History taking in psychiatry

History taking in psychiatry:

History taking in psychiatry Presented by:- Veenu Rani Moderated by:- Prof. Sandhya Gupta CON, AIIMS

introduction:

introduction different from other medical disciplines to obtain information about the patient’s problems both physical and psychological, and their life-long experiences interests and hobbies, problems, interpersonal or intrapersonal difficulties, job-stresses and their miscellaneous problems

Setting of environment: :

Setting of environment: Separate room, where repeated interruptions should not take place. no overhear of the conversation. Seating arrangement could be around a table. It is better to seat the patient on the right-hand side of the table. The table should not have loose objects which could be used by the patient as missiles. The chairs should be comfortable. If any recording device is used, the patient should be informed. If the patient refuses the use of recording devices, he must be convinced for its need.

Type of patient: :

Type of patient: The patient who has sought consultation himself The patient who has been brought by his family members against his wish. The patient who are referred by other agencies like the police, employers or by the other doctors.

Objectives of history taking:

Objectives of history taking To describe patient’s condition, family, development and factors affecting his or her behavior. To find out predisposing cause and primary cause for his or her behavior. To make nursing diagnosis. To plan nursing interventions . To know about the prognosis & course of illness

Steps of history taking:

Steps of history taking

Identification data: :

Identification data: Name, age, sex, education, occupation, income, residential address, office address, language, nationality, date of admission, marital status, provisional diagnosis, informant, identification mark.

Name of informant and their relationship with the patients. :

Name of informant and their relationship with the patients. Name of informant Their relationship Reliability Duration of stay with the patient Chief complains: As experienced by patient(in verbatim) with duration. As described by patient’s relative.

History of present illness: :

History of present illness: Time and type of illness: Acute onset Sub acute onset Insidious onset Imp:- Present episode of illness should have been clearly separated from other episodes by a period of 3 months of symptom free period.

Continued………………..:

Continued……………….. Prodromal symptoms : Some minimal changes in behavior prior to the development of clear-cut symptoms. Change in daily routine Poor appetite Disturbance in sleep Lack of interest in work or studies Irritability

Continued………………:

Continued……………… Precipitating factors : Stressors Operating period of stresses prior to onset of disease Enquire about who all are living at home at that time, employment, job satisfaction.

Continued………………:

Continued……………… Development of symptoms : Quality(severity) Duration Frequency Distress caused by it Presenting symptoms can be manifestation of other psychiatric disorders.

Continued……………………:

Continued…………………… Treatment taken and response : Drug Dosage Duration Patient’s compliance Response: history of weight loss, menstrual difficulties, sleep disturbances

Past medical history: :

Past medical history: Prolong physical illness Tuberculosis, hypertension, epilepsy, prolong fever, DM, etc. Neurological illness Head injury and other illness(which may associated with psychiatric dysfunctions)

Past psychiatric history: :

Past psychiatric history: Time of onset and duration Symptomatology Treatment and response Interval period

Family history: :

Family history: Pedigree chart showing the patient, his siblings, parents and grandparents on both sides Any evidence of mental illness in family Supportive Censoring and disruptive Neutral Family interaction with patient(childhood and current)

Family support system: :

Family support system: Any familial assests Personality of parents and significant others Socio-economic status Income(total) Occupation of employed members of family

Personal history::

Personal history: Birth & oral development- Record the details of prenatal, natal & postnatal periods. As Certain whether milestones of development were normal or delayed. Behavior during childhood- enquire about------ Sleep disturbances, thumb-sucking, nail-biting, tamper tantrums, bed-wetting, stammering, mannerism. Conduct disturbances in form of frequent fights, truancy, stealing, lying & gang activities. Relationship with parents, siblings & peers.

Personal history continued………:

Personal history continued ……… Physical illness during childhood School Occupation Menstrual history Sexual history Marital history Use & abuse of alcohol

Premorbid personality::

Premorbid personality: Social relations Intellectual activities Mood Character Attitude Interpersonal relationships Standards Energy and initiative Fantasy life-frequency and content of day dreaming Habits

Check list: :

Check list: To cover all items of history adequately

Thank you:

Thank you