The document provides an overview of history taking in psychiatry. It discusses the importance of the psychiatric interview and outlines key elements that should be covered, including identifying data, chief complaint, history of present illness, past psychiatric history, medical history, and more. Specific considerations for interviewing children and geriatric patients are also reviewed. The goal of the psychiatric interview is to gather information to make an accurate diagnosis and guide treatment planning.

1. HISTORY TAKING IN
PSYCHIATRY
Presentation -DR ANJALI S
Chaired by – DR NISHA A

2. OVERVIEW
1. INTRODUCTION
2. INTERVIEW TECHNIQUE
3. ELEMENTS OF INTIAL PSYCHIATRIC INTERVIEW
4. HISTORY TAKING IN CHILDREN
5. HISTORY TAKING IN GERIATRICS
6. REFERENCES

3. 1.INTRODUCTION
• The psychiatric interview is the most important element in the
evaluation and care of persons with mental illness
• The purpose of a diagnostic interview is to gather information that
will help the examiner make a diagnosis, which guides the
treatment.
• The psychiatric diagnosis are based on descriptive phenomenology.
• The psychiatric examination consists of two parts- psychiatric
history and mental status examination

4. PURPOSE
• To describe adaptive and maladaptive behaviour
• To formulate priorities and to identify problems
• To establish a criteria based diagnosis
• To predict course of illness and prognosis leading to
treatment decisions
• To predict probable responses to potential interventions
• To analyse the client’s perceptions
• Develop person centered care plan

5. 2.INTERVIEW TECHNIQUE
• The psychiatrist should introduce themself and,
depending on the circumstances, may need to identify
why one is speaking with the patient
• A Patient centered and consistent Scheme with
flexibility and circumstance.
• Patient should be seen first and statements of patient
and informant should be recorded separately

6. • Patient should be put at ease and warm, empathic
relationship should be established
• The interviewer must observe the abnormalities in
verbal and non-verbal communications
• Record the patient’s responses verbatim
• Ask open-ended and non-directive questions
• Attend and listen carefully
• Avoid interrupting

7. Privacy and Confidentiality
• Confidentiality is an essential component of the patient–doctor
relationship
• The interviewer should make every attempt to ensure that the
content of the interview cannot be overheard by others
• Some evaluations, including forensic and disability evaluations,
are less confidential and what is discussed may be shared with
others
• A special issue concerning confidentiality is when the patient
has homicidal/suicidal risk; cases of child abuse.
• The psychiatrist may have a legal obligation to warn the
potential victim

8. RAPPORT EMPATHY
Harmonious responsiveness of
physician to patient and the
patient to physician
Understanding what the patient
is thinking and feeling and
occurs when the psychiatrist is
able to put oneself in the
patient’s place while at the same
time maintaining objectivity
Empathic interventions further
increase the rapport
THERAPEUTIC ALLIANCE

9. The Interview Room
• Should be relatively sound proof
• The decor should be pleasant and not distracting
• the interviewer’s chair and the patient’s chair be of relatively
equal height so that the interviewer does not tower over the
patient
• Seated approximately 4 to 6 feet apart
• Unless there is an urgent matter there should be no telephone
or beeper interruptions during the interview

10. Safety and Comfort
• Both the patient and the interviewer must feel safe
• Emergency room settings: may require other staff being present or
the door to the room where the interview is conducted left ajar
• Psychotic or confused patients need to be reassured that they are
safe and the staff will do everything possible to ensure their safety
• the interviewer should inquire about the patient’s comfort and
continue to be alert to the patient’s comfort throughout the
interview
• It is generally advisable for the interviewer to have a clear,
unencumbered exit path
• The interview may need to be shortened or quickly terminated if the
patient becomes more agitated and threatening

11. Time and Number of
Sessions
• For an initial interview, 45 to 90 minutes is generally allotted
• In patients on a medical unit or who are confused/considerable
distress/ psychotic, the length of time that can be tolerated in one sitting
may be 20 to 30 minutes or less ( a number of brief sessions may be
necessary)

12. 3.ELEMENTS OF THE INITIAL
PSYCHIATRIC INTERVIEW
• Identifying data
• Source and reliability
• Chief complaint
• Present illness
• Past psychiatric history
• Past medical history
• Developmental and social history
• Family history
• Educational history
• Occupational history
• Menstrual-Sexual-martial
history
• Premorbid personality
• Mental status examination
• Physical examination
• DSM multi axial diagnosis
• Treatment plan

13. IDENTIFYING DATA
• Name
• Age
• Gender
• Education
• Occupation
• Marital status
• Socioeconomic status
• Religion
• Place
• Language
• Informant
• Reliability
• Date of admission
• Mode of admission
(voluntary /not)
• Hospital number
• ?Referred case

