Tempus Fugit

Time Flies…

   May 26

Psych History Taking

When taking a Psychiatric History the following headings should be considered:

  • Presenting Complaint
  • What is the psychiatric problem of interest in this patient.

  • History of presenting complaint
  • Tease out the details of the presenting complaint including precipitating factors that might have caused this presentation. Ascertain whether this is a new problem or a presentation of an old problem.

  • Past Psychiatric History
  • The presence of a previous psychiatric history will affect the management of the patient. Look for other co-morbid conditions and ascertain the details of what has happened in terms of the psychiactric past of the patient.

  • Past Medical and Surgical and Obstetric history
  • These histories may give you clues as to what might be contributing to the problem or may show things that have been caused by potential psychiatric issues – e.g. Alcoholic liver disease, miscarriages, terminal illness, thyroid dysfunction…..

  • Medications
  • May show a cause of mental illness or a predelection for substance abuse. If already taking psychotropic medication this may assist with management and diagnosis.

  • Allergies
  • It never pays to miss an allergy. You might get sued – or worse….the patient might suffer.

  • Alcohol and Cigarettes
  • Big problems. Ascertain consumption amounts and types. Where consumed. Pattern of consumption etc.

  • Illicit Substances
  • Pot. Amphetamines etc….can contribute to the psychiatric problem. May be the cause of a psychosis etc.

  • Forensic History
  • This can be particularly important for a number of reasons – there may be an attempt to hide behind insanity for a crime committed. Alternatively, a substance abuse problem or mental illness may predispose person to crime. There are potential legal complications if there is a forensic history. This may affect management.

  • Developmental History
  • (may need collateral)

    Details of childhood, normal birth, how the patient grew up. What their relationships were like with their siblings. Did the have many friends or were they loners. Has this changed recently.

  • Education and Occupation
  • (may need collateral)

    Level of functioning prior to mental illness they are presenting with. What occupation do they have? Is this affecting the patient’s illness. Is there a need to consider workcover or a disability pension or assistance to help the patient recover. Are they able to work in their current condition.

  • Relationships
  • (may need collateral)

    How do they relate to other people. How do they relate to family. Are they loners? Are they scared of personal interaction? How have these relationships been affected?

  • Supports
  • Does the person live alone? Are they elderly? Is their home appropriate for their level of functioning? Are they able to support themselves financially?

  • Pre-Morbid Personality
  • Personality before the condition may provide insight into the prognosis of the patient.

Of course collateral can be a useful tool for all of the above.

You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Bad Behavior has blocked 79 access attempts in the last 7 days.