History-taking
CPSA · Focused history · Psychiatry
Low mood / depression
Assess the core and biological symptoms of depression, screen the differentials (bipolar, organic, substance) and — critically — perform a risk assessment.
Focused questions
Core symptoms (≥2 weeks)
- Low mood, anhedonia (loss of interest/pleasure), low energy/fatigue
Biological & cognitive
- Sleep (early-morning waking), appetite/weight, concentration, libido, diurnal variation
- Guilt, worthlessness, hopelessness
Risk assessment (never skip)
- Thoughts of self-harm or suicide — ideation → plan → intent → means; protective factors
- Risk to others; risk from others; self-neglect
Screen differentials
- Manic/hypomanic episodes ever (bipolar), psychotic symptoms, alcohol/substance use, thyroid symptoms, medications, recent stressors
Differentials to screen
DepressionLow mood + anhedonia + biological symptoms ≥2 weeks
Bipolar affective disorderHistory of manic/hypomanic episodes
Adjustment disorder / griefClear recent stressor, proportionate, time-limited
Organic (hypothyroid, anaemia)Physical symptoms, abnormal bloods
Substance-inducedTemporally related to alcohol/drug use
Red flags — exclude these
- Active suicidal ideation with plan/intent/means
- Psychotic symptoms (nihilistic delusions)
- Self-neglect / not eating or drinking
- Risk to dependents/others
OSCE tips
- Always do the risk assessment — asking about suicide does not increase risk and can fail the station if omitted.
- Screen for a manic episode — it changes the diagnosis to bipolar and the treatment.
- Anhedonia is the most discriminating core symptom.