14. INFORMANT
• The source of information
• Informant’s name
• Relation to the patient
• Reliability of the sources
• Intimacy with the patient
• Degree of concern regarding patient
• Does he/ she live with the patient
• Duration of stay
• Intellectual or observational ability

15. CHIEF COMPLAINT
• 3-4 main complaints ideally in patient’s own words
• At least one biological function
• Duration of onset
• Mode of onset
• Course – continuous / fluctuating /episodic
• Precipitating factors

16. HISTORY OF PRESENT ILLNESS
• Chronological description of evolution of the symptoms
• Changes in the patients interests, interpersonal
relationships, behaviors ,personal habits
• Duration of symptoms & fluctuations in the nature or
severity of symptoms
• Presence or absence of stressors
• Factors that alleviate or exacerbate symptoms
• Treatment history (for current episode)

17. .
• Let the patient speak uninterrupted for the first few minutes before
continuing questioning.
• Use open-ended questions to elicit these
• All patients should be asked about suicidal ideation, depression,
obsessional behaviour and psychosis
• When did the problem start?
• Has it changed over time? If so how?
• Were there any precipitating events?
• Any other psychological symptoms?
• Any physical symptoms, e.g. disturbance of sleep or appetite,
diurnal mood variation?
• Any psychological/drug treatments for the current problem? If
so, did they help?
• Screen for any other problems.

18. PAST PSYCHIATRIC HISTORY
• Psychiatric illnesses and their course over the patient’s lifetime,
including symptoms and treatment
• Description of past symptoms should include when they occurred,
how long they lasted, and the frequency and severity of episodes
• Past treatment episodes should be reviewed in detail
• should explore what was tried ,how long and why they were
stopped
• Any side effects
• Drug compliance
• Legal Complications

19. • Past suicidal ideation, intent, plan, and attempts should be
reviewed including the nature of attempts, perceived lethality
of the attempts, save potential, suicide notes, giving away
things, or other death preparations.
• Substance abuse-
• Substance used
• Routes of use
• Frequency & amount of use
• Tolerance , need for increasing amounts
• Any withdrawal symptoms
• Determine abuse or dependence

20. PAST MEDICAL HISTORY
• History of medical/neurological illness; surgical procedures, accident
or hospitalization.
• Past history of etiological causes such as head injury, convulsions,
unconsciousness, DM, HTN, CVA, CAD, STDs, Cancers etc.
• Allergic history
• Medical illness that can
precipitate a psychiatric disorder :- Cancer- Anxiety,depression
mimic a psychiatric disorder :- Hypothyroidism-depression
Hyperthyroidism-anxiety
influence the choice of treatment :- CKD/hyponatremia and lithium carbonate
precipitated by a psychiatric disorder or
its treatment :-
Metabolic syndrome -2nd gen anti psychotics

21. FAMILY HISTORY
• Many psychiatric illnesses are familial and a significant number of
those have a genetic predisposition
• Family tree and details
• Joint/ nuclear/ extended
• Consanguinity
• Psychiatric illness, substance use disorders, suicide ,ID ,seizures ,
dementia
• Medical illnesses present in family histories may also be important
• Family traditions, beliefs, and expectations also play a significant role
in the development, expression, or course of the illness

23. PERSONAL HISTORY
• Birth and development
• Any antenatal or perinatal complications
• Developmental milestones
• Childhood health and adjustment(illness, parental lack, home
situation)
• Childhood neurotic traits /ADHD /conduct symptoms/temper
tantrums
• h/o substance abuse in parents/care taker for co-dependence

24. EDUCATIONAL HISTORY
• Age of starting and finishing
• Last class studied
• Academic performance
• Disparity in patient’s educational achievements compared to siblings
• Relationship with teachers and peers
• Reasons for drop out
• Other achievements , games, hobbies

25. OCCUPATIONAL HISTORY
• Age of starting work
• Chronological lists of jobs
• Reasons for change/loss of job
• Present occupation
• Relationship with superiors and co-workers
• Job satisfaction and dissatisfaction
• Reasons for dissatisfaction

26. SEXUAL AND MARITAL HISTORY
Menstrual History–
• Age of menarche
• Puberty
• Regularity of menses
• Obstetric history
• Use of contraceptives
• Perimenopausal period
• Age of menopause
• Symptoms associated with
menopause
Sexual History-
• sexually active or not
• Attitude towards sex
• Masturbation
• Libido
• Homo/heterosexual
• Number of partners
• Sexual perversions
• Dysfunction/risk behaviours
• Sexual life satisfactory/not
Marital history-
• Age of marriage
• Spouse-age,education,occupation
• Marital life satisfactory/not
• Sexual adjustment
• Sharing of responsibility
• Miscarriages
• Children
• Attitude towards children

