A Guide to taking a Psychiatric History
Psychiatric History can split into three main things; Diagnostic
To gain a biopsychosocial understanding of the patient’s problem
Therapeutic & psycho-educational
The basic components of a Psychiatric History:
Identification
History of Presenting Complaint
Systems Review
Past Psychiatric History
Past Medical History
Family History
Personal History
Childhood
Occupational
Psycho-sexual
Drug & Alcohol
Forensic
Pre-morbid Personality
The key to psychiatric assessment is a comprehensive history & mental state examination.
Current Symptoms: onset, stressors, duration & course
Sleep: currently, changes over time
Appetite: normal / increased / decreased
Memory & concentration changes
Current Mood
Classify: Anxious? Depressed? Obsessional? Psychotic?
Screen for relevant historical events.
Details of any help-seeking behaviour.
Important to go through a check-list of other Psychiatric Symptoms, noting the positive & negative findings.
It can also be useful to rule out any organic causes of the patient’s presentation.
Past Psychiatric History
Suicide attempts
Treatments: medication, psychotherapy,
Adverse reactions or events due to treatments
Past medical history is useful to ascertain the general health of the patient.
Chronic medical conditions can often cause a decrease in the quality of life for that individual, which can manifest as psychiatric symptoms.
Prior hospitalizations, surgeries.
Medication sensitivities and current medicatioNS.
Family History as many psychiatric disorders have a genetic component.
Mapping out the patient’s life in a longitudinal manner is helpful.
Noting developmental milestones and family environment.
Occupation
Psychosexual
Puberty
Relationships-past & current)? Marriage, Pregnancies
Current life situation.
Drug & Alcohol History
Forensic history
Premorbid Personality
Attitudes to others and to self.
Predominant mood
Hobbies & interests
Reactions to stress