IDENTIFICATION DATA NAME AGE SEX FATHER/SPOUSE NAME ADDRESS EDUCATION OCCUPATION INCOME MARITAL STATUS RELIGION INFORMANT PRESENTING CHIEF COMPLAIN- HISTORY OF PRESENT ILLNESS- DURATION –DAYS/WEEK/MONTH/YEAR MODE OF ONSET-ABRUPT/ACUTE/SUBACUTE/INSIDIOUS COURSE-CONTINOUS/EPISODIC/FLUCTUATIG/UNCLEAR PRECIPITATING FACTOR-YES(EXPLAIN)/NO DESCRIPTION OF THE PRESENT ILLNESS- (CHRONOLOGICAL DESCRIPTION OF ABNORMAL BEHAVIOUR ASSOCIATED WITH PROBLEM LIKESUCIDE ,SPEECH,MOOD STATE,CHNGES IN ACTIVITY IN DAILY LIVING(ADL) TREATMENT HISTORY DRUGS (NAME OF DRUGS, DOSE, ROUTE,SIDE EFFECT) ECT(ELECTROCONVULSIVE THERPY) PSYCHOTHERPY PAST PSYCHIATRY AND MEDICAL/SURGICAL HISTORY NUMBER OF PREVIOUS EPISODE DURATION TREATMENT DETAILS TREATMENT OUTCOME SUBSTANCE ABUSE ANY SURGICAL PROCEDURE

1. HISTORY TAKING
FORMAT IN PSYCHIATRIC
NURSING
MS.POOJA SEN
M.SC ( PSYCHIATRIC NURSING)

2. IDENTIFICATION DATA
 NAME
 AGE
 SEX
 FATHER/SPOUSE NAME
 ADDRESS
 EDUCATION
 OCCUPATION
 INCOME
 MARITAL STATUS
 RELIGION
 INFORMANT

3. PRESENTING CHIEF COMPLAIN-
HISTORY OF PRESENT ILLNESS-
 DURATION –DAYS/WEEK/MONTH/YEAR
 MODE OF ONSET-ABRUPT/ACUTE/SUBACUTE/INSIDIOUS
 COURSE-CONTINOUS/EPISODIC/FLUCTUATIG/UNCLEAR
 PRECIPITATING FACTOR-YES(EXPLAIN)/NO
 DESCRIPTION OF THE PRESENT ILLNESS-
(CHRONOLOGICAL DESCRIPTION OF ABNORMAL BEHAVIOUR
ASSOCIATED WITH PROBLEM LIKESUCIDE ,SPEECH,MOOD STATE,CHNGES
IN ACTIVITY IN DAILY LIVING(ADL)

4. TREATMENT HISTORY
 DRUGS (NAME OF DRUGS, DOSE, ROUTE,SIDE EFFECT)
 ECT(ELECTROCONVULSIVE THERPY)
 PSYCHOTHERPY

5. PAST PSYCHIATRY AND MEDICAL/SURGICAL
HISTORY
 NUMBER OF PREVIOUS EPISODE
 DURATION
 TREATMENT DETAILS
 TREATMENT OUTCOME
 SUBSTANCE ABUSE
 ANY SURGICAL PROCEDURE

6. FAMILY HISTORY
• DESCRIPTION OF EACH FAMILY MEMBER, AGE, EDUCATION,
OCCUPATION,HEALTH STATUS,AND RELATIONSHIP WITH THE
PATIENT.
• FAMILY TREE

7. PERSONAL HISTORY
 PERINATAL HISTORY
ANTENATAL HISTORY – MATERNAL INFECTION/EXPOSURE TO
REDIATION/ANY OTHER
INTERANATAL HISTORY-
- TYPE OF DELIVERY-NORMAL/INSTRUMENTAL/CESEARIAN/ANY
COMLICATION
- BIRTH – FULL TERM/PREMATURE/POST MATURE
- BIRTH CRY-IMMEDIATE/DELAYED
- BIRTH DEFECT-YES(EXPLAIN)/NO
POST NATAL COMPLICATION-CYANOSIS/CONVULSION/JAUNDICE/NEONATAL
INFECTION/ANY OTHER

8. CHILDHOOD HISTORY
- PRIMARY CARE GIVER-
- FEEDING- BREAST FEEDING/ARTIFICIAL MODE OF FEEDING
- AGE OF WEANING-
- DEVELOPMENTAL MILSTONES- NORMAL/DELAYED
- BEHAVIOURAL AND EMOTIONAL PROBLEMS- THUMB SUCKING/EXCESIVE
TEMPERTANTRUMS/NAIL BITING/PICA/ENURESIS/NIGHT
TERRORS/SOMNABULISM
- ILLNESS DURING CHILDHOOD- CNS INFECTION/EPILEPSY/NEUROTIC
DISORDER/MALNUTRITION

9. EDUCATIONAL HISTORY-
- AGE OF BEGINNING OF FORMAL EDUCATION-
- ACADEMIC PERFORMANCE-
- SCHOOL PHOBIA-
- REASON FOR TERMINATION OF STUDIES-

10. PLAY HISTORY-
- GAMES PLAYED
- RELATIONSHIP WITH PLAYMATES
EMOTIONAL PROBLEM DURING
- ADOLSCENTS- RUNNING AWAY FROM HOME
- DELIQUENCY
- SMOKING
- DRUG TAKING
- ANY OTHER

11. PUBERTY
- AGE OF APPEARNCE
- AGE OF MENARCHE
- REGULARITY OF CYCLE
- DURATION OF FOLLOW
- ABNORMALITIES IF ANY
OBSTETRICAL HISTORY
- L M P-
- NUMBER OF CHILDREN
- ANY ABNORMALITY ASSOCIATED WITH PREGNANCY, DELIVERY AND
PUERPERIUM
- TERMINATION OF PREGNANCY
- MENOPAUSE-

12. OCCUPATIONAL HISTORY-
- AGE OF STARTING WORK-
- JOBS HELD IN CHRONOLOGICAL ORDER
- REASONS FOR CHANGES
- CURRENT JOB SATISFACTION
SEXUAL AND MARITAL HISTORY-
- GENOGRAM (DETAILS OF SPOUSES AND CHILDREN)
- TYPES OF MARRIAGE-
- DURATION OF MARRIAGE-
- SEXUAL RELATIONSHIP –
- EXTRA MARITAL RELATIONSHIP IF ANY SPECIFY-

13. PRE-MORBID PERSONALITY
- INTERPERONAL RELATIONSHIP-
- FAMILY AND SOCIAL RELATIONSHIP-
- USE OF LEISURE TIME-
- PREDOMINANT MOOD- OPTIMISTIC/PESSIMISTIC/FLUCTUATING/CHEERFUL
- USUAL REACTION OF STRESS FULL EVENT-
- ATTITUDE TO SELF AND OTHERS-
- ATTITUDE TO WORK AND RESPONCIBILITY-
- RELIGIOUS BELIFS AND MORAL ATTITUDES-
HABITS-
- EATING PATTERNS-
- ELIMINATION-
- SLEEP-
- USE OF DRUGS, TABACCO,ALCOHOL-

14. THANK YOU