- Mood: done.
- Energy: “How is your energy level? Do you feel tired?”
- Concentration: “Do you have difficulty concentrating or making decisions? .. Has there been a change in your memory?.. In what way?”
- Appetite: “Has there been a change in your appetite or weight?..
More or less than usual?”increased in atypical
- Psychomotor:
- Retardation: “Do you feel slowed down/ Dose it take you longer to get dressed?”
- Agitation: “Do you feel restless, agitated?”
- Suicide: “Do you have recurrent thoughts of death or suicide?..
Any attempts to hurt yourself? What have you done?.. When?..
Why.. What was the outcome?….. Any plans now?”
- Bereavement: “As there are many causes to feel sad, I need to ask you, has any close person to you passed away during the last 2 months?”
2. Mania (Feeling high):
“Have others around you noted a persistently elevated, expansive mood, energy, or self-esteem?”
Mania screen. Yes: Explore OSCD PqrST UVW AAA.
- Course: “Is it constantly feeling high(mania) or there are periods that you felt down(Bipolar II)?.. How often does your mood alternate in a year?.. So, it is more(Rapid cyclic)/ less than 4 times a year?”
- Duration: “….., So, you’ve been felling down for less/ more than 1 weeks?(Manic episode)”
- V: “Has it happened before?”... When?”(Yes: Bipolar I disorder, No: Manic episode).
“For how long you’ve been having these episodes on & off?... So, it is more(chronic)/ less than 2 years”
- AAA: “How was your feeling before?...
Does anything happened or changed in your life?...
Are there any stresses at this point in your life?...
Were you taking any medications that you stopped recently?”
- GST PAID: 3 of the 7.
- Grandiosity: “Do you feel you are a very important person with special talents, power, mission, or role?”
- Sleep: “How is your sleep?.. Do you feel you can get by through the day with less sleep than usual”
- Talkative: “Do people say that you are more talkative than usual?”
- Pleasurable activities
Painful consequences: “Do you drink & drive?... Do you use a substance a lot?... Do you spend more than you can afford?… Do you have inappropriate sexual behaviors?”
- Activity: “Do you feel you have increased energy?” … Continued
The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: …. Cont.
- Ideas, flights of: “Are thoughts racing in your mind?.. Do people say you jump from topic to topic?”
- Distractibility: “Do you get distracted easily?”
- Organic causes: STEAM: SLE, Trauma, Endocrine, AIDS, MS 4-
A nxiety:
1. Panic Disorder:
“Have you experienced a sudden onset of intense fear or discomfort?”
“Do you have fear going to closed or crowded places?” Agoraphobia
Panic disorder screen. Yes: Explore OSCD PqrST UVW AAA.
- Timing: “Does it wake you up?”
- AAA:Activity, Coffee, Stress, Places, Situations, meds/drugs.
“How was your feeling before?...
Does anything happened or changed in your life?...
Are there any stresses at this point in your life?...
Were you taking any medications that you stopped recently?”
- STUDENTS Fear 3Cs: 4 of 15 occur abruptly & reach a peak in 10 min.
“Do you sometimes abruptly get: ….
-
S
weating?..-
T
rembling or Shaking?..-
U
nsteadiness or Dizziness?..-
D
erealization:feeling of being unreal?..-
D
epersonalization:feeling of being detached from yourself?..-
E
xcessive heart beat or racing?..-
N
ausea or stomach distress?..-
T
ingling or numbness?..-
S
hortness of breath?..-
F
ear of dying?.. Fear of losing control?.. Fear of going crazy?..-
C
hest pain?..-
C
hoking?-
C
hills or hot flushes?… How long dose it take to reach its peak?”
Followed by more than a month of AWC:
- Anticipatory anxiety: “Do you have a persistent concern of having other attacks?…. For how long?… So, it is more than a month?”
- Worry: “Are you worried about the consequences of the attacks?”
- Changes: “Have you changed your behavior accordingly?”
2. Generalized Anxiety Disorder:
“Are you a person that has an on going excessive worries or fears about several things but can’t control them?”
“What makes you anxious?”
Anxiety disorder screen. Yes: Explore OSCD PqrST UVW AAA.
… Continued
65 The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: …. Cont.
- Duration: “When did it start?… So, it is more than 6 months?”
- What: “What are the thinks that you worry about?”
- BE SKIM: 3 (1 in children) of 6, for 6 months:
- Blank mind: “Do you feel blank minded?”
- Easily fatigued: “How is your energy level? Do you feel tired?”
- Sleep disturbances: “How is your sleep?”
