Presenting Complaint

This is "probably the most important part of the psychiatric history" [1] It usually beings by asking the patient what they perceive the main problem is and quoting down the patients own words. Quoting verbatim can immediately provide invaluable insight into the presentation.

Example. 1 James 89 year old male inpatient on a ward who was sectioned after being found wandering and confused. “I am absolutely fine sir, actually I work here…" "I do the odd jobs to keep the place looking nice for the other workers."

Example. 2 Julie 28 year old female presented at A&E with chest pain was given the all clear. “I am always scared about everything nowadays... but I am positive I have a heart disease" "I cant concentrate at work anymore… its also this lump on my neck - I've got a cancer lump" “I am really not coping; I keep seeing doctors who all say nothings wrong with me... it doesn't go away tho..." “I often feel like I am totally worthless I am just a big burden on my husband and son, what's the point of carrying on at all?”

The two examples above demonstrate quite different quotes from patients. Both impart equally important information.

Although example 1 is rather short it tells the reader that this patient is disorientated or deluded as to where he is and why he is there and probably lacks insight into what's wrong with him, suggesting a psychotic or delirious presentation.

Example 2 imparts a list of psychiatric and medical complaints not all linked. The number and nature of the symptoms and the past help sought suggests the patient may have a neurotic / somatoform condition.

When inquiring about the presenting complaint the following mnemonic can be useful to ensure you don't miss out any important information. It is included in the PocketBook - you can download and print out.

Fig.1 'NOT SAD' presenting complaint mnemonic

1. Carlat, D. J. The Psychiatric Interview: a practical guide. Lippincott Wiliams & Wilkins., 1999, pp. 66