Psychiatric History Taking Flashcards
What is the Overall structure for Psych History Taking?
- PC
- HPC
- Previous Psych History (Including use mental health act)
- PMH
- DH
- FH + Family Psych History
- Personal (Developmental)
- SH (Who lives with them, relations, alcohol, drugs)
- Forensic History (Ever been in trouble with police or criminal justice system)
- Premorbid History (How would someone described you before this?)
- MSE
- Sleep
- Weight
- Formulation
What is included in the MSE?
- Appearance & Behaviour
- Mood – Subjective, Objective & Affect
- Speech
- Thought-form
- Thought-content (delusions, suicidal intent)
- Perceptions
- Insight
- Cognition
- Suicide and Homicide
What should be covered in the Presenting Complaint (PC)?
What the patient says is wrong or what they have been referred about if they do not
perceive that there is any problem.
*As other types of history taking you will generally want to start with open questions but it may be necessary to use closed questions to start some patients talking. You should
avoid leading questions.
Why have you come to see me today?
How have you been feeling recently?
Your doctor was a bit worried about you and asked me to see you. What seems to be the
problem?
What should be covered in the History Presenting Complaint (HPC)?
Short history of the events leading up to referral. The symptoms described by the patientand those revealed by questioning. The severity and duration of each symptom, how it
began and the course it took. Consider the relevance of the absence of symptoms that
might be expected in a symptom cluster.
Describe any signs that might suggest the likely presence of disease. Relevant recent
medication
What should be covered in the Previous Psychiatric History (PPH)?
Record previous episodes of illness, their treatment, and duration.
Especially comment onany episodes requiring the use of the Mental Health Act.
What should be covered in the Past Medical History (PMH)?
Record all illnesses that have required medical attention, operations and hospital admissions.
Particular interest in head injuries, birth trauma and epilepsy.
What should be covered in the Family Medical Psychiatric History (FPH)?
Parents /siblings: - relationships with them etc
Family history of psychiatric and medical problems
*Has anyone in the family ever suffered from problems like you’re having?
Has anyone in the family ever had a mental illness?
What should be covered in the Personal History (PH)?
- Early development
- Childhood experiences
- Educational attainment
- Occupational history
- Relationship and marital history-children
- Sexual history
*This can sometimes feel a bit strange as it is a little different. You may wish to introduce
the idea by a short pre-amble.
I would like to know a bit about your early life and how you got on as a youngster so I’m
going to ask some questions about that now.
It’s often important to ask about various experiences in your life so I’d like to go right backto the start to get a full picture of how things have been.
Then - As far as you know were there any problems with your mother’s pregnancy with you, your birth or early life? Etc…
What should be covered in the Social History (SH)?
Current social circumstances, accommodation, work, who lives with them, financial support, family/friends, interests and activities.
What should be covered in the Drugs and Alcohol (DH)?
Current and past use of alcohol / drugs. Types, quantity, duration, whether this has led to
any problems with withdrawal / dependence.
*Handle sensitively but most people are happy to talk about this. I need to ask about use of
alcohol and drugs. How much would you drink in an average week? Etc
What should be covered in the Forensic History (FH)?
Record instances of contact with the police / criminal justice services leading to a charge
or conviction. State the charge / conviction and the outcome. Also record any contact with
forensic psychiatry.
*Again this is a bit different to a general history. You may wish to ask general questions
like. Have you ever been in trouble with the police? Then go on to ask why, when and
what the outcome was. Find out about prison sentences.
What should be covered in the Pre-Morbid Personality (PMP)?
Information of patient’s character prior to the illness.
*How would you describe your normal self?
How would you describe yourself as a person before you felt like this?
How would your friends describe you?
What should be covered in your Formulation?
- Summary Of the relevant history and mental state
- Differential Diagnosis and Aetiological Factors
- Further investigations
- Management and Treatment prognosis
What questions would you as around Mood in the MSE?
This can be either depressed or elated. Often anxiety will be asked about in this section.
How have you been feeling in terms of your spirits recently?
Have you been feeling reasonably cheerful?
Are there times when you are feeling low or tearful?
Have you been feeling especially cheery or good recently?
Have you been feeling on top of the world?
Are there times when you become very anxious or frightened? Can you describe what
happens?
What questions would you as around Thoughts in the MSE?
Phobias - Do you have fears of any particular things – like spiders or snakes?
Obsessions and compulsions. Do the same things keep coming into your mind even
though you try not to think about them? Do you ever find yourself spending a lot of time
doing the same thing over and over again, even though you’ve already done it?
Delusions and Overvalued Ideas. You may wish to start with an introduction to this. I’m
going to ask you some routine questions that I ask everyone but they may seem a little
strange. Do you have any ideas or beliefs that your friends and family don’t have or think
are odd? You might want to go on to ask about things like delusions of control, jealousy,
guilt etc as appropriate to the presentation. If trying to test whether something is held with
delusional intensity you might want to ask something like Do you have any doubts about
that? How sure are you about that?
