Psychiatric History

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Introduction

Mental health illnesses cannot be tested for and is not visible; history is essentially everything.

The goal of the assessment is first to build a relationship with the patient. Obtaining a psychiatric history is the second thing.

During an interview, seek to identify:

It is important to assess suitability for therapy, which refers to a patient's psychology and personality, type of therapy sought, and therapeutic alliance.

 

Biological

psychological

social

 

Ask patients:

 

Reluctant/guarded patients are common in psychiatry.

Use open ended or commenad questions

neutral ground

 

Screening for Mental Health

Transitioning techniques can be used to bring up sensitive topics based on previous comments.

 

To screen for depressive symptoms (SIG-E-CAPS), each can be rhymed off as follows:

"How has your mood affected your life over the past few weeks? For example, how has it affected your sleep? Your interests?... etc"

For patients who seem reluctant to go this way, beginning with, "Do you have any troubles sleeping?" is a good way to go.

It may be a good idea to have screening tools available in the waiting room, for folks to check out, check off, and bring up if they would like.

 

Psychiatric Review of Symptoms: a Screening Tool for Family Physicians (Am Fam Phys, 1998)

Screening for Mental Health - US non-profit

 

 

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Identifying Data

 

 

Chief Concern

 

 

History of Presenting Illness

"what sort of things led up to this?"

 

 

 

Psychiatric Functional Inquiry

It is very important to screen people quickly for other potentialities...

 

 

Past Psychiatric History

 

 

 

Past Medical History

"anything medical we should know about you?"

"any problems with your heart, blood pressure..."

 

 

 

Family Psychiatry/Medical History

 

 

Past Personal History

 

 

Functional Inquiry


General: Weight, Fatigue, General well-being, Fever, Chills, Sweats
Current Health: Sleep, Diet

"we all have our blue days. Do you ever feel this way?"

 

"We're all human, and sometimes we talk to ourselves. Sometimes it might seem like there are voices talking to us. Does this ever happen to you?"


Learn symptoms for systems.

 

 

Ratings Scales

Rating scales tend to originate from research protocols, where heterogeneous patient populations are categorized to control for various characteristics. They also allow for more objective follow-up in regards to response to therapy. Lastly, they help new learners organize their approach and gain confidence. They are supposed to be a-theoretical. Diagnostic criteria help with:

 

 

Supposed to be a-theoretical

Diagnostic Criteria helps with

HamD = Hamilton Depression score

Substance Use Risk Profile Scale (SURPS)

 

 

 

Other Great Bits of Advice

Make sure to ask about delirium, dementia, and substance abuse; these very common things are important and easily missed!

 

Have the courage to go into uncomfortable areas with people. If someone has an acute abdomen, you gotta palpate to find where the problem is.

 

You can ask anyone anything if: a) it is a logical thing b) they know you will treat them with respect

 

Care about the person. Don't try to be the nice doctor. When people get anxious or uncomfortable, you know you're on the right track.

 

Go after the anxiety-provoking factors; don't just try to figure out what pill will work for what.

 

 

 

Barriers

People won't talk with you if they are:

 

 

Resources and References

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