History

Begin by explaining who you are, and outlining the purpose, format, and length of interview. For example, shake hands, invite the patient to sit down, and say, 'My name is Paula Johnson. I am a psychiatrist working with your consultant,

Dr Jones. We have about an hour to get an idea of your problems and what help we could offer.' The material may then be presented as follows:

• introduction: name, age, marital status, occupation, where seen, and how referred; for inpatients, legal status: whether informal or on a 'section' of the Mental Health Act 1983 (if so, which one)

• complaints: in patient's own words

• history of present illness:

- symptoms, including changes in sleep, appetite, mood, energy, and concentration

- duration

- possible precipitating factors

- effect of illness on lifestyle, relationships, and working ability

- treatment so far.

(Note: if the disorder is a recurrent one, concentrate on the latest episode here, leaving the rest for 'past psychiatric history'.)

• past psychiatric history: previous episodes of illness with dates, precipitating factors, symptoms, diagnosis, and treatment, plus previous 'sections' under the Mental Health Act, hospital admissions, and episodes of deliberate self-harm

• substance use: alcohol, illegal drugs; any psychological or physical dependency on substances or binge use. Tobacco and caffeine may be enquired into; their use tends to be higher in psychiatric patients, but they are seldom directly relevant to diagnosis or treatment of mental disorder.

• medical history: past illnesses, present physical symptoms, and medication

• forensic history: previous offending behaviour, with any cautions or convictions; attitude to this and presence or absence of remorse; previous sentences if applicable; and any currently outstanding matters, including whether the patient is on probation, parole, or bail, and whether he is subject to an injunction or arrest warrant.

- parents' and siblings' ages, occupation, health, and relationship with patient. If dead, cause of death, age at death, and patient's age at the time.

- family history of psychiatric illness (the term 'nervous breakdown' may be useful), suicide, or alcoholism.

(Note: this section is concerned with family of origin. Spouse and children come later.)

- complications during pregnancy or birth, serious illness in infancy, or delays in development

- home environment: place of birth, subsequent changes of residence, emotional atmosphere and practical circumstances at home, and outstanding events

- school: academic achievements, ability to mix with other children, attitude to teachers.

• work: training and qualifications, jobs held, reasons for change, extent of satisfaction with work and ability to cope, relations with workmates and employers.

- sexual practice: hetero- and homosexual experience, extent of satisfaction, sexual difficulties, and past history of sexual abuse

- marital: duration of marriage/cohabitation; partner's age, occupation, health, and relationship with patient. For any previous marriages or long-term relationships, record duration and reasons for ending

- children: names, ages, health, and relationships with patient

- for women: live births, stillbirths, miscarriages, abortions, contraceptive practice, and menstrual pattern.

(Note: use judgement about the extent of questioning on sexual topics. For some patients, detailed questioning is not relevant and may cause offence.)

• premorbid personality:

- social relations: ability to make friends and relate to those in authority

- mood: cheerful or despondent, anxious or placid, tendency to mood swings, way of expressing anger, and response to stress

- character: confident or diffident, independent or reliant on others, conscientious or casual, and impulsive or cautious

- level of energy and activity

- ways of coping with stress

- attitude to religion, politics, membership of societies, and hobbies.

In some patients, the presenting disturbance is an exaggeration of long-standing personality problems. In others, recent alteration of mood and behaviour suggest psychiatric illness.

(Note: many patients cannot describe their previous personality accurately and an account from another informant is often useful.)

• present circumstances: type of accommodation, people in household, and financial or practical problems.

(Note: parts of the history not concerned with the present illness are called the 'personal history'.)

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