HISTORY

            NAME 

            ADDRESS

            MARITAL STATUS

            JOB

            CHILDREN

            REFERRED BY

            P/C

            Verbatum 

            H.P / C

            SEVERITY

            ASSOCIATIVE SYMPTOMS

            DURATION

            ONSET

            COURSE AND TREATMENT

            AGGREVATORS / RELIEVERS

            IMPACT

            ASSOCIATED BIOLOGICAL FEATURES

            SOMATIC SYNDROME AND OTHERS SOMATIC FEATURES

            ASSOCIATED PSYCHOLOGICAL FEATURES

            ASSOCIATED SOCIAL FEATURES

            PSYCHIATRIC HX

            SUICIDE

            1ST EPISODE

            SUBJECTIVE DX

            TX TO DATE BIOPSYCHOSOCIAL

            TX AS INPT/OUTPT

            IMPACT

            FUNCTIONING BETWEEN EPISODES

            FORENSIC HX

            MEDICAL HX

            MEDS

            ALLERGIES

            SURGICAL HX

            GYNAE HX.

            PERSONAL HX

            BIRTH...obstetric complications, order

            INFANCY AND MILESTONES

            CHILDHOOD....separation / bereavement, home, atmosphere, neuresis

            ADOLESCENCE

            SCHOOL.....refusal / truancy, peers, post school

            WORK....satisfaction, why left etc.

            RELATIONSHIPS / PSYCHOSEXUAL HX

            MARRIAGE / CHILDREN.... current satisfaction

            SOCIAL CIRCUMSTANCE

            ALCOHOL AND DRUGS

            HOUSING

            FAMILY

            FATHER

            MOTHER

            SIBLINGS

            HX OF PSYCH ILLNESS and suicide

            HX OF MEDICAL ILLNESS

            Expressed emotions at home

            PMP

            CHARACTERISTICS IN GENERAL

            A; "ODD"....paranoid, schzoid, jealousy, introverted, suspicious

B; IMPULSIVE..unstable, histrionic, antisocial, aggressive, extroverted

C; ANXIOUS..avoidant, dependent, anakastic, perfectionistic, quiet

            HABITUAL MOOD

            ATTITUTE TO OTHERS

            ATTITUTE OF OTHERS TO THE PT

            INTERESTS AND HOBBIES

            RESPONSE TO STRESS-COPING STRATEGIES

            MSE

            APPEARANCE

            BEHAVIOUR...and negative signs

            SPEECH..r/t/r/v..attitute,content,flow

            MOOD

            AFFECT

            SUICIDE ASSESSMENT

            THINKING    Flow

                                    Pressure

                                    Form.abstraction and association

                                    Possession

                                    Content

                                    Preoccupations

                                    Obsessions

                                    Phobias

                                    Overvalued ideas

                                    Delusions

            PERCEPTION

            Depersonalisation/derealisation

            Sensory distortions

            Sensory deceptions

            COGNITION

            MMSE

            Orientation. (10)

            Registation and recall. (6)

            Attention and conc. (5)

            Language. (4)

            Apraxis. (5)

            General knowledge

            INSIGHT

            Recognises somethings wrong

            Recognises its psychological

            Recognises the need for tx

            Accept tx

            FORMULATION

            BIOLOGICAL

            PSYCHOLOGICAL

            SOCIAL

            PSYCHODYNAMIC

INX

Some of the following investigations can be considered depending on the differential diagnoses.

BLOOD TESTS

           HAEMATOLOGICAL e.g. FBC,

           BIOCHEMICAL e.g. U+E, LFTS, BONE PROFILE 

           ENDOCRINOLOGY e.g. TFTS

           OTHERS  e.g. CHOLESTEROL, B12, FOLATE COPPER

RADIOLOGICAL

           CXR, Abd. XR, Abd. ultrasound, CT BRAIN

           More Advanced examinations include MRI Head SPECT/PET

ELECTROPHYSIOLOGICAL

          ECG, EEG, AMBULATORY EEG, POLYSOMNOGRAPHY+MSLT, EMG, EVOKED POTENTIALS 

            DDX

         Organic

        "Functional" (This term is loosing favour.)