Psychiatric History

Psychiatric History Identify data and current circumstances Name Age Gender Ethnicity Language Referral source Living situation Employment Presenting Complaint Can you tell me what brought you here today? Tell me about the issues you have been experiencing. To expand: Can you tell me more about X? Exploring symptoms (NOTEPAD) Nature Onset Triggers Exacerbating/relieving factors Progressions Associated symptoms Disability Condition Specific Questions Have you been feeling yourself? What has your mood been like? Have you been feeling sad, blow, down or depressed? Have you lost interest in things that you previously enjoyed? Have you been sleeping? Depression (MDD) Have you been feeling guilty? Are there any changes to your appetite? Is there a retardation or agitation? Any ideas of self-harm or suicide? Do you have any issues with concentration? Have you felt especially good about yourself? Have you been feeling that you need less sleep than normal? Do you feel that you are special or have any special powers? Have you been spending more than usual or involvement in risky behaviours? Do you talk more than usual? Do you get irritable? Are you getting more distracted? How would you describe your concentration levels? Do you get involved in risky behaviours? E.g. speeding, sexual indiscretion or social overfamiliarity Mania Ask about delusions Is there a non comprehensible speech Is there a loss of insight or self neglect Are you always anxious or does it happen at certain times? W hatsort of things have you been worrying about? Have you been feeling nervy or tense? Do you worry a lot about things? Do you find it hard to relax/switch off? Do you worry about things most other people would not worry about? Are you able to put your worries out of your mind? Do you get you get sudden attacks of anxiety? Anxiety Have you ever felt distracted from yourself or your surroundings? Do you avoid things because if your worries? Do you have any issues with concentration? Ask about presence of physical symptoms: Palpitations Chest tightness Breathlessness Sweating Dizziness Dry mouth Nausea and vomit Insomnia/difficulty sleeping Paraesthesia Have you ever had an attack of acute anxiety or panic suddenly when feeling very anxious, frightening or feeling that something terrible would happen? Does it happen in situations that other people don’t usually fear? Can these attacks happen at any time? Do they suddenly come on? How long do they last for? Do you have any of: Sweating Trembling Unsteadiness/dizziness Panic Disorder Derealisation Elevated HR Nausea Tingling SOB Fear of dying Going crazy Chest pain Chocking Chills Do you avoid going out? Agoraphobic Do you avoid going to places or situations because you fear you may have an anxiety attack? Have you ever heard other people speak even when there is no one around? If yes, is it one person or multiple? Is it animals, humans, angles, devils etc.? Do you ever hear voices speaking as if someone is there? Have you heard your thoughts or beliefs spoken out loud, as if by someone else? Do you feel that you have thoughts or beliefs that others might find unusual or strange? Do you ever feel that someone or something is touching you when there is nobody there? Have you ever felt like you have been assaulted despite nobody is present? Schizophrenia and delusional disorders Have you ever felt like insects are crawling beneath your skin? Are your thoughts your own? Do you ever hear your thoughts echoed or repeated? Is there anyone or anything taking thoughts out of your head? Have you felt that people may be against you? Have you felt that TV or radio sends you a message? Do you ever feel as if someone is spying on you or plotting to hurt you? Do you have any ideas that you don’t like to talk about because you are afraid other people will not believe you or will think that something is wrong with you? Obsessions are thoughts, images or impulses that are recurrent and impulsive They enter the mind despite resistance and recognised by the patient that are their own thoughts and not due to insertion. Patients find them distressing. Obsessions and compulsions Patients tend to remain aware that these thoughts are irrational but still feel they have no control over. Compulsions are repetitive mental processes or acts a patient feels compelled to perform due to an obsession or a rule Abnormally euphoric or irritable mood Pressured speech Flights of ideas Bipolar Disorder Grandiosity Disinhibited behaviour Little need for sleep Severe disruption to normal life Have you ever felt that you need to cut down on your drinking? Have people annoyed you by criticising your drinking? Have you ever felt guilty about your drinking? Have you ever felt you needed a drink first thing in the morning? Alcohol of substance abuse Have you ever had any physical symptoms or adverse effects as a result? Amount of money spent Do you feel a strong desire