Psychiatry Made Easy

History Taking Technique Using

Life Event Chart

Dr Norzila Zakaria
Universiti Sains Malaysia

Introduction

1
Taking #sychiatry history is not an easy task. Many new students find it difficult
to get i(#ortant history that lead to a diagnosis. So(eti(es they do not know
how to take the i(#ortant history as the history is too long.

A si(#lified way to ask history and working towards the diagnosis is shown in this
(ethod.

There are two #arts in this (ethod.

• History taking te(#late

• Life event Chart

• Practical section

*
1. History taking te(#late +#age 1)

Na(e:
Age:
Se/: 0ccu#ational: Differential Diagnosis:
1elevant #sychiatry history: Underlying (edical #ro2le(:
Provisional Diagnosis:

Chief Co(#laint5s: Must 2e towards the diagnosis you want to sell

Ti(eline

Sy(#to(

Treat(ent

4unction

Example of Life Event Chart

6
Example of Life Event Chart

7
 7

+Page *)

Relevant Past medical History Past psychiatry History Family History

Relevant Past Surgical History

Note: 8All #ast (edical5 surgical5#sychiatry history can 2e e/tracted fro( the (ood chart

9
+Page *)

Relevant Past medical History Past psychiatry History Family History

Relevant Past Surgical History

Note: 8All #ast (edical5 surgical5#sychiatry history can 2e e/tracted fro( the (ood chart

+ #age 3)

Relevant Social History Differential Diagnosis:

Diagnosis Points 4or Point againts

Provisional Diagnosis:

Note: 8 4a(ily history and social history (ust 2e related to the #redis#osing: #reci#ititating: #er#etuating and #rotective
factors

;
+ #age 3)

Relevant Social History Differential Diagnosis:

Diagnosis Points 4or Point againts

Provisional Diagnosis:

Note: 8 4a(ily history and social history (ust 2e related to the #redis#osing: #reci#ititating: #er#etuating and #rotective
factors

+#age 6)

Analysis of the pro#lem

Provisional Predisposing factorsPrecipitating factorsPerpetuating factorsProtective factors
Diagnosis

AxiS I:All diagnostic

categories except mental retardation and personality
disorder E/tract fro(

fa(ily
history5su##or t

Personality
AxiS II:
disorder and mental retardation
socal history

2elief syste(
General
AxiS III:
medical condition; acute medical conditions and physical disorders

AxiS IV: Psychosocial and environmental factors contributing to the disorder

AxiS V:Global Asessment of

Functioning

<
+#age 6)

Analysis of the pro#lem

Provisional Predisposing factorsPrecipitating factorsPerpetuating factorsProtective factors
Diagnosis

AxiS I:All diagnostic

categories except mental retardation and personality
disorder E/tract fro(

fa(ily
history5su##or t

Personality
AxiS II:
disorder and mental retardation
socal history

2elief syste(
General
AxiS III:
medical condition; acute medical conditions and physical disorders

AxiS IV: Psychosocial and environmental factors contributing to the disorder

AxiS V:Global Asessment of

Functioning

<

+#age 7)

Management
Managem %iological Psycho social and spiritual
ent

Investiga=lood >erify history fro( fa(ily (e(2ers and related #eo#le +with #atient?s
tion consent)
1adiological
1eview old notes5(edical re#ort fro( #revious hos#ital ad(issions

Assess su##ort: 4a(ily: financial: s#iritual and 2elief syste(

Treatmen Phar(acological Psychoeducation:

t
Anti#sychotic • @(#ortant to engage with the #atient and fa(ily (e(2ers
•

Antide#ressant Advice on #har(acothera#y: Oside effect 5co(#liance Odrug interaction

Owhat to do if ran out of (edication

OTelefon nu(2er to 2e contacted if e(ergency +clinic: e(ergency de#art(ent)

An/iolytic
Advice on rela#se sy(#to(s
OAetting early a##oin(ent5e(ergency5ad(ission
Sedative hy#notic
•

0ther treat(ent fro( other

disci#line

1eferral to other disci#lines +(edical: surgical etc)

4ollow u# clinic: reha2ilitation: day care activity: trans#ortation assisstance

1eferral to social welfare de#art(ent for financial assistance5 finding jo25 assisst in any difficulties

9
+#age 7)

Management
Managem %iological Psycho social and spiritual
ent

Investiga=lood >erify history fro( fa(ily (e(2ers and related #eo#le +with #atient?s
tion consent)
1adiological
1eview old notes5(edical re#ort fro( #revious hos#ital ad(issions

Assess su##ort: 4a(ily: financial: s#iritual and 2elief syste(

Treatmen Phar(acological Psychoeducation:

t
Anti#sychotic • @(#ortant to engage with the #atient and fa(ily (e(2ers
•

Antide#ressant Advice on #har(acothera#y: Oside effect 5co(#liance Odrug interaction

Owhat to do if ran out of (edication

OTelefon nu(2er to 2e contacted if e(ergency +clinic: e(ergency de#art(ent)

An/iolytic
Advice on rela#se sy(#to(s
OAetting early a##oin(ent5e(ergency5ad(ission
Sedative hy#notic
•

0ther treat(ent fro( other

disci#line

1eferral to other disci#lines +(edical: surgical etc)

4ollow u# clinic: reha2ilitation: day care activity: trans#ortation assisstance

1eferral to social welfare de#art(ent for financial assistance5 finding jo25 assisst in any difficulties

S#iritual advice and discussion

1
 S#iritual advice and discussion

10

How to uSe HiStory Taking Tenplate

It iS Sinple:
@nterview your #atients : develo# ra##ort and find what is the chief co(#laint.

Write any of i(#ortant finding in the res#ective colu(ns that you have #re#ared.

At any ti(e you want to know (ore detail: infor( the #atient and get the
detail. 1ecord in the area s#ecified.

The concept:
Let the #atient talk and get the i(#ortant #oints: fit the( in the history taking
te(#late accordingly.

Then only clarify and get (ore detail.

With this (ethod: you will notice that you have i(#rove your interviewing skill
and know where to get (ore detail infor(ation.
How to uSe HiStory Taking Tenplate

It iS Sinple:
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
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 of ad(ission.

Lets analyse this text

=iodata of the Possi2le #reci#itating

#atient is very factors: why he is sick

This is to show that he is

a known case of chronic #sychiatry #ro2le(
1elevant
(edical

@ a( #resenting Mr A who is a 67 years old Malay gentle(an: known to have

#sychiatry #ro2le( for the #ast 17 years and currently on Ta2. =: Ta2 C and Ta2
D. He is also known to have several ad(ission to #sychiatry ward due to #oor co(#liance to (edication and follow u#

He was ad(itted one week ago: 2rought to the casualty de#art(ent 2y his son with chief co(#laints of not slee#ing w
ad(ission.

Gou want o sell Mode of

the diagnosis

1
Practice and practice

Practice #resent your #atient history: (ake sure your chief co(#laint5s is5are
towrads the diagnosis you want to sell

Example 1:

• Stri##ed naked and increase in se/ual drive #ast * days

• 4eeling very energetic #ast 7 days

Selling a diagnosis of =i#olar disorder in (anic state

Example 2:

• 4eeling sad for the #ast one 1 (onth

• 4requent awakening for the #ast 3 days

• @ntention to die #ast * days

Selling a diagnosis of Major de#ression with (elancholic features

Example 3:

• Sudden #al#itation without any o2vious reasons #ast 3 (onths

• 4eeling like getting a heart attack #ast * weeks with 3 visits to

the e(ergency de#art(ent

Selling a diagnosis of #anic attack

1
E/a(#le: History of #resenting illness

Mr A was a##arently well until a2out one (onth ago when he ran out of his (edication. He started to have difficulty

0n the day of ad(ission he was noted to carry a #arang and shouted Ikalau 2erani (ari datang: jangan kata aku day