Psychiatry Made Easy

Psychiatry Made
Easy
History Taking Technique Using

Life Event Chart
Dr Norzila Zakaria
Universiti Sains Malaysia
Introduction
1
Taking psychiatry history is not an easy task. Many new students find it difficult to
get important history that lead to a diagnosis. Sometimes they do not know how
to take the important history as the history is too long.
A simplified way to ask history and working towards the diagnosis is shown in this
method.
There are two parts in this method.
 History taking template
 Life event Chart
 Practical section
2
1.History taking template (page 1)
Name:
Age:
Sex: Differential Diagnosis:
Occupational:
Relevant psychiatry history: Provisional Diagnosis:
Underlying medical problem:
Medication taken:
Chief Complaint/s: Must be towards the diagnosis you want to sell
Timeline
Symptom
Treatment
Function
3
Example of Life Event Chart
4
5
(Page 2)
Relevant Past medical History Past psychiatry History Family History
Relevant Past Surgical History
Note: *All past medical/ surgical/psychiatry history can be extracted from the mood chart
6
( page 3)
Relevant Social History Differential Diagnosis:
Diagnosis Points For Point againts
Provisional Diagnosis:
Note: * Family history and social history must be related to the predisposing, precipititating, perpetuating and protective
factors
7
(page 4)
Analysis of the problem

Provisional Predisposing factors Precipitating factors Perpetuating factors Protective factors
Diagnosis
Axis I: All diagnostic

categories except
Extract from
mental retardation
and personality
 family
disorder
history/suppor
t
Axis II: Personality
disorder and mental  socal history
retardation
 belief system
Axis III: General
medical condition;
acute medical
conditions and
physical disorders
Axis IV: Psychosocial

and environmental
factors contributing to
the disorder
Axis V: Global
Asessment of
Functioning
8
(page 5)
Management
Managem Biological Psycho social and spiritual
ent
Investiga Blood Verify history from family members and related people (with patient’s
tion consent)
Radiological
Review old notes/medical report from previous hospital admissions
Assess support: Family, financial, spiritual and belief system
Treatmen Pharmacological Psychoeducation:

t
 Antipsychotic  Important to engage with the patient and family members
 Advice on pharmacotherapy:
 Antidepressant o side effect /compliance
o drug interaction
 Anxiolytic o what to do if ran out of medication
o Telefon number to be contacted if emergency (clinic,
 Sedative hypnotic emergency department)
 Advice on relapse symptoms
Other treatment from other o Getting early appoinment/emergency/admission
discipline
Referral to other disciplines (medical, surgical etc)
Follow up clinic, rehabilitation, day care activity, transportation assisstance
Referral to social welfare department for financial assistance/ finding job/

assisst in any difficulties
9
Spiritual advice and discussion
10
How to use History Taking Template
It is simple:
Interview your patients , develop rapport and find what is the chief complaint.
Write any of important finding in the respective columns that you have prepared.
At any time you want to know more detail, inform the patient and get the detail.
Record in the area specified.
The concept:
Let the patient talk and get the important points, fit them in the history taking
template accordingly.
Then only clarify and get more detail.
With this method, you will notice that you have improve your interviewing skill
and know where to get more detail information.
Presenting a psychiatry case

It is important that you practice to present the case to make yourself fluent.
Tips:
Use your own script for each section

Example: Introduction
When you present the introduction section, the examiner should get the
overall idea of what is the problem of this patient. It is more or less like the
formulation in short.
I am presenting Mr A who is a 45 years old Malay gentleman, a divorcee

with 5 grown up children, staying with his eldest son. He is not/known to
have psychiatry problem for the past 15 years and currently on Tab. B, Tab
C and Tab D. He is also not/known to have any/several admission to
psychiatry ward due to poor compliance to medication and follow up. He is
also known to have multiple medical problem namely diabetis, heart
disesase and rheumatoid arthritis.
He was admitted one week ago, brought to the casualty department by his
son with chief complaints of not sleeping well for the past one week, being
irritable at home for the past 3 days and aggressive behaviour on the day
11
of admission.
Lets analyse this text
Biodata of the Possible precipitating

patient is very factors: why he is sick
important now
This is to show that he is
a known case of chronic
Relevant psychiatry problem
medical
I am presenting Mr A who is a 45problem
years old Malay gentleman, known to have
psychiatry problem for the past 15 years and currently on Tab. B, Tab C and Tab
D. He is also known to have several admission to psychiatry ward due to poor
compliance to medication and follow up. He is also known to have multiple
medical problem namely diabetis, heart disesase and rheumatoid arthritis.
He was admitted one week ago, brought to the casualty department by his son
with chief complaints of not sleeping well for the past one week, being irritable
and talking to himself for the past 3 days and aggressive behaviour on the day of
admission.
You want o sell

the diagnosis Mode of
of....... ? admission
12
Practice and practice
Practice present your patient history, make sure your chief complaint/s is/are
towrads the diagnosis you want to sell
Example 1:
 Stripped naked and increase in sexual drive past 2 days
 Feeling very energetic past 5 days
Selling a diagnosis of Bipolar disorder in manic state
Example 2:
 Feeling sad for the past one 1 month
 Frequent awakening for the past 3 days
 Intention to die past 2 days
Selling a diagnosis of Major depression with melancholic features
Example 3:
 Sudden palpitation without any obvious reasons past 3 months
 Feeling like getting a heart attack past 2 weeks with 3 visits to the
emergency department
Selling a diagnosis of panic attack
13
Example: History of presenting illness
Mr A was apparently well until about one month ago when he ran out of his
medication. He started to have difficulty in sleeping in which he sometimes woke
up several times at night and worsening for the past one week in which he was
not able to sleep at all. He was also noted to be talking to himself and scolding
his son and grandchildren for no reason. He admitted to hear a female voice
commenting on his life and accusing him as “dayus”. He was very angry with the
voice and started to become irritable.
On the day of admission he was noted to carry a parang and shouted “kalau
berani mari datang, jangan kata aku dayus!”, looked very angry and did not
respond to any persuasion by the family members. With the help of several
people, the son managed to restrain him and brought him to the hospital.
14

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Psychiatry Made

History Taking Technique Using

There are two parts in this method.

 History taking template

 Life event Chart

Relevant Past medical History Past psychiatry History Family History

Relevant Past Surgical History

Relevant Social History Differential Diagnosis:

Diagnosis Points For Point againts

Analysis of the problem

Axis I: All diagnostic

Axis IV: Psychosocial

Assess support: Family, financial, spiritual and belief system

Treatmen Pharmacological Psychoeducation:

Follow up clinic, rehabilitation, day care activity, transportation assisstance

Referral to social welfare department for financial assistance/ finding job/

Then only clarify and get more detail.

Presenting a psychiatry case

Use your own script for each section

I am presenting Mr A who is a 45 years old Malay gentleman, a divorcee

Lets analyse this text

Biodata of the Possible precipitating

You want o sell

 Stripped naked and increase in sexual drive past 2 days

 Feeling very energetic past 5 days

Selling a diagnosis of Bipolar disorder in manic state

 Feeling sad for the past one 1 month

 Frequent awakening for the past 3 days

 Intention to die past 2 days

Selling a diagnosis of Major depression with melancholic features

 Sudden palpitation without any obvious reasons past 3 months

Selling a diagnosis of panic attack

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