psychiatric history

Last reviewed 01/2018

The psychiatric history has many similarities to the medical history. It is a concise recounting of the psychiatric problems that have led up to the current presentation in a manner that makes sense of the information. Initially the patient is given time to talk and the doctor asks only open questions. As hypotheses begin to be generated the clinician will begin to ask directive questions to test the possible diagnoses.

It is important to achieve a clear description of both the present complaint and the timecourse of the psychiatric disorders that have preceded the consultation. A corroborative history from a friend, relative or other professional may be helpful. Showing empathy towards the patient will improve the quality of the history.

Psychiatric signs are obtained from the mental state examination which represents a "snap shot" of the patient's mental state.

Cognitive testing, often using the mini mental state examination, may provide evidence of impaired congition.

Finally, investigations may be requested to test some psychiatric diagnoses.