or compulsion to take it? Do you often take more than intended? Do you have that you need to take more to achieve the same effect? Has your use of X made you give up important obligations? Has the use caused any physical or mental problems? Have you continued to use, even though you knew you had problems? Do you worry about your weight? Do you think you are fat? What are your feelings about your weight? How often do you weigh yourself? Can you describe your current food intake? Do you diet? What things have you been doing to control your weight? Have you ever made yourself sick after a meal? What do other people say about your weight? Do you exercise excessively? Do you binge eat ? Eating Disorders Do you eat faster than usual? Do you eat large amount even when not hungry? Do you eat alone because of embarrassment? Do you feel disgust, depressed or guilty after eating? Do you eat until uncomfortably full? Do you avoid certain types of food? Do you have any of: Amenorrhea Fatigue Constipation Dizziness Haematemesis (doe to oesophageal tears) Seizures Have you been worried about your health? What do you think might be wrong? Somatoform Disorders Do you often feel sick? Have you had symptoms that your doctor has not been able to find a cause for? What has your doctor told you? What tests have been done for you? Have a deficit in: Reasoning Problem solving Planning Intellectual disabilities Abstract thinking Academic learning L ea rning from experience Are any inattentive features present: Careless mistakes Attention deficiency Losses things Listening problems Fails to finish tasks Organisational difficulties Reluctance to do tasks Forgetful Easily distracted Any hyperactivity features present: ADHD Runs, climps restless Uninhibited conversations Not playing quietly Fidgets Interrupts others Difficulty waiting for turb Gets going Evacuates seat unexpectedly Deficits in social communication and interactions: Deficits in social-emotional reciprocity Autism Deficits in nonverbal communication Deficits in developing, maintaining and understanding relationships Participating events May occur for no reason Past History General, medical and surgical Head injuries Epilepsy Obesity Diabetes Hypertension Psychiatric history Counselling, Psychotherapy Similar or other psychiatric symptoms/diagnosis Forma; psychiatric admissions Other therapy ECT For the treatment options, ask the patient of they thought these were effective. Where you ever admitted to the psychiatric unit? If yes -> why, for how long, how brought you, what is voluntarily? Risk behaviours Self-harm and to others Thoughts, attempts Forensic history Addictions Alcohol Illicit drugs Gambling history Smoking Developmental History Birth order Infancy, milestones and early neuroses Parents: Married Divorced Schooling: Friendship Relationships Academic Sports Further educations Work experience Later adolescents and adult relationships Significant events, trauma and abuse Forensic history Have you ever been in trouble with the police/law. Childhood Do you know if there were any problems with your mother’s pregnancy with you? Are you aware of any problems around your birth? As far as you know, did you meet the normal milestones growing up? How would you describe your childhood? Was there any childhood abuse? School and education Did you enjoy school? Did you have a lot of friends at school? Did you have any problems with bullies at school? At what age did you leave school? What qualifications did you leave school with? Occupation Are you employed at the moment? How long have you been at your current jobs? What jobs have you had in the past? Why did you leave your previous jobs? Have you been dismissed from a previous job? How do you cope at work? Relationships How you get on with your family? Do you find it easy to make friends? Do you feel like you have a good social support system? Are you in a romantic relationship at the moment? What have your previous romantic relationships been like? Have your current problems affected your relationships? Both romantic and social Personality How would you describe yourself? How would others describe you? Ask about self-esteem and self-view. Cultural, spiritual beliefs/values Activities, interests and hobbies? What do you do in your spare time? Do you still find enjoyment for them? Living circumstances Where do you currently live? r Are there any children at home? Activities of daily living How are you coping at home at the moment? Do you feel you are able to look after yourself? Do you have any worries at the moment? What is your current diet? Insight and judgement What do you think the cause of the problem is? Do you think you have a problem at the moment? Do you feel you need help with your problem? Risk Assessment Risk to self Any thoughts of self -harm Do you want to act upon them Have you planned how Risk to others Same questions are risk to self, but change to suit others