How does psychiatrist diagnose depression - depression history taking and assessment- In this article Dr Shariq, Psychiatrist in India discusses what all points are discussed with a patient presenting with depression symptoms. The information obtained forms the basis for treatment of depression and subsequent therapy and counseling for depression as well. 1. Preparation and Introduction - Greet the patient and clearly state your name and role. - Confirm Patient's Details : Verify the patient’s name and age ensure accuracy. 2. Presenting Complaints - Open-ended Questions : Start by asking open-ended questions such as: - “How are you today?” - “How have you been feeling recently?” - “What’s brought you in to see me today?” - “Tell me about the issues you’ve been experiencing.” - Allow the Patient to Express Themselves : Avoid interruptions and give them adequate time to respond. - Clarify the Complaint : If necessary, use follow-up questions like “Can you tell me more about that?” 3. Screening for Depression - Risk Assessment : Depression should be screened in high-risk individuals, including those with a history of mental health conditions or chronic illnesses. - Use Screening Questions : According to NICE guidelines, England, use the following questions: - “During the past month, have you been bothered by feeling low, depressed, or hopeless?” - “Had little interest or pleasure in doing things?” - Follow-up on Positive Responses : If affirmative, probe further. A negative response doesn’t rule out depression. 4. Exploring Symptoms of Depression Biological Symptoms - Sleep Disturbances : - “How has your sleep been recently?” - “Do you have trouble falling asleep or staying asleep?” - Low Mood : Explore mood changes with questions such as: - “How has your mood been recently?” - “Are there particular times of day when you feel worse?” - Appetite and Weight Changes : - “Have you noticed a change in your appetite?” - “What’s your usual diet like now?” - Fatigue : Inquire about energy levels: - “Have you felt more tired than usual?” - “Have you noticed slower movement or thinking?” - Reduced Libido : - “Has there been any change in your libido?” Cognitive Symptoms - Concentration : - “How’s your concentration been lately?” - “Can you focus on reading or watching TV without getting distracted?” - Negative Perception of Self : - “How do you feel about yourself?” - “Do you blame yourself for things that go wrong?” 6. Assessing Suicide Risk - Crucial Screening : Depression significantly raises the risk of suicide, so assess this early and sensitively. - “Have you ever felt that life is no longer worth living?” - “Have you thought about taking your life?” - “Have you made any plans for this?” - “Do you have any ideas on how you would do it?” 7. Screening for Other Psychiatric Diagnoses - Bipolar Disorder : Ask about any periods of elevated mood: - “Have you ever felt particularly energetic or euphoric?” - Schizophrenia : Inquire about possible psychotic symptoms: - “Have you heard voices that others can’t hear?” - “Do you feel that people may be talking about you negatively or plotting against you?” 8. Past Psychiatric History - Previous Episodes of Depression : - “Have you had any other episodes of feeling low or depressed in the past?” - “Have you ever been diagnosed with depression?” - “What treatments have you received, and did they help?” 9. Past Medical History - Chronic Illnesses : These can trigger or worsen depression. Ask about any ongoing medical conditions, such as Diabetes, Hypertension, hypothyroidism or chronic pain. - Medications : Inquire about current medications, including both prescribed and over-the-counter treatments. 10. Family History - Mental Health in Family : Ask about any first-degree relatives with mental health problems: - “Have any of your parents or siblings had mental health issues?” - “What kind of mental health problems were they diagnosed with?” 11. Social History - Assess the patient’s social support systems: - “Do you live alone or with someone?” - “Are there any social or family relationships affected by your mood?” - “Has your ability to work been impacted by your symptoms?” - Risk Factors : Ask about smoking, alcohol consumption, recreational drug use, and gambling: - “Do you smoke or use any substances like alcohol or drugs?” - “Do you gamble, and do you think it’s a problem?” 12. Insight - Assess Awareness : Evaluate the patient’s understanding of their mental health condition: - “What do you think is causing your current problems?” - “Do you feel that you need help with your problem?” 13. Closing the Consultation - Address Patient’s Concerns : Ask if there’s anything else the patient wants to discuss or any concerns that have not been addressed. - Thank the Patient : Show appreciation for their time and willingness to share their experiences.