Assessment of the condition of older people. History of present illness

Anamnesis(anamnesis; Greek anamnē sis memory) - a set of information about the patient and his disease, obtained by interviewing the patient himself and (or) people who know him and used to establish a diagnosis, prognosis of the disease, choice optimal methods its treatment and prevention. A. how the process of obtaining this information is one of the main methods of clinical examination of the patient.

The method of interviewing a patient was purposefully developed and introduced into clinical practice by the classics of Russian medicine M.Ya. Mudrov, G.A. Zakharyin, A.A. Ostroumov. In modern clinical medicine, A. continues to play a significant role in understanding the patient and the disease. It is of paramount importance in the diagnosis of mental illness and a number of forms somatic pathology. Thus, for the diagnosis of angina pectoris, A. is more informative than many other methods of studying the heart.

Using the anamnestic method, the doctor is obliged to follow the rules of deontology (see. Medical deontology ). During the collection of A., mutual understanding and trust must be achieved between the doctor and the patient, and medical confidentiality is guaranteed. Collection of A. is carried out in the absence of other patients. It is necessary to first listen to the patient himself - everything that he considers necessary to tell the doctor, and then ask questions, without imposing his characteristics of symptoms and without suggesting possible move development of the disease. It is important to achieve reliable information, which is possible if the patient has an adequate attitude towards his illness. Sometimes dissimulation, aggravation or simulation are possible on the part of the patient; The ability to recognize these deviations and find out their motivation depends on the doctor’s experience. When examining patients in extremely critical or unconscious, as well as the deaf and dumb, use information received from the patient’s relatives and other people who know him. In the case of cancer, venereal disease, tuberculosis, as well as during expert examination, A. is necessarily supplemented with medical documentation data.

The main sections of the anamnesis are A. illness and A. life, each of them is collected according to a specific plan.

A new direction in the development of the anamnestic method is the introduction into practice of a programmed survey in various specific sections (allergies, chest pain, acute stomach etc.), carried out by filling out a questionnaire, the data of which can be entered into programs for machine diagnostics. However, when filling out questionnaires, a direct impression of the patient’s personality, which is very important for the doctor, is missing and the often important feeling for the patient of confidence in the doctor’s correct understanding of his illness is not realized.

A.'s reliability is assessed by comparison with data from an objective examination and medical documentation.

History in children collected mainly by interviewing the mother, father and people around the child. Some questions need to be asked to a child of preschool and school age in order to establish proper contact with him, but the child’s answers should be assessed with caution, because Children are easily suggestible and do not sufficiently differentiate their sensations. When listening to the mother's complaints, one must tactfully and skillfully give them the desired direction. It is necessary to clarify the time of onset of the disease, the characteristics of its onset and course, changes in body temperature, manifestations on the part of individual organs and systems, what treatment was carried out, its results, and the presence of reactions to medications.

A. Children under 3 years of age begin their lives with information about their mother. It is necessary to find out: from what pregnancy and birth the child was born; the course of pregnancy,

By collecting A. lives of older children, they find out what kind of child the child is, how he developed during the period early childhood; what is the behavior at home and in the team, performance at school; what diseases you have suffered, preventive vaccinations; when was it carried out tuberculin test and what is its result; whether there was contact with infectious patients.

The family history should contain information about the age of the parents, their profession, and financial security; when and what diseases did you suffer from? about other children in the family, their age and development, health (if they died, then from what reasons); about visiting children's institutions, schools, observing the daily routine, nutrition, for schoolchildren - about academic performance, additional workloads. Special attention focus on identifying hereditary diseases.

In the process of examining and treating the patient, A.’s data is clarified with additional information.

History of the mentally ill. The influence of mental illness on the patient’s memories and his attitude to the past makes it necessary to distinguish between subjective A. and objective A., each of which is important for understanding the characteristics and course of the disease. When establishing the first signs of the disease, it should be taken into account that the patient,

Obvious signs of the disease must be examined in detail, because often it is by their characteristics that the nature and genesis of the disease are determined. One should be careful about A.’s data on the significance of various hazards that preceded or supposedly preceded the disease. Often harmful effects are not the true causes, but factors that provoke the disease and put a certain shade on it.

If due to mental state It is not possible to collect subjective anamnestic information from the patient; only an objective anamnesis is collected. It is necessary to obtain from those giving information an unbiased description of the characteristics and changes in the patient’s personality, behavior at home, at work, and contacts with others. In this case, you should especially pay attention to the nature of the patient’s thinking, erroneous judgments, incomprehensible actions, strange (unjustified) actions. It is recommended to treat with great caution the attempts of relatives and friends to interpret pathologically alarming actions and actions of patients.

THERAPEUTIC ASPECTS IN GERIATRICS

Paramedic general practice must take into account the usual for elderly people plurality pathology. Upon careful examination of elderly patients, they find pathological changes in various body systems. Their reasons may be various factors, including age-related changes.

