Social history
Drug and alcohol history
Family history
Personal history
Premorbid personality
What introductory questions should be asked when beginning a psychiatric history?
Name?
Age?
Where they’re from?
Who they live with?
How did they present to psychiatric services?
In what ways may a person present to psychiatric services for the first time?
Self-seeking help via GP or other service
Family worried
Referred by other services e.g. police
In what way can asking how a patient presented be useful?
It can help in assessing current risk
What are some examples of presenting complaints in a psychiatric setting?
Low mood
Anxiety
Self-harm/suicide
Memory loss
Elated mood
Sleep changes
Indicators of psychosis e.g. ‘I have a chip in my arm’
Why won’t a patient experiencing psychosis ‘present with psychosis’?
They lack insight so won’t know that they are experiencing hallucinations
When investigating the HPC what is it important to ask about?
Onset and precipitating factors
Severity
Duration
Aggravating and relieving factors
Associated symptoms
How should a history begin and then eventually progress?
By starting with open questions and moving to closed questions later
What aspects of psychosis should be asked about?
Thought possession
Hallucination
Why is it important to directly ask about symptoms of psychosis?
Patients lack insight so may not consider them “symptoms” or may not open up about them on their own
What should be asked about then inquiring about thought possession?
Ask if in control of their own thoughts
Is anyone interfering with their thoughts
Then move on to ask about specific types of thought possession
What questions should be asked when inquiring about past psychiatric history?
Ever had treatment before?
Where was this?
Any admissions?
Were these informal?
How many and how long for?
Were they ever considered a risk?
Why is it important to ask about PMH in a psychiatric history?
People with mental health disorders are more prone to other problems
What aspects of a social history should have been included?
Housing?
Who do they live with?
Are they employed?
Benefits?
Package of care?