- Keyed up: “Do you feel most of the time you are on the edge?”
- Irritability: “Do you feel irritable?”
- Muscular tension: “Are you having any muscular spasm or pain?”
3. Phobic Disorder:
“Do you have a lot of fear or anxiety of something specific like heights, bridges, snakes, social events?”
Phobia disorder screen. Yes: Explore OSCD PqrST UVW AAA.
- HE Avoids
- “What happens if you are in these places/ situations/ facing these things?”
- “Is your reaction reasonable or excessive?”Realize it is excessive.
- “Are you avoiding these places/ situations/ things?”
4. Obsessive-Compulsive Disorder: WRITE
“Do you have certain thoughts or behaviours over and over that you need to get rid of?”
OCD screen. Yes: Explore OSCD PqrST UVW AAA.
- WRITE
- “What are they?”
- “Are you having repetitive behaviors or mental acts that you feel driven to perform in response to these thoughts?”Compulsions.
Yes: “What are they?.. How frequent do you do them?.. For how long?..”
- “Do you consider these thoughts as intrusive and inappropriate or not?”
- “Are they time consuming, causing distress, and interfering with your normal routine life?”
- “Have you felt that these thoughts & behaviors are excessive or not reasonable?”
5. Post-Traumatic Stress Disorder:
“Have you ever experienced or witnessed a major physical or emotional trauma or stress in your life that made you feel intense fear, horror, or helplessness?”
PTSD screen. Yes: Explore OSCD PqrST UVW AAA.
- Events persistently re-experienced: 1 or more of 5:
1- Recollections of images and thoughts: “Do you recall any images or
thoughts about that event”. … Continued
The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: … Cont.
2- Dreams: “Do you have distressing dreams about that event?”.
3- Flashbacks/ Acting out: “Do you feel yourself sometimes as if you are having the same event again?”
4- Distress at exposure to cues that resemble the events: “Do you feel distressed when you come across something that remind you about the event?”
5- Physiological reactivity in response to cues: “Do you feel your heart racing when you come across something that reminds you about the event?”
- Persistent avoidness of reminding stimuli: 3 or more of 7:
1- Detachment/ emotional numbness: “Do you feel emotionally detached from those close to you?”.
2- Diminished interest in significant activities: “Have you lost interest in activities that were interesting to you?”
3- Inability to recall important elements of the event: “Do you remember every aspect of the event?”
4- Restricted affect: “Do you have feelings towards someone and are you able to express it?”
5- Avoidness of event reminding situations and activities: “Are you avoiding places, people, or situations that remind you of the event?”
6- Avoidness of event reminding thoughts or feelings: “Are you
avoiding thoughts, feelings, or conversations that remind you of the event?”
7- Sense of foreshortened future: “Do you think that you won’t have a normal life as others concerning career, marriage, children, or life span?”
- Persistent increased arousal: 2 or more of 5:
1- Difficulty sleeping: “Do you have difficulty falling asleep or maintaining sleep?”
2- Irritability and anger outbursts: “Do you have periods that you felt irritable or had bursts of anger?”
3- Difficulty concentrating: “Do you have difficulty concentrating?” 4- Hypervigilance: “Do you feel excessively vigilant?”
5- Exaggerated startle response: “Do you get excessively startled by trivial things?”
- Duration: “When did it start?… So, it started more/less than one month ago?”
4- P sychosis:
Schizophrenia: 2 of the followings for > 1 month active phase & residuals for > 6 months.
1. Hallucinations: Auditory, visual, tasting, olfactory.
“Are you sensing things that others think they are not actually there, like seeing, hearing, or smelling things?”
Hallucination screen. Yes: Explore OSCD PqrST UVW AAA.
67 The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: … Cont.
- Duration: “When did it start?... So it is less than a month(Brief
psychosis)/ more than a month but less than 6 months(Schizophreniform)/ more than 6 months?(Schizophrenia)”.
- “What?……. Where?….. When?……”
- If auditory: “Are these voices familiar?... Whose voices are you hearing?. Are they voices of one or more persons talking?. What do they say?”
Diagnostic if two voices conversing to each other or one commenting on his actions: “Are they telling you to do things?... What things?… Are they commenting on your actions?”.
2. Delusions:
“Do you believe that there are unusual things happening concerning you?”
Delusion screen. Yes: Explore OSCD PqrST UVW AAA.
- Non-Bizarre:
- Persecutory: “Are you being followed?”
- Grandiosity: “Are you having special power, task, role?”
- Erotamia: “Are you being loved by another person?”
