The following document was written by Dr Satvir Singh FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry) Kent & Medway NHS and Social Care Partnership Trust Canterbury, Kent in Dec 2007.
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The purpose History Taking in psychiatry or an Assessment Interview is to gather factual information, elicit signs and symptoms of the presenting disorder, along with feelings and emotions and more importantly, establish a rapport and therapeutic alliance with the patient.
The success of psychiatric assessment interview depends on how well the doctor communicates with the patient, how easily he relaxes himself and thus help to relax the patient. And, despite the time constraint, makes his patient feel that he has all the time for the patient and the patient is the most important person at this point in time for him.
Whereas some specific “Question Set” must be asked from almost each and every patient, but it must not be followed in a rigid manner. Ultimately, a successful session leaves a patient satisfied with some hope for recovery and trust in his treating physician.
In medicine and especially in psychiatry, the quality of communication between the patient and doctor is positively correlated with the accuracy of diagnosis made, patient’s understanding of the information given and compliance to the prescribed treatment. Patient’s dissatisfaction with his/her consultation with a physician often results in poor clinical outcome and for some, prompts the start of litigation against the doctor. Essentially, a patient must always leave the consulting room a lot happier than when he/she came in.
This article is mainly written for medical students who are now increasingly encouraged to interview as many patients as possible during their clinical years of training. It is good practice to observe accomplished physicians’ style and the art to elicit key signs and symptoms, and more importantly, how they respond verbally and non-verbally to patients’ complaints, feelings and expressed emotions during the interview.
From here on this chapter would deal only with the key headings of history taking, while the Art of History Taking and Examination would be dealt with elsewhere.
As in any other branch of medicine, we are essentially concerned with the history of presenting problems and the current clinical diagnosis. This follows essential investigations to confirm the most likely diagnosis and also exclude some other possible diagnoses. Then follows the treatment appropriate to the disorder.
In psychiatry, the presenting symptoms are often influenced by various life-events, current social circumstances, support network, relationship with parents, siblings, partners and children. Also, as elsewhere in medicine, family history and past medical history are important not only in making the diagnosis, but also in the management of current disorder.
Most significantly, the patient’s development and personal history, cultural background, family and religious values will influence and modify the presenting symptoms and how these factors are perceived by the patient and his/her family and caregivers. Lastly, it is the patient’s attitude and personality that would determine as to what is required to be done in a given situation and what help and support he or she would be willing to seek.
Thus, it is relevant in psychiatry to spend a good portion of available time to cover all the essential historical life-events in some order.
It is also important to remember that while going through the process of history taking, we will naturally evoke certain behaviour, emotions and responses and gain some understanding into how the patient thinks, perceives and believes. These observations will form the essential part of Mental State Examination, which would be described elsewhere. At this point, however, it is important to note that experienced physicians move backwards and forwards while history taking and ask relevant questions concerning the patient’s history or mental state as and when opportunity arises during the interview. There is a structured approach to a Psychiatric Assessment Interview for history taking and Mental State Examination, which is only known to the physician and not to the patient. Sometimes a patient would be eager to talk about his visual hallucinations within the first few minutes of the interview session, and indeed may not see any relevance with his personal development and employment history. Hence, it is reasonable to concentrate on the psychopathology that the patient is most concerned about and then follow your structured format to complete the history and other parts of Mental State Examination. Quiet listening on the part of the physician also forms a very essential part of a psychiatric interview.
The following are the key headings under which we expect to complete the history taking in psychiatry:
History Taking in Psychiatry continues in History Taking in Psychiatry – 2
Author:
Dr Satvir Singh
FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS
Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry)
Kent & Medway NHS and Social Care Partnership Trust
Canterbury, Kent