Skip to main content

Psychiatry History Taking


🧠 DIFFERENTIALS + 3 MOST COMMON CHIEF COMPLAINTS (Layman’s Words)

(Each differential = exactly 3 complaints, short & simple)

1. Schizophrenia

  • “I hear voices talking to me.”

  • “People are plotting against me.”

  • “I don’t feel like doing anything or talking to anyone.”

2. Acute & Transient Psychotic Disorder (ATPD)

  • “Something suddenly happened — I’m seeing things that aren’t real.”

  • “People are after me; I need to run.”

  • “I haven’t slept at all for 2–3 days.”

3. Bipolar Mania

  • “I have too much energy; I don’t feel tired at all.”

  • “I’m talking a lot and my thoughts keep running.”

  • “I feel unusually happy or irritated without reason.”

4. Bipolar Depression

  • “I don’t feel like living or doing anything.”

  • “I feel tired all the time.”

  • “I can’t concentrate on anything.”

5. Major Depressive Disorder

  • “I feel sad all the time.”

  • “I can’t enjoy anything anymore.”

  • “I don’t feel like eating or getting out of bed.”

6. Delirium

  • “He is not recognizing us.” (family reports)

  • “He keeps saying strange, confused things.”

  • “He becomes more restless at night.”

7. Substance-Induced Psychosis (e.g., Cannabis)

  • “I’m hearing voices after taking ganja.”

  • “I feel extremely scared; something bad will happen.”

  • “I feel like people are watching me.”

8. Alcohol Withdrawal / Delirium Tremens

  • “My hands are shaking when I stop drinking.”

  • “I’m seeing insects or shadows that aren’t real.”

  • “I feel extremely anxious and sweaty.”

9. Obsessive–Compulsive Disorder (OCD)

  • “I keep getting unwanted thoughts that I can’t stop.”

  • “I have to repeat checking/washing again and again.”

  • “If I don’t do it, I feel very tense.”

10. Panic Disorder

  • “Suddenly my heart starts racing and I feel like I will die.”

  • “I can’t breathe properly during these attacks.”

  • “These attacks come out of nowhere.”

11. Generalized Anxiety Disorder

  • “I keep worrying about everything, all the time.”

  • “I feel tense and restless throughout the day.”

  • “I can’t sleep because of overthinking.”

12. PTSD

  • “I keep getting memories of that incident again and again.”

  • “I get nightmares about it.”

  • “I avoid anything that reminds me of it.”

13. Somatic Symptom Disorder

  • “I have pain everywhere but no one finds anything.”

  • “I’m always tired and sick.”

  • “My health worries don’t go away.”

14. Conversion Disorder

  • “I suddenly cannot move my arm/leg.”

  • “I suddenly cannot speak.”

  • “I faint or have fits when stressed.”

15. Dementia (Alzheimer’s type)

  • “I keep forgetting recent things.”

  • “I ask the same question again and again.”

  • “I get lost even in familiar places.”

16. Depression with Psychotic Features

  • “I feel extremely hopeless.”

  • “I hear a voice saying I’m worthless.”

  • “I believe my body is rotten or I deserve punishment.”

17. Personality Disorder (Borderline)

  • “My mood changes suddenly without control.”

  • “I often hurt myself when upset.”

  • “People leave me; I feel abandoned.”

18. ADHD (Adults)

  • “I can’t focus on anything for long.”

  • “I keep losing things and forgetting work.”

  • “I act on impulse without thinking.”

19. Autism Spectrum Disorder (Adolescent/Young Adult presentation)

  • “I don’t understand social cues or conversations.”

  • “I like repeating routines.”

  • “I get very upset with small changes.”

20. Epilepsy-related Psychosis (Post-ictal)

  • “He is behaving strangely after a seizure.” (family)

  • “He hears voices and speaks oddly after fits.”

  • “He becomes scared or confused for many hours.”

21. Anti-NMDAR / Autoimmune Encephalitis (Psychiatric presentation)

  • “She suddenly started talking strangely.”

  • “She is seeing things that aren’t there.”

