Past Psychiatric History
This should give a chronological account of the duration, nature and management of all past psychiatric illness. Episodes which were not brought to the attention of doctors or treated should be included. Be sure to inquire about these as it is often the case that psychiatric illness goes unrecognised and untreated [1].
Asking about mental health can be tricky. Here are come carefully phrased questions which delicately probe into a patients psychiatric history.
'Have you ever had any problem to do with your mental state of well being?'
'Have you ever seen anyone because of problems with your inner emotional health or sate of mind?'
'Have you ever suffered from ongoing or severe nervousness, depression, extreme prolonged excitement/elation, an altered sense of reality, seeing/hearing things that others couldn't, alcohol or drug abuse, deliberate self harm, suicide or hospitalisation for any psychiatric illness?' (good screening question)
For each illness the patient has had you will need to find out the symptoms / diagnosis, date, what happened (briefly), hospital / doctor and the outcome. If relevant ask about treatments they have had including non-pharmacological treatments (e.g. ECT, psychotherapy...) and the outcomes. This information could be valuable when formulating the management plan. Specifically inquire about: -
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Treatment
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Compliance
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Benefits
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Side effects
Writing up the Psychiatric History
The style you write up the past psychiatric history depends on its content. Below are a few examples you could use.
Example 1. A short recent history, with only minor unremarkable complaints
| Diagnosis/Symptom |
Date |
Treatment/Effects |
Outcome |
| Insomnia |
Jan '06 |
Diazepam (2wks) caused ataxia |
resolved |
| Phobia (cats) - panic |
Feb '06 |
Hypnotherapy / CBT - Un helpful |
ongoing |
| Mild Depression (low mood, insomnia, low appetite) |
Oct '06 |
Dothiepin - dry mouth, headache |
resolved |
| |
|
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Some mental health patients can have very lengthy past psychiatric histories. If the patient has difficulty remembering all the exact details or you are short of time you can abbreviate this section and include just the following...
| Example 2. Sally |
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|
Past Ψ history
Sally has been diagnosed with Psychotic mania, Schizoaffective Disorder and Bipolar Disorder (rapid cycling).
Between 1988-2009 Sally has had 59 admissions, 32 of which where under section. She has had problems with her concordance and says this is due to the lithium side effects (weight gain, acne with scarring, thinning hair, lip tremor)
(First acute episode) Psychotic mania - Dec 1988
Sally began behaving strangely whist collecting pay for Christmas babysitting work (aged 18). She began shouting loudly, became uncontrollable and expressed grandiose delusions of richness and royal connection. Auditory Hallucinations of "my aunty from Cuba... she was calling out to me to feed her children".
Sectioned at Barkam District Hospital. Given haloperidol and commenced on prophylactic Lithium. She recovered and returned home to live with her mum.
(Most recent episode) Schizoaffective disorder - Jan 2009
Diagnosed after admission to hospital voluntarily - having been found dishevelled, half dressed on a high street, looking disorientated and mumbling incoherently.
Resumed on prescription of Lithium, Sodium Valporate, Olanzopine. Mood resolved.
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1. Stevens, L., Rodin, I., Psychiatry: an illustrated colour text. Harcourt Publishers Ltd., 2001, pp. 7
