PSYCHIATRIC HISTORY
TAKING FORMAT
BY:
Akanxa Rao
Assistant professor
GUNI-KBION

IDENTIFICATION DATA
• NAME:
• AGE:
• SEX:
• FATHER/SPOUSE:
• ADDRESS:
• EDUCATION:
• OCCUPATION:
• INCOME:
• MARITAL STATUS:
• RELIGION:
• INFORMANT:
• INFORMATION:RELEVANT/NOT
RELEVANT,ADEQUATE/NOT ADEQUATE

PRESENTING CHIEF COMPLAINT
• (WITH DURATION IN CHRONOLOGICAL
ORDER,IN PATIENT’S OWN WORDS &
INFORMANT’S OWN WORDS)

HISTORY OF PRESENT ILLNESS
• DURATION(DAYS/WEEKS/MONTHS/YEARS):
• MODE OF ONSET(The length of time it takes for a
symptoms to start to
completely):ABRUPT(SUDDEN)(<48
HOURS)/ACUTE(<1 WEEK)/SUBACUTE(1-
2WEEKS)/INSIDIOUS(SLOWLY)(WITHIN A FEW
WEEKS)

• COURSE(the development of symptoms including the
sequence & the speed it
takes):CONTINUOUS/EPISODIC/FLUCTUATING/DETER
IOTING(GETTING WORSE)/IMPROVING/UNCLEAR
• INTENSITY(તીવ્રતા):SAME/INCREASING/DECREASING
• PRECIPITATING FACTORS(triggering factors-ઉત્તેજક
પરિબળો):YES/NO,IF YES EXPLAIN
• DESCRIPTION OF PRESENT ILLNESS:

TREATMENT HISTORY
• DRUGS(NAME OF THE
DRUG,DOSE,ROUTE,SIDE-EFFECTS,IF
ANY):
• ECT:
• PSYCHOTHERAPY:
• FAMILY THERAPY:
• REHABILITATION:

PAST PSYCHIATRIC & MEDICAL
HISTORY
• NUMBER OF PREVIOUS
EPISODES/HOSPITALIZATION(PSYCHIATRIC)WIT
H ONSET & COURSE:
• COMPLETE OR INCOMPLETE
REMISSION(RECOVERY):
• DURATION OF EACH EPISODE:
• TREATMENT DETAILS & IT’S SIDE EFFECTS IF
ANY:
• TREATMENT OUTCOME:

• DETAILS OF ANY PRECIPITATING
FACTORS IF PRESENT:
• SUBSTANCE USE DETAILS:
• SURGICAL
PROCEDURES/ACCIDENTS/HEAD
INJURY/CONVULSIONS/UNCONSCIOUSNE
SS/DM/HTN/CAD/VENEREAL
DISEASES(SEXUAL DISEASES)/HIV
POSITIVITY//ANY OTHER

FAMILY HISTORY
• DESCRIPTION(TABLE)
• GENOGRAM

PERSONAL HISTORY
• PERINATAL HISTORY
ANTENATAL PERIOD:MATERNAL
INFECTIONS/EXPOSURE TO RADIATION/ANY OTHER
CHECK UPS
ANY COMPLICATIONS
INTRANATAL PERIOD:TYPE OF DELIVERY-
NORMAL/INSTRUMENTAL/CESEARIAN
ANY COMPLICATIONS
BIRTH:FULL-TERM/PREMATURE/POSTMATURE
BIRTH CRY:IMMEDIATE/DELAYED
BIRTH DEFECTS:YES OR NO,IF YES,SPECIFY
POSTNATAL
COMPLICATIONS:CYANOSIS/CONVULSIONS/JAUNDIE
NE/NEONATAL INFECTIONS/ANY OTHER

• CHILDHOOD HISTORY
PRIMARY CAREGIVER:
FEEDING:BREASTFED/ARTIFICIAL MODE OF
FEEDING
AGE AT WEANING:
DEVELOPMENTAL
MILESTONES:NORMAL/DELAYED
BEHAVIORAL & EMOTIONAL PROBLEM:THUMB
SUCKING/EXCESSIVE TEMPER
TANTRUMS/STUTTERING/HEAD-BANGING/BODY
ROCKING(REPEATATING MOVEMENT OF
BODY)/NAIL BITING/PICA/ENURESIS(NIGHT
TIME BED WETTING)/MORBID FEARS(ABNORMAL
FEAR)/NIGHT TERRORS/SOMNABULISM(SLEEO
WALKING)
ILLNESS DURING CHILDHOOD:SPECIFICALLY
FOR CNS INFECTIONS/EPILEPSY/NEUROTIC
DISORDERS/MALNUTRITION

