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“I’m going to ask some general questions about your alcohol use and how it affects
you.”
1. How often do you have a drink ? lets say per day and per week? What do you drink?
6. Do you often end up drinking more than you intend to?
7. Do you need to drink more than you used to in order to get the desired effect?
9. What time do you start drinking? Do you need a drink in the morning to steady your
nerves?
15. Are you aware of any alcohol related health problems? Ask about black outs.
Psychological assessment
Perform a brief assessment of the patient’s current mood to identify signs of
depression:
“During the past month have you felt low, depressed or hopeless?”
“Have you recently had little interest or pleasure in doing things?”
“When did you first notice an increase in the amount of alcohol you were
drinking?”
“Was there anything going on at the time that played a role in this?”
It may be useful to write down alcohol intake on a piece of paper (Monday – Sunday
with approximate timings and drinks had). This ensures a history which is as
comprehensive as possible and accounts for varied intake across the week.
Drinking behaviours
Ask about the patient’s drinking behaviours:
“I’m going to ask some general questions about your alcohol use and how it affects
you.”
Ask the CAGE questions:
Have you ever felt that you should Cut down on your drinking?
Have people Annoyed you by criticising your drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get
rid of a hangover (known as an Eye-opener)?
Low mood
“Are there any particular times of day that you notice your mood is worse?”
“Does your mood vary throughout the day?”
Appetite changes
The appetite of patients with depression can be significantly altered:
Reduced concentration
Patients with depression typically exhibit reduced levels of concentration:
“Have you ever heard voices speaking when there seems to be no-one around?”
“Do you ever feel that people are discussing you negatively?”
“Do you fear that people may be out to get you?”
“Have you ever felt that something or someone is able to put thoughts into your
head?”
“Have you ever felt that something or someone can remove thoughts from your
brain?”
“Have you ever felt that something or someone can hear your thoughts?”
“Have you noticed any sensations that seem odd or inexplicable?”
Past psychiatric history
Previous episodes of depression:
“Have you ever had any other periods of feeling particularly low?”
“Have you ever been told you have depression in the past?”
“Have you ever received any treatment(s) for depression in the past and if so, did
they help?”
“Have you previously had any problems with your mental health?”
“Have you ever been diagnosed with a psychiatric condition?”
“What treatment(s) did you receive for this diagnosis and did they seem to help?”
“Have you ever been admitted to the hospital because of your mental health?”
Chronic illness is also a major risk factor for depression (e.g. chronic pain, cancer,
etc).
Allergies
Ask if the patient has any allergies and if so, clarify what kind of reaction they had to
the substance (e.g. mild rash vs anaphylaxis).
Drug history
Ask if the patient is currently taking any prescribed medications or over-the-
counter remedies:
“Have you noticed any side effects from the medication you currently take?”
Family history
Ask the patient if there is any family history of psychiatric disease in first-degree
relatives:
“Have any of your parents or siblings had problems with their mental health in
the past?”
“Do you know what type of mental health problems they had?”
Social history
Explore the patient’s social history to both understand their social context and identify
potential psychiatric risk factors.
the type of accommodation they currently reside in (e.g. house, bungalow) and if
there are any adaptations to assist them (e.g. stairlift)
who else the patient lives with and their personal support network
what tasks they are able to carry out independently and what they require
assistance with (e.g. self-hygiene, housework, food shopping)
Smoking
Record the patient’s smoking history, including the type and amount of tobacco used.
Alcohol
Record the frequency, type and volume of alcohol consumed on a weekly basis.
Gambling
Ask the patient if they gamble and if they feel this is a problem.
Insight
Insight refers to the ability of a patient to understand that they have a mental health
problem and that what they’re experiencing is abnormal. Patients with severe
depression may demonstrate loss of insight into their illness.