  • “She becomes confused and behaves child-like.”

22. Hypothyroidism (Psychiatric presentation)

  • “I feel very tired and sleepy.”

  • “I feel low and slow in everything.”

  • “I’m gaining weight and feel mentally dull.”

23. Hyperthyroidism (Psychiatric presentation)

  • “My heart beats fast all the time.”

  • “I feel very anxious and shaky.”

  • “I cannot tolerate heat and sweat a lot.”

24. Opioid Withdrawal

  • “I have severe body aches when I stop taking smack / brown sugar.”

  • “I feel restless and can’t sleep.”

  • “I have loose motions and a runny nose.”

25. Chronic Pain with Depression

  • “My pain doesn’t go away no matter what I take.”

  • “It is affecting my daily life.”

  • “I feel hopeless because of this.”


1. Low Mood / Depression

Key Questions

  • When did the low mood start? Sudden or gradual?

  • Was there any triggering event?

  • Is the low mood continuous or episodic?

  • Do you still enjoy things you previously liked? (Anhedonia)

  • How is your energy level?

  • Any feelings of hopelessness, guilt, worthlessness?

  • Any crying spells?

  • How is your sleep? (Early morning awakening?)

  • How is your appetite and weight?

  • Any suicidal thoughts? Plans? Past attempts?

  • Effect on functioning: work, study, interpersonal relationships.

  • Any previous depressive episodes?

2. Anxiety / Generalized Anxiety

Key Questions

  • What are you most worried about?

  • How long have you been experiencing excessive worry?

  • Is the worry difficult to control?

  • Associated symptoms: restlessness, tension, sweating, palpitations?

  • Any physical symptoms (GI upset, headache, tremors)?

  • Does anxiety affect sleep?

  • Impact on daily functioning.

  • Any avoidance behaviour?

  • Any previous anxiety episodes or treatment?

3. Panic Attacks

Key Questions

  • Describe exactly what happens during the episode.

  • Sudden onset? Peak within minutes?

  • Symptoms: palpitations, sweating, choking, breathlessness, chest pain, fear of dying?

  • Duration of each episode?

  • Frequency of attacks?

  • Situational or unexpected?

  • Any anticipatory anxiety between attacks?

  • Any avoidance of places due to fear of attacks?

  • History of ER visits thinking it was a heart attack?

4. Phobias (Social, Specific, Agoraphobia)

Key Questions

  • What specific situation/object causes fear?

  • What thoughts occur during exposure?

  • Degree of avoidance?

  • Physical symptoms associated?

  • Does the patient recognize fear as excessive?

  • Impact on daily and social functioning.

  • Duration of problem.

5. Psychosis (Suspiciousness, Hallucinations, Disorganized Behaviour)

Hallucinations

  • Do you hear voices when no one is around?

  • Do the voices talk to you, about you, or give commands?

  • Are the voices inside your head or outside?

  • Frequency and duration?

  • Distress caused?

Delusions / Suspiciousness

  • Do you feel someone is trying to harm you?

  • Any belief that others are watching, spying, following you?

  • Do you have unusual beliefs about yourself or the world?

  • Are you able to explain why you believe this?

Thought & Behaviour

  • Any difficulty in organizing thoughts?

  • Talking to oneself?

  • Social withdrawal?

  • Neglect of self-care?

  • Aggressive or erratic behaviour?

Course

  • Onset: acute or insidious?

  • Progression? First episode?

  • Any substance use related to onset?

6. Substance Use Disorder

Alcohol / Drugs

  • What substances are you using? (Type, route)

  • Quantity and frequency?

  • Pattern (daily, binge, weekend)?

  • Craving present?

  • Loss of control over use?

  • Withdrawal symptoms (tremors, sweating, anxiety, seizures)?

  • Any blackouts?

  • Any previous quit attempts? Why unsuccessful?

  • Impact on occupation, family, finances.

  • Any legal problems?

  • Co-use of multiple substances?

7. Suicidal Ideation / Attempt

Assessment Questions

  • What thoughts of self-harm or suicide have you had?

  • Do you have a plan? Means available?

