Psychosis

• Presenting symptoms

  • Screen for hallucinations: Can you hear or see things that others can’t hear or see? Can you smell or taste things that don’t make sense to you/ feel a bit strange? 

  • Detailed history of auditory hallucinations – How many voices are there? Does it feel like the voices are speaking directly to you or asking you to do certain things? Does it ever feel like the TV or the radio is speaking to you? 

  • Differentiate between different types of delusions if any are present and check if it’s a fixed delusion or if they can be persuaded away from it. 

    • Persecutory delusions 

    • Grandiose delusions 

    • Nihilistic delusions 

• Establish duration and progression

  • How long have you had these symptoms? How have things changed from when this first started to now? Do you feel worse in certain environments or at particular times of day? Do you feel the voices/images are more prominent when you are by yourself? 

• Identify triggers/ significant life events

  • Has anything happened in your life recently that you think might have started these symptoms? Do the voices/images imitate events that have already happened in your life

• Other symptoms – Do you get any other symptoms alongside this? 

  • Screen for other psychiatric disorders – How have you been feeling in yourself generally? 

    • Depression - Do have any feelings of worthlessness or guilt? Can you see a future for yourself/ Do you feel hopeful about the future? 

    • Anxiety – Have you felt increasingly on edge or more worried and fearful recently? 

    • Mania – Have you experienced unusually high, euphoric or irritable mood recently? (ask specifically about grandiose delusions) 

  • Sleep – Has your sleep been affected by these symptoms?

  • Appetite – Are you eating and drinking okay?

  • Cognition – Do you feel your concentration levels have changed since the onset of these symptoms? 

  • Insight – How would you describe what has been happening to you in the last couple of days? Do you think there’s anything unusual about how you’ve been feeling or behaving recently?  DO NOT challenge the patients delusion

    
    

  Risk – In all psychiatry histories you must ALWAYS screen for risk of self harm and suicide. 

  • Give a warning shot before asking the question as they can be quite distressing for some patients. I’m sorry things have been difficult for you recently. I’d like to ask you a few questions to keep you and the people around you safe if that’s okay?

  • Proceed once the patient confirms it’s okay. Have you thought about harming yourself or ending your life recently? Have you had thoughts about harming others?

• Rule out physiological causes for symptoms 

  • Hyperthyroidism can present with anxiety as the first symptoms - Ask specifically about recent weight loss, excess sweating, palpitations. 

  • Cardio respiratory causes -  take a thorough background history for any chest pains, shortness of breath and palpitations if indicated to make sure you’re not missing an organic cause for symptoms.

Use this opportunity to elicit Ideas, Concerns and Expectations

Be sure to summarise the history