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Additional resources for Psychiatry Mentor: Your Clerkship & Shelf Exam Companion, 2nd Edition (Davis's Mentor)
A. Easier for new recent-onset illness, not so easy for patients with prior episodes, symptoms, or treatment encounters b. , a patient with schizophrenia may have had an admission last year, began using cocaine the last 6 days, and began escalating psychosis and suicidal focus the last 6 hours before coming to the emergency department. Do your best to figure what is most related to the current state, but can reference previously diagnosed with schizophrenia in HPI, with more detail about this previous diagnosis (dx) in “Past Psychiatric History” section.
Advantage: simplicity; an overarching conception of patient’s illness is not necessary—just report the order events occurred ii. Disadvantage: reader needs to pull data together from different parts of chronology to develop a conception of patient’s illness b. Better and tighter HPIs use syndromic approach i. Analogy: like arguing a legal brief ii. Strands of history in HPI (pertinent positives and negatives) should be filtered and organized to lead inexorably to “closing argument”—formulation and differential diagnosis c.
Have you ever been hospitalized for emotional or psychiatric reasons? Have you ever tried to harm or kill yourself in the past? (may be surprising how many people tell you “yes” after denying all prior queries about emotional troubles or treatment) “Yes” answers should lead to a series of questions designed to elicit specifics (1) What diagnoses were given? (2) What specific symptoms were present? (3) What treatments were used (including details of medication trials as doses, duration, adverse effects)?