Psychiatric History

NB Before starting- consider (where possible) the patient’s details, the location of the consultation, the legal status of the patient, the reason for the consultation and who is the main source of the history (the latter is particularly important).

  • WIPE (Wash hands, introduce self, check patient details and explain the nature of the consultation/develop some rapport)
  • Presenting complaint(s)- find out what are the main concerns for the patient
  • History of presenting complaint
    • When did you last feel well?
    • SOCRATES- i.e. when/how did things start; any triggers/exacerbating/alleviating factors etc; progression
      • NB a detailed analysis of each symptom e.g. low mood, should be done prior to discussing other symptoms
        • Onset/development/major events
        • Severity/frequency/persistance (e.g. good days/bad days)
        • Exacerbating/relieving factors
        • Impact on daily life
    • Ask about associated symptoms (if the patient has not mentioned them) after this (i.e. psychiatric systemic enquiry)
      • Sleep, diet, concentration/employment, weight, appetite, bowel habit, energy etc
  • Present social situation
    • Where do they live? Who with? Support? Relationships? Social/family circle? Working? Alcohol/Drugs? Legal problems?
  • Past Psychiatric history
    • Previous Dx and Mx- what has been tried and what has been effective
    • Any important similarities with this episode
    • Important to ask about suicide attempts if appropriate
  • PMHx/Developmental Hx
    • Particularly any problems or major events (physical or emotional) in the past
    • Note ‘organic’ events e.g. meningitis; head injury; epilepsy etc
  • Current and past RHx
    • And do they feel it works?
  • FHx
    • Particularly of similar psychiatric conditions
  • Past Social History/Personal History/Developmental History
    • Childhood- siblings, school, parents, events, learning
    • Education/jobs- able to cope reading/writing/numbers; past employment and duration at each; relationship with employer/colleagues
    • Activities (particularly if unemployed)- how do they fill time; anything they enjoy? How does the patient cope with stress?
    • Relationships/support, any children/family
    • Past Forensic history
    • Alcohol and drugs – CAGE
    • How would you describe your normal self (personality)?

Note that a history may be difficult in psychotic patients and that, throughout the consultation, you should be examining the patient’s mental state.  Different presenting complaints require a different approach (see Psychiatry Core Clinical Problems).

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