• EDUCATIONAL HISTORY:
AGE AT BEGINNING OF FORMAL EDUCATION:
ACADEMIC PERFORMANCE(SPECIFICALLY
LEARNING DISABILITY & ATTENTION DEFICIT
DISORDERS):
EXTRACURRICULAR ACHIEVEMENTS,IF ANY:
RELATIONSHIPS WITH PEER & TEACHERS:
SCHOOL PHOBIA:YES/NO
LOOK FOR CONDUCT DISORDERS,FOR
EXAMPLE TRUANCY(STAYING AWAY FROM
SCHOOL)/STEALING:YES/NO
REASON FOR TERMINATION OF STUDIES:

• PLAY HISTORY
GAMES PLAYED(AT WHAT STAGE & WITH
WHOM):
RELATIONSHIP WITH PLAYMATES:

• EMOTIONAL PROBLEMS DURING
ADOLESCENCE:
RUNNING AWAY FROM
HOME/DELIQUENCY(minor crime,
especially that committed by young
people)/SMOKING/DRUG TAKING/ANY
OTHER

• PUBERTY:
AGE AT APPEARANCE OF SECONDARY
SEXUAL CHARACTERISTICS:
ANXIETY RELATED TO PUBERTY CHANGES:
AGE AT MENARCHE(STARTING OF
MENSTRUAL CYCLE):
REACTION TO MENARCHE:
REGULARITY OF CYCLES,DURATION OF
FLOW:
ABNORMALITIES, IF
ANY(MENORRHAGIA(menstrual periods with
abnormally heavy or prolonged
bleeding),DYSMENORRHEA(painful menstruati
on),ETC.)

• OBSTETRICAL HISTORY
LMP(LAST MENSTRUAL PERIOD):
NUMBER OF CHILDREN:
ANY ABNORMALITIES ASSOCIATED WITH
PREGNANCY,DELIVERY,PUEPERIUM(the
period of about six weeks
after childbirth during which the mother's
reproductive organs return to their
original non-pregnant condition):
TERMINATION OF PREGNANCY,IF ANY:
MENOPAUSE(the time that marks the end
of menstrual cycles),IF ANY(INCLUDING
ANY ASSOCIATED PROBLEMS):

• OCCUPATIONAL HISTORY
AGE AT STARTING WORK:
JOBS HELD IN CHRONOLOGICAL ORDER:
REASONS FOR CHANGES:
CURRENT JOB SATISFACTION:
(INCLUDING RELATIONSHIPS WITH
AUTHORITIES,COLLEAGUES,SUBORDINAT
ES)
WHETHER JOB IS APPROPRIATE TO
PATIENT’S BACKGROUND:

• SEXUAL & MARITAL HISTORY
GENOGRAM(FAMILY OF PROCREATION-
DETAILS OF SPOUSE & CHILDREN):
TYPE OF MARRIAGE:SELF-
CHOICE/ARRANGED
DURATION OF
MARRIAGE:INTERPERSONAL & SEXUAL
RELATIONS:SATISFACTORY/UNSATISFACT
ORY
EXTRAMARITAL RELATIONSHIP IF ANY
SPECIFY:

• PREMORBID PERSONALITY
INTERPERSONAL
RELATIONSHIPS:EXTROVERT/INTROVERT
FAMILY & SOCIAL RELATIONSHIPS:
USE OF LEISURE TIME:
PREDOMINANT
MOOD:OPTIMISTIC(POSITIVE)/PESSIMIST
IC(NEGATIVE),STABLE/FLUCTUATING,CHE
ERFUL(HAPPY)/DESPONDENT(SAD)
USUAL REACTION TO STRESSFUL
EVENTS:
ATTITUDE TO SELF & OTHERS:SELF-
APPRAISAL OF ABILITIES,ACHIEVEMENTS
& FAILURES

• ATTITUDE TO WORK & RESPONSIBILITY:
• RELIGIOUS BELIEFS & MORAL
ATTITUDES:
• FANTASY LIFE:DAYDREAMS A FREQUENCY
& CONTENT
• HABITS
EATING PATTERN:REGULAR/IRREGULAR
ELIMINATION:REGULAR/IRREGULAR
SLEEP:REGULAR/IRREGULAR
USE OF DRUGS,TOBACCO,ALCOHOL: