Skip to Main Content



Making the Patient Comfortable

The initial interview is of utmost importance to the psychiatrist. With practice, you will develop your own style and learn how to adapt the interview to the individual patient. In general, start the interview by asking open-ended questions. Carefully note how the patient responds, as this is critical information for the mental status exam. Consider preparing for the interview by writing down the subheadings of the exam (see Figure 2-1). Find a safe and private area to conduct the interview. Use closed-ended questions to obtain the remaining pertinent information. During the first interview, the psychiatrist must establish a meaningful rapport with the patient in order to get accurate and pertinent information. This requires that the questions be asked in a quiet, comfortable setting so that the patient is at ease. The patient should feel that the psychiatrist is interested, nonjudgmental, and compassionate. In psychiatry, the history is the most important factor in formulating a diagnosis and treatment plan.


Psychiatric history outline.

image  WARDS TIP

The history of present illness (HPI) should include information about the current episode, including symptoms, duration, context, stressors, and impairment in function.

image  WARDS TIP

If you are seeing the patient in the ER, make sure to ask how they got to the ER (police, bus, walk-in, family member) and look to see what time they were triaged. For all initial evaluations, ask why the patient is seeking treatment today as opposed to any other day.

image  WARDS TIP

When taking a substance history, remember to ask about caffeine and nicotine use. If a heavy smoker is hospitalized and does not have access to nicotine replacement therapy, nicotine withdrawal may cause anxiety and agitation.

Taking the History

The psychiatric history follows a similar format as the history for other types of patients. It should include the following:

  • Identifying data: The patient's name, preferred gender, age, marital status.

  • Chief complaint (use the patient's own words): If called as a consultant, list reason for the consult.

  • Sources of information.

  • History of present illness (HPI):

    • The 4 Ps: The patient's psychosocial and environmental conditions predisposing to, precipitating, perpetuating, and protecting against the current episode.

    • The patient's support system (whom the patient lives with, distance and level of contact with friends and relatives).

    • Neurovegetative symptoms (quality of sleep, appetite, energy, psychomotor retardation/activation, concentration).

    • Suicidal ideation/homicidal ideation.

    • How work and relationship have been affected (for most diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition [DSM-5] there is a criterion that specifies that symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning).

    • Psychotic symptoms (e.g., auditory ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.