27. PREMORBID PERSONALITY
• refers to the state of functionality prior to the onset of disease
• Obtained from patient's own description and from other people
accounts.
INCLUDES
• Social relations ,use of leisure time
• Intellectual activities , hobbies & interests
• attitude to family members,peers,work & responsibility
• interpersonal relationship, moral,religious,social health standards
• Fantasy life,habits,reaction pattern to stressors, prominent traits
• temperamant

28. 4.HISTORY TAKING IN CHILDREN
• Identifying data
• DOB
• Class of study
• School, syllabus
• Presenting c/o & HOPI
• Past history
• Family history
• Type of parenting (consistent /inconsistent)
• Education and occupation of parents
• Parenting style & disciplining
(permissive/authoritarian/autocratic)
• Conflicts or separation among parents
• co-dependence
• Grand parenting
• Personal history
• Birth, perinatal details
• Birth weight
• Developmental milestones
• Academic history
• Premorbid Temperament

29. TEMPERAMENT
• Its ones nature; usual way of thinking and acting ;the behavioral style of responding to
the world.
• A child displays temperament style from birth.
• Are instinctive(natural) than learned behaviours.
• They control our actions and behaviours and have its own strength and weakness
• It is influenced by 9 temperament traits and each trait has a range of levels, and
temperament reactions will vary depending upon the strength of each trait.
• Has association with anxiety and mood disorders
• Need to be assessed if the patient is below 18yrs or onset of illness is before 18yrs

30. Temperament
• Innate, biological patterns of
behavior & emotional response
over which our personality
develops
• present since birth and remains
stable throughout life
Personality
• The set of characteristics,
behaviors, and thinking patterns
that are developed when
exposed to environmental /social
factors.
• It is shaped by life experiences,
cultural background, upbringing,
and life choices and also by
temperament style.

31. TRAIT DEFINITION RANGE
ACTIVITY Energy level and amount of movement Energetic vs. Sedentary
REGULARITY Natural patterns and schedules for biological functions
(ex. sleeping, elimination, eating).
Predictable vs. Variable
INTIAL REACTION Reaction to new people and situations. Open vs. Hesitant
ADAPTABILITY Ability to adjust to changes Accommodating vs. Resistant
INTENSITY Emotional response to events. Exuberant vs. Lethargic
MOOD
Typical emotional outlook.
Positive vs. negative
DISTRACTABILITY Ability to focus. Attentive vs. Sidetracked
PERSISTANCE-ATTENTION
SPAN
Ability to stay with an activity Immersed vs. disinterested
SENSORY THRESHOLD Reaction to sensory stimuli. (ex. texture, touch,
brightness, volume, taste, aroma)
Unaffected vs. Irritated

32. 5.HISTORY TAKING IN GERIATRICS
• Best place –Patient’s home(relaxing & to assess living conditions, social activities)
• Independent History from patient, family members and care givers
 Preliminary identification(name,age sex,etc.),chief complaint,HOPC,past history,
Childhood and Adolescent h/o(personality ,coping and defence mechanism),
Personal h/o ,family h/o..
 Enquire about losses, social history and social circumstances; family support
 Activities of daily living- level of independence
 Current social situation

33. • Patient's parents attitude and adaptation to old age, their COD
• Patient's parent-child relationship
• Patient’s attitude to old age
• Financial history-to asses economic hardship to patient and for realistic
treatment recommendations
• Marital history-Description about partner and relationship
-How Bereavement grieving handled
• Sexual symptoms-impotence, anorgasmia
• Care taker of patient
• ?mistreatment/abusive/neglect behaviour

34. QUESTIONS TO CARE TAKERS
• Relationship with the patient
• amount of care provided
• Degree of stress they are under
• Understanding and knowledge about patients illness
• What help they needed?

35. 6.REFERENCES
• Sadock B,Sadock V,Ruiz P.Synopsis of Psychiatry.11th ed.
Philadelphia:Lippincott Williams &Wikins;2015
• Allan Tasman, Jerald Kay, Jeffrey A. Lieberman.Psychiatry.4th edition
• Karam, E.G., Salamoun, M.M. & Yeretzian, J.S. Temperament and
psychiatric disorders. Ann Gen Psychiatry 7 (Suppl 1), S18 (2008)
• Femi Oyebpde;SIMS symptoms in mind; Textbook of Descriptive
psychopathology;5th edition
• Davind Semple,Roger Smith.Oxford Handbook of psychiatry.2nd edition
• Neeraj Ahuja ;A short textbook of psychiatry,20th year edition
• Claudia C. Mincemoyer et al. (2016). Departments of Human Services and
Education. The Pennsylvania State University.
https://extension.psu.edu/programs/betterkidcare

36. THANK YOU

42. Not valid for other substance abuses
Modified CAGE for others.

43. One yes indicates a possible alcohol abuse.