Psychiatric History

0:00 this talk is about how to complete an initial psychiatric history interview I'll teach you how to complete the interview using a simple visual organizer the four major components of the interview are the psychiatric review of symptoms represented here in the top left psychiatric history in the bottom left Social history in the top right and formulation in the bottom right note that this does not include the history of present illness which should be included prior to this part of the interview we'll start in the top left with the review of symptoms the four symptom clusters you should usually ask about are represented here with a pneumonic damp depression anxiety Mania and psychosis starting with depression you can use the pneumonic sigy caps to ask about the symptoms of a major depressive episode this is also a good time to ask

0:47 about suicide risk factors including prior suicide attempts prior non-suicidal self-injurious behavior and access to Firearms next is anxiety you can use the pneumonic worry warts to ask about the symptoms of generalized anxiety disorder this is also a good time to ask about panic attacks next is Mania you can use the pneumonic Dig Fast to ask about the symptoms of a manic episode since you'll be asking about outof character and risky behaviors this is also a good time to screen for homicidal ideation finally is psychosis some of the core symptoms of psychosis can be determined through your mental status exam for example disorganized thinking disorganized behavior and negative Sy symptoms therefore focus on asking about hallucinations and two of

1:34 the most common kinds of delusions in psychosis ideas of reference and paranoia next we'll move to the bottom left with the psychiatric history in this section you should ask about prior psychiatric diagnosis and prior psychiatric medication trials you can use the pneumonic meds to ask about some of the more useful aspects of a prior medication trial including the maximum dose that the patient ever received the efficacy of the treatment or how effective it seemed to be in treating the patient's symptoms the duration of treatment or how long they were taking the medication and any side effects of the treatment asking these questions will help you to determine if the patient actually had adequate Trials of these medications and to know how well they were tolerated next ask about any past inpatient psychiatric treatment here

2:21 it's important to know the approximate dates of admission and the indications for which they were admitted next ask about Outpatient Psychiatric treatment including who is prescribing them medications who is providing them therapy and any intensive outpatient or partial Hospital program treatments they've had in the past finally ask about family history of mental illness and any problems the patient has had in the past with substance use as well as their current use of substances next we'll move to the top right with the social history here you should ask about their living situation and who their social supports are their employment and education history and their Developmental and Trauma history history I should note here that in an initial interview before you've had a chance to develop long-standing rapport with a patient you don't need to ask about

3:08 sensitive details of past trauma typically when I'm screening for trauma in an initial interview I simply ask about major categories of trauma including physical trauma sexual trauma and emotional trauma and I don't ask the patient to go into more detail than that what's more important at this point in formulating a diagnosis is to ask about trauma related symptoms which are represent ad here with the pneumonic hard finally in some cases it's important to ask about legal and military history in this section you should also complete a brief medical history including relevant chronic illnesses current medications and allergies to medications and complete a physical review of systems as you would during any medical interview the bottom right is a section reserved for you to keep notes about the mental status exam

3:54 and any ideas you have about the diagnosis formulation or plan for the patient here's the complete organizer feel free to use this to structure your own interviews note that interview scenarios in Psychiatry can differ greatly from one patient to the next and you may need to be flexible in how you structure your interview jumping between the different sections gaining more detail on particular topics or omitting certain parts altogether My Hope Is that this organizer will help you to remain structured even when you're taken on tangents with time and practice you will develop your own style of performing a thorough concise and compassionate interview thank you