  • Intention to die at the time?

  • What prevented you from acting?

  • Past attempts? Methods used?

  • Triggers or stressors?

  • Feelings of hopelessness or burdensomeness?

  • Any substance use during the event?

  • Current suicidal intent (very important).

8. Somatic Symptom Disorder / Functional Symptoms

Key Questions

  • What physical symptoms are troubling you?

  • How long have they been present?

  • Do symptoms shift from one body part to another?

  • Any excessive preoccupation or fear regarding illness?

  • How much time per day do you think about illness?

  • Have you consulted multiple doctors?

  • Any tests already done?

  • Effect on daily functioning.

  • What explanation does the patient believe?

9. Conversion Disorder

Key Questions

  • Exactly describe the symptom (paralysis, non-epileptic seizures, sensory loss).

  • Onset and progression?

  • Preceding stress or conflict?

  • Sudden or gradual?

  • Inconsistency between complaint and examination?

  • Any past similar episodes?

  • Patient attitude (la belle indifférence)?

10. OCD (Obsessions & Compulsions)

Obsessions

  • What repetitive, intrusive thoughts trouble you?

  • Do they feel unwanted and excessive?

  • How much time spent per day thinking about them?

Compulsions

  • What behaviours do you repeat? (Checking, washing, counting)

  • What happens if you resist performing them?

  • Duration and frequency of rituals.

  • Degree of distress and interference.

11. Cognitive Decline / Dementia

Key Questions

  • What memory problems are you noticing? (Recent vs remote)

  • Repetition of questions?

  • Difficulty performing routine tasks?

  • Getting lost in familiar places?

  • Personality or behaviour changes?

  • Disturbance in sleep/wake cycle?

  • Onset: sudden vs insidious.

  • Any strokes, head injury, alcohol use?

  • Impact on ADLs/IADLs.

12. Mania / Mood Elevation

Key Questions

  • Elevated or irritable mood? Duration > 1 week?

  • Increased energy and activity?

  • Reduced need for sleep?

  • Excessive talking / pressured speech?

  • Racing thoughts?

  • Increased involvement in risky activities?

  • Increased spending, hypersexuality?

  • Grandiosity?

  • Past manic/hypomanic episodes?

13. Insomnia / Sleep Problems

Key Questions

  • Difficulty initiating or maintaining sleep?

  • Early morning awakening?

  • Sleep quality and duration?

  • Daytime sleepiness?

  • Stressors or worrying thoughts at bedtime?

  • Use of caffeine, nicotine, stimulants?

  • Snoring or apnea symptoms?

  • Sleep–wake routine.

14. Aggression / Irritability

Key Questions

  • Nature: verbal or physical aggression?

  • Triggers?

  • Frequency and severity?

  • Substance use involved?

  • Impulsivity?

  • Harm to self or others?

  • Insight into behaviour?

  • History of violence?

15. Child Psychiatry (ADHD / ASD / Poor Scholastic Performance)

ADHD

  • Inattention symptoms (careless mistakes, easily distracted).

  • Hyperactivity (running, fidgeting).

  • Impulsivity (interrupting, blurting out).

  • School performance and teacher complaints.

  • Onset before 12 years?

ASD

  • Eye contact? Social reciprocity?

  • Speech delay?

  • Repetitive behaviours?

  • Restricted interests?

  • Sensory sensitivities?


🧠 CHARACTERISTIC “RULE-OUT” FEATURES FOR PSYCHIATRIC DIFFERENTIALS

1. Schizophrenia

➡️ Characteristic sign: Third-person running/ commenting auditory hallucinations
(If absent in chronic psychosis → reconsider diagnosis)

2. Acute & Transient Psychotic Disorder (ATPD)

➡️ Characteristic sign: Abrupt onset within days to 2 weeks
(No acute onset → ATPD unlikely)

3. Bipolar Mania

➡️ Characteristic sign: Markedly decreased need for sleep without fatigue
(If patient is tired next day → not mania)

4. Bipolar Depression

➡️ Characteristic sign: History of prior manic/hypomanic episode
(No past mania → cannot diagnose bipolar depression)