- Jealous: “Do you think your partner is unfaithful?”
Yes: “When did it start?”non-bizarre for > 1 month: Delusional disorder.
- Bizarre:
- Reference: “Are there events having direct reference to you?”
- Control: “Are you being controlled by some external sources?”
- Thought broadcasting/Insertion/ withdrawal: “Do others know your thoughts?”
- Religious: “Are you having a religious mission or task?”
Yes: “When did it start?” Bizarre: part of schizophrenia.
3. Disorganized: “Do you get agitated, excited, or hostile?”
4. Thought disorder: “Are you unable to think straight?”
- Loss of association.
- Tangentiality: Jumping from subject to another.
- Incoherence
- Neologism (new words) - Though blocking.
5. Negative Symptoms:
- Alogia: Poverty of speech. “Do you have difficulties finding words to explain things?”
- Affective flattening: “Do you have less emotional or inappropriate emotional responsiveness?”.
- Avolition: “Any loss of motivation, drive, initiativeness?”.
- Anhedonia: “Any loss of interest in things were enjoyable to you?”.
- Apathy: Lack of interest in the surroundings: “Have you lost interest in things or activities that where interesting to you?” … Continued
Delusions are
The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: … Cont.
5- C ognitive Disorders:
“Do you have memory problems or forgetfulness?(Dementia), …Do you feel agitated, irritable?(Delirium)”
Cognitive screen. Yes: Explore OSCD PqrST UVW AAA.
- Onset: “How did it start? Was it all of a sudden(Delirium)or gradually?
(Dementia)”
- Course: “Is it getting worse, better or just the same?”
Worse “How fast is it getting worse?”(Slowly progressively: Alzheimer/
Step wise deterioration: Vascular/ Fluctuating: Delirium).
- Duration: “For how long?”(Days-weeks: Delirium/ Months: Dementia).
- Severity:
- Memory: A must for diagnosis.
“Are the memory problems concern recent events or remote ones?”
(Recent/ Remote: Dementia/ Marked recent: Delirium).
- Sleep-wake cycle: “Any sleep problems?…Sleep like on and off?
(Fragmented: Dementia) …Sleep in the morning and awake all night?
(Reversed: Delirium)”
- Behavior: “Any impairment in your daily living activities or using devices or appliances?(Dementia)”
- Cognitive: 1 of 6:
- Liable mood: “Do you have mood swings?….”
- Aphasia: “Difficulty speaking?….”
- Agnosia: “Difficulty recognizing objects…?”
- Apraxia: “Impaired ability to carry out purposeful movement?..”
- Impaired executive thinking: Abstraction/ Planning/ Organizing:
“Impaired ability to plan or organize things?...”
- Judgment impairment: “Impaired ability to make a judgment?...”
- AAA:
- Wandering attention: “Do people tell you, you jump from subject to subject?….”
- Distractibility: “Do you get distracted easily and cannot concentrate?….”
- Disorientation: “Do you get disoriented to places or time easily?….”(to people: Delirium: rarely / Dementia: advanced.)
- Misinterpretation/ Illusion/ Hallucination: “Are you sensing things that are not actually there, like seeing, hearing, or smelling things?”
- Affect: Anxiety/ Fear/ Depression/ Irritability/ Anger/ Euphoria/
Apathy: “Do you feel anxious, fear, depressed, irritable, angry, high, don’t care?”
- Psychomotor activities shift: Picking of cloths/ Attempt to get out of bed/ Sudden movementsThen: Sluggishness/ Lethargy
“Do you sometimes feel slow and other times feel energetic and
want to move around?” …. Continued
69 The History Taking Interview: Station Appropriate Question Box: PSYCHIATRY
Psychiatric appropriate questions: … Cont.
6- Psychiatric V ITALS:
Must ask in all psychiatric cases.1.“Do you have thoughts of hurting yourself?…Any suicide attempts?...Any plans now?”
2.“Have you ever hurt anyone?…Any plans now?” 3.“Have ever had difficulty caring for yourself?”
4.“How has this been affecting you, your relationship, your family, or your work?...What things are you no more able to do?”
Marked distress needed for all psychiatric diagnoses.
7- Psychiatric P ast Hx:
“Any other similar complaints in the past?…Any psychiatric illnesses in the past? … How have you been before this?”
“Any problems with the police or the law?”
8- Family Hx of SADDD :
Suicide, Alcohol, Drugs, Depression, Divorce.“Any family history of suicide?... Alcohol abuse?... Depression?...
Drugs?.... Divorce?”