Towards the end of enquire interview,the student/doctor should give the patientsome indication that the interview is drawing to a close.This can be done his/her timeand cooperation.This can be done bythe patient that there a few minutes left,and thatthere are one or twopoints that you would like to clarify.Time must always be allowedforthe patient to voice any queries and forthese queries tobe answered. Itis besttoask,“beforewe finish...is there anythingyouwould liketo ask me?'.Ifthepatient asksa question that you cannot answer, for example about treatment, it is important totellthepatient that you will pass on his/her concerns to theappropriate person (e.gregistrar).Itis important that youdo pass on these concerns,as patients willsometimes tell medical students or relatively junior doctors about worries that theyhave not revealed to other members of staff.At the very end of the interview, itisimportanttothankthepatientforhis/hertimecooperation
• Towards the end of enquire interview, the student/doctor should give the patient some indication that the interview is drawing to a close. This can be done his/her time and cooperation. This can be done by the patient that there a few minutes left, and that there are one or two points that you would like to clarify. Time must always be allowed for the patient to voice any queries and for these queries to be answered. It is best to ask, ‘before we finish. is there anything you would like to ask me?'. If the patient asks a question that you cannot answer, for example about treatment, it is important to tell the patient that you will pass on his/her concerns to the appropriate person (e.g. registrar). It is important that you do pass on these concerns, as patients will sometimes tell medical students or relatively junior doctors about worries that they have not revealed to other members of staff. At the very end of the interview, it is important to thank the patient for his/her time cooperation
FormatofapsychiatrichistoryPresenting complaintandhistoryof presentingcomplaintThe main purpose of the first part of thepsychiatric history is to establish the nature ofthe psychiatric condition.It should start with the presenting complaint and the history ofthepresenting complaint. It is helpful to focus upon the patient's main symptom beforemovingon toassociated symptoms.Ifthepatient's mainsymptomis depression,afullhistory of thedepression should be elicited beforemoving onto enquire about othersymptoms associated withdepression,suchas poor concentration or sleeploss.Auseful analogy is to thinkabout taking ahistory of chest pain. If a patient presents withchest pain, it is usual to establish the nature of the pain,its quality,severity,consistencyduration,radiation, relieving and exacerbating factors.It would be unusual to ask aboutankle swellingbefore onehad a clearhistoryofthe painitself.Students,howeveroftenaskoneortwoquestionsaboutdepressionandthenmoveontoothersymptomswithout establishing a clear picture of the nature and severity of the mood state itself
Format of a psychiatric history • Presenting complaint and history of presenting complaint • The main purpose of the first part of the psychiatric history is to establish the nature of the psychiatric condition. It should start with the presenting complaint and the history of the presenting complaint. It is helpful to focus upon the patient’s main symptom before moving on to associated symptoms. If the patient’s main symptom is depression, a full history of the depression should be elicited before moving on to enquire about other symptoms associated with depression, such as poor concentration or sleep loss. A useful analogy is to think about taking a history of chest pain. If a patient presents with chest pain, it is usual to establish the nature of the pain, its quality, severity, consistency, duration, radiation, relieving and exacerbating factors. It would be unusual to ask about ankle swelling before one had a clear history of the pain itself. Students, however, often ask one or two questions about depression and then move on to other symptoms without establishing a clear picture of the nature and severity of the mood state itself
Only after a clear accountofthe main symptom has been obtainedshould the interviewer move onto associated symptoms.Basic knowledgeabout the different psychiatric syndromes is required to be able to checkwhether specific symptomsthatmaybeexpected inacertain conditionarepresent.Afterthesymptomatology hasbeen established,it is usual toenquirewhether there were any changes in the patient's circumstances prior to theonset of the disorder.Some people themselves will identify an importanteventthatmayhaveprecipitatedtheirillness;othersmayhave experiencedsuchaneventbutnotmadea connectionbetweentheevent andthelateronsetoftheirillness
• Only after a clear account of the main symptom has been obtained should the interviewer move on to associated symptoms. Basic knowledge about the different psychiatric syndromes is required to be able to check whether specific symptoms that may be expected in a certain condition are present. After the symptomatology has been established, it is usual to enquire whether there were any changes in the patient’s circumstances prior to the onset of the disorder. Some people themselves will identify an important event that may have precipitated their illness; others may have experienced such an event but not made a connection between the event and the later onset of their illness
PastpsychiatrichistoryIt is logical to enquire about previous episodes of illness,after one hasdiscussed thepatient's current problems.All contacts with psychiatricservices should be recorded including details of the nature of the illnessand the kinds of treatment that the patient received. Treatment ofpsychological illness in primary care should also be recorded. It is helpfultoestablishwiththepatientwhether thecurrent illnessis similartoprevious episodes or whether there are significant differences either in theseverity ornature ofthecondition
Past psychiatric history • It is logical to enquire about previous episodes of illness, after one has discussed the patient’s current problems. All contacts with psychiatric services should be recorded including details of the nature of the illness and the kinds of treatment that the patient received. Treatment of psychological illness in primary care should also be recorded. It is helpful to establish with the patient whether the current illness is similar to previous episodes or whether there are significant differences either in the severity or nature of the condition
FamilyhistorydAhistory of psychiatric and medical illness in the patient's nearestrelatives should be elicited.Any deaths should be recorded and how thepatient dealt with those deaths should be described.The degree of contactwith surviving relatives should be noted and the quality of patient'srelationships with parental figures,whena child,should be describedRelationshipswithsiblings should alsobebriefly described
Family history • A history of psychiatric and medical illness in the patient's nearest relatives should be elicited. Any deaths should be recorded and how the patient dealt with those deaths should be described. The degree of contact with surviving relatives should be noted and the quality of patient’s relationships with parental figures, when a child, should be described. Relationships with siblings should also be briefly described