5. Major Depressive Disorder

➡️ Characteristic sign: Persistent low mood or anhedonia
(Without either → MDD cannot be diagnosed)

6. Depression With Psychotic Features

➡️ Characteristic sign: Mood-congruent delusions (guilt, nihilism)
(If psychosis is mood-incongruent → consider schizophrenia/schizoaffective)

7. Generalized Anxiety Disorder

➡️ Characteristic symptom: Excessive worry on most days for ≥6 months
(No chronic worry → not GAD)

8. Panic Disorder

➡️ Characteristic sign: Recurrent unexpected panic attacks
(If attacks are always situational → rule out panic disorder)

9. OCD

➡️ Characteristic sign: Ego-dystonic intrusive thoughts
(If thoughts are ego-syntonic → not OCD → think delusions)

10. PTSD

➡️ Characteristic sign: A clearly identifiable traumatic event
(No trauma → PTSD ruled out)

11. Somatic Symptom Disorder

➡️ Characteristic sign: Excessive preoccupation with symptoms
(If patient is unconcerned → consider conversion or true medical illness)

12. Conversion Disorder

➡️ Characteristic sign: Incompatibility with known neurological pathways
(If symptoms follow anatomical pattern → not conversion)

13. Illness Anxiety Disorder

➡️ Characteristic sign: Fear of illness despite minimal/no symptoms
(If real physical symptoms are dominant → not IAD)

14. Alcohol Intoxication

➡️ Characteristic sign: Slurred speech
(Absent → consider other causes of altered behavior)

15. Alcohol Withdrawal

➡️ Characteristic sign: Tremors within 6–24 hours after cessation
(No tremors → reconsider withdrawal diagnosis)

16. Delirium Tremens

➡️ Characteristic sign: Fluctuating consciousness + visual hallucinations
(If consciousness is clear → NOT DT)

17. Cannabis-Induced Psychosis

➡️ Characteristic sign: Recent cannabis use preceding symptoms
(Psychosis without cannabis exposure → cannot label as cannabis induced)

18. Opioid Withdrawal

➡️ Characteristic sign: Dilated pupils
(If pupils are normal → reassess diagnosis)

19. Sedative–Hypnotic Withdrawal

➡️ Characteristic sign: Severe anxiety + tremors after stopping benzodiazepines
(If no recent cessation → rule out withdrawal)

20. Delirium (any cause)

➡️ Characteristic sign: Disturbance in attention + fluctuating course
(If attention intact → delirium unlikely)

21. Dementia (Alzheimer’s)

➡️ Characteristic sign: Gradual progressive memory decline
(No progressive deterioration → not Alzheimer’s type dementia)

22. Korsakoff’s Syndrome

➡️ Characteristic sign: Confabulation (filling memory gaps)
(If no confabulation → consider other dementias)

23. Anti-NMDAR Encephalitis

➡️ Characteristic sign: Psychiatric symptoms + abnormal movements/seizures
(Pure psychiatric picture without neuro features → suspect primary psychosis)

24. Borderline Personality Disorder

➡️ Characteristic sign: Chronic instability of relationships + fear of abandonment
(If no interpersonal instability → BPD unlikely)

25. Adjustment Disorder

➡️ Characteristic sign: Symptoms occurring within 3 months of a stressor
(If timing doesn’t match → not adjustment disorder)

26. Post-ictal Psychosis

➡️ Characteristic sign: Clear temporal relation to a seizure event
(No seizure → cannot diagnose post-ictal psychosis)

27. ADHD (Adults/Adolescents)

➡️ Characteristic sign: Childhood onset before age 12
(No childhood symptoms → not ADHD)

28. Hyperthyroidism (Psychiatric presentation)

➡️ Characteristic sign: Elevated thyroid hormone levels (biochemical evidence)
(Normal TFT → psych presentation not due to hyperthyroidism)

29. Hypothyroidism (Psych presentation)

➡️ Characteristic sign: Low T4 + elevated TSH
(Labs normal → rule out hypothyroid-induced depression)


Comments

Post a Comment