The following document was written by Dr Satvir Singh FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry) Kent & Medway NHS and Social Care Partnership Trust Canterbury, Kent in Dec 2007.
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HISTORY TAKING IN PSYCHIATRY Ė 2

Introduction

This section deals with the details of Psychiatric Assessment Interview, concentrating only on the history taking.

It is important in psychiatry that we also obtain an objective account of the patientís presenting problem from other independent sources. However, this must be cleared with the patient in advance. Often, a family member of patientís choice, a GP, a close friend or a work colleague may be a good source to obtain additional information about the patientís current health issues as well as their views about the current presenting problems and possibly, the underlying causes as they understand it. Family members, spouse or parents are a good source of information about the patientís pre-morbid personality, habits, relationship issues and other areas such as dependency on drugs, alcohol, financial difficulties and any current or past forensic history, which a patient may not always disclose to the treating physician.

Often, medical students or Accident & Emergency doctors may not have the opportunity or time to explore the patientís history from other sources, but they must always mention this important aspect of history taking while formulating their case and highlight the need to do so at a later stage by themselves or through other health professionals.

Obtaining history from another appropriate source serves very many important purposes.

  1. Firstly, it gives further insight into the patientís illness and personality and other relevant psychosocial issues.

  2. It helps the patient psychosocially by knowing that a professional has formally involved members of his family and briefed them about the nature of his illness and the proposed treatment Ė of course, with the patientís consent.

  3. From the familyís point of view, they now understand the medical reasons for their loved oneís somewhat abnormal behaviour and the expected treatment outcome.

  4. Furthermore, members of the family feel involved in patientís care and thus not so guilt ridden as they often unconsciously feel and blame themselves for their partnerís or childís ill health.

In my opinion, we should always aim to include at least one close member of the family, or another person of patientís choice, to complete the history taking in psychiatry.

Following is the standard schema for history taking in psychiatry:

1. Personal Details and Reasons for Referral:


2. Place of interview, by whom, date and time, and who else was present


3. History of the current problems


4. Past Psychiatric History


5. Past Medical History and Current Status


6. Family History


7. Personal History


8. Social History


9. Forensic History


10. Pre-morbid Personality


11. History as given by others


The Process of History Taking is dealt with in the next section:
History Taking in Psychiatry Ė 3

Author:
Dr Satvir Singh
FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS
Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry)
Kent & Medway NHS and Social Care Partnership Trust
Canterbury, Kent


References:

  1. Companion to Psychiatric Studies, Eve C Johnstone, et al, 1998
  2. Shorter Oxford Textbook of Psychiatry, Fifth Edition, M Gelder et al, 2006


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