Psychiatry Made Easy

History Taking Technique Using Life Event Chart

Dr Norzila ZakariaUniversiti Sains Malaysia

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Introduction

Taking psychiatry history is not an easy task. Many new students find it difficult to get important history that lead to a diagnosis. Sometimes they do not know how to take the important history as the history is too long.

A simplified way to ask history and working towards the diagnosis is shown in this method.

There are two parts in this method.

History taking template

Life event Chart

Practical section

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1.History taking template (page 1)

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Name:Age:Sex:Occupational:Relevant psychiatry history:Underlying medical problem:

Medication taken:

Differential Diagnosis:

Provisional Diagnosis:

Timeline

Symptom

Treatment

Function

Chief Complaint/s: Must be towards the diagnosis you want to sell

Example of Life Event Chart

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(Page 2)

Relevant Past medical History

Relevant Past Surgical History

Past psychiatry History Family History

Note: *All past medical/ surgical/psychiatry history can be extracted from the mood chart

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( page 3)

Note: * Family history and social history must be related to the predisposing, precipititating, perpetuating and protective factors

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Relevant Social History Differential Diagnosis:

Diagnosis Points For Point againts

Provisional Diagnosis:

(page 4)

Analysis of the problem

Provisional Diagnosis Predisposing factors Precipitating factors Perpetuating factors Protective factors

Axis I: All diagnostic

categories except

mental retardation

and personality

disorder

Axis II: Personality

disorder and mental

retardation

Axis III: General

medical condition;

acute medical

conditions and

physical disorders

Axis IV: Psychosocial

and environmental

factors contributing to

the disorder

Axis V: Global

Asessment of Functioning

Extract from

family history/support

socal history

belief system

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(page 5)

Management

Management Biological Psycho social and spiritual

Investigation Blood

Radiological

Verify history from family members and related people (with patient’s consent)

Review old notes/medical report from previous hospital admissions

Assess support: Family, financial, spiritual and belief system

Treatment Pharmacological

Antipsychotic

Antidepressant

Anxiolytic

Sedative hypnotic

Other treatment from other discipline

Psychoeducation:

Important to engage with the patient and family members Advice on pharmacotherapy:

o side effect /complianceo drug interactiono what to do if ran out of medicationo Telefon number to be contacted if emergency (clinic, emergency department)

Advice on relapse symptomso Getting early appoinment/emergency/admission

Referral to other disciplines (medical, surgical etc)

Follow up clinic, rehabilitation, day care activity, transportation assisstance

Referral to social welfare department for financial assistance/ finding job/ assisst in any difficulties

Spiritual advice and discussion

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How to use History Taking Template

It is simple:Interview your patients , develop rapport and find what is the chief complaint.

Write any of important finding in the respective columns that you have prepared.

At any time you want to know more detail, inform the patient and get the detail. Record in the area specified.

The concept: Let the patient talk and get the important points, fit them in the history taking template accordingly.

Then only clarify and get more detail.

With this method, you will notice that you have improve your interviewing skill and know where to get more detail information.

Presenting a psychiatry caseIt is important that you practice to present the case to make yourself fluent.

Tips:

Use your own script for each section Example: Introduction

When you present the introduction section, the examiner should get the overall idea of what is the problem of this patient. It is more or less like the formulation in short.

I am presenting Mr A who is a 45 years old Malay gentleman, a divorcee with 5 grown up children, staying with his eldest son. He is not/known to have psychiatry problem for the past 15 years and currently on Tab. B, Tab C and Tab D. He is also not/known to have any/several admission to psychiatry ward due to poor compliance to medication and follow up. He is also known to have multiple medical problem namely diabetis, heart disesase and rheumatoid arthritis.

He was admitted one week ago, brought to the casualty department by his son with chief complaints of not sleeping well for the past one week, being irritable at home for the past 3 days and aggressive behaviour on the day of admission.

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Lets analyse this text

I am presenting Mr A who is a 45 years old Malay gentleman, known to have psychiatry problem for the past 15 years and currently on Tab. B, Tab C and Tab D. He is also known to have several admission to psychiatry ward due to poor compliance to medication and follow up. He is also known to have multiple medical problem namely diabetis, heart disesase and rheumatoid arthritis.

He was admitted one week ago, brought to the casualty department by his son with chief complaints of not sleeping well for the past one week, being irritable and talking to himself for the past 3 days and aggressive behaviour on the day of admission.

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Biodata of the patient is very important

This is to show that he is a known case of chronic psychiatry problem

Mode of admissionYou want o sell the diagnosis of....... ?

Relevant medical problem

Possible precipitating factors: why he is sick now

Practice and practice

Practice present your patient history, make sure your chief complaint/s is/are towrads the diagnosis you want to sell

Example 1:

Stripped naked and increase in sexual drive past 2 days

Feeling very energetic past 5 days

Selling a diagnosis of Bipolar disorder in manic state

Example 2:

Feeling sad for the past one 1 month

Frequent awakening for the past 3 days

Intention to die past 2 days

Selling a diagnosis of Major depression with melancholic features

Example 3:

Sudden palpitation without any obvious reasons past 3 months

Feeling like getting a heart attack past 2 weeks with 3 visits to the emergency department

Selling a diagnosis of panic attack

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Example: History of presenting illness

Mr A was apparently well until about one month ago when he ran out of his medication. He started to have difficulty in sleeping in which he sometimes woke up several times at night and worsening for the past one week in which he was not able to sleep at all. He was also noted to be talking to himself and scolding his son and grandchildren for no reason. He admitted to hear a female voice commenting on his life and accusing him as “dayus”. He was very angry with the voice and started to become irritable.

On the day of admission he was noted to carry a parang and shouted “kalau berani mari datang, jangan kata aku dayus!”, looked very angry and did not respond to any persuasion by the family members. With the help of several people, the son managed to restrain him and brought him to the hospital.

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