The patient tells the paramedic only the symptoms that worry him, but the paramedic is obliged to find out all the pathology in the body for the right approach to treatment.

In elderly people and old age may experience diseases that arose in them when they were young or mature age. Like young people, they experience many acute diseases, including infectious diseases, but age characteristics cause significant deviations in clinical picture these diseases (atypicality, unresponsiveness, smoothness of symptoms). All this complicates diagnosis and contributes to the appearance early complications. Acute diseases in elderly and senile people are rare; they often take on a subchronic form.

The age-related characteristics of the body of elderly and senile people, the characteristics of their psychology and clinical manifestations of the disease require a special approach to questioning.

Questioning technique.. Interviewing elderly and senile patients requires more time than younger patients. Elderly and senile patients often have visual impairment, hearing impairment, slow reactions, and irritability. In this regard, it is necessary to establish mutual psychological contact with the patient at the very beginning of the questioning. The face of the interviewer (paramedic) should be sufficiently illuminated, since the movements of his lips help understand the question, and the expression of participation and sympathy on the face promotes psychological contact. You should speak clearly and slowly, and you should not shout into the patient's ear.

If there is a relative next to the patient, then first you should interview him without the patient. This helps to better clarify many aspects of personal relationships, family situations, problems hidden from the patient by others.

The initial questioning of a mentally retarded patient should be carried out with the participation of relatives.

There are “dissatisfied patients” - personal characteristics persist into old age. They should not be interpreted as symptoms of a disease if the patient has always had difficult, conflictual relationships with others.

Usually the paramedic tries to find out the presence coronary disease hearts, arterial hypertension, stroke, depression, malignant tumor, diabetes mellitus, arthritis. Some of these diseases are present in patients and require attention first, although elderly patients themselves do not consider the manifestations of such diseases to be major (urinary incontinence, hearing loss, dizziness, falls, nocturia, etc.).

You should pay attention to the so-called minor complaints, which may turn out to be symptoms of serious illnesses. For example, progressive weakness, fecal incontinence, and constipation that were not there before may be signs of bowel cancer. It is important to find out living and working conditions.

It is necessary to get an idea of ​​the patient’s daily routine, week, preferences, hobbies, etc.

A feature of the anamnesis of elderly patients is the inclusion of types of anamnesis: social, nutritional, assessment of previous treatment, sexual and psychiatric.

Social history includes information about living conditions, family composition, family relationships related to attitudes towards an elderly person, about friends and acquaintances who help meet needs. It is necessary to find out what kind of help the patient receives from outside medical workers And social services, whether it continues to work and what are the working conditions. It is necessary to establish how capable the patient is of self-care (non-working). It is important to find out how the patient experienced the termination labor activity, death of loved ones, etc.

Nutritional history. They ask the patient about the frequency of meals, whether there are dentures, what the diet is in the past and present, and whether there is a lack of protein foods. They find out: does the patient take alcohol and in what quantity, has he lost weight and over what period of time? Is it far from home to a grocery store or market? Can he cook hot food himself?

Treatment being carried out. During the survey, it is necessary to find out: what medicines taken by the patient (ask the patient to show them), at what time and in what order (before or after meals). They ask about the state of health in connection with the use of medications (improvement or deterioration).

Psychiatric history. The patient is asked in detail about the presence of anxiety and depression, whether he has suicidal thoughts, what is the reason for their occurrence, whether he or his relatives have had mental illness in the past.

Sexual history. An anamnesis is taken if the patient and the paramedic have established a trusting relationship.

Clinical example No. 1

Patient S, 64 years old

Anamnesis of life: No evidence of burdened heredity was identified. The patient's daughter suffers from a chronic mental illness. He grew up in a poor peasant family and had 6 brothers and sisters. As a child, he did not lag behind his peers in development. I went to school at the age of 7. I was always distinguished by diligence, hard work, and studied well and with pleasure. Graduated from 7th grade school, geological technical school. Then he graduated from the geological department of the university and postgraduate studies at the Research Institute of Geological Exploration. He quickly defended his dissertation. He worked fruitfully and defended his doctoral dissertation. Ages 51-54held the position of deputy director of the research institute for scientific affairs, and then - chief researcher of the research institute. Since the age of 58, he has not worked, he is disabled in group 2 due to mental illness. Married, has an adult son and daughter. Lives with his wife, daughter and grandson in separate apartment. Past illnesses: childhood infections, colds. TBI with loss of consciousness in 1984, was treated as an inpatient.

Somatically: IHD, atherosclerosis coronary arteries, angina pectoris 2 f.k., hypertension 2 stages, presbyopia, early age cataract, retinal angiosclerosis, vascular encephalopathy.

History of the disease: Psychasthenic traits were always present in the patient’s personality structure: anxiety, shyness, self-doubt, impressionability. Combined with hard work, conscientiousness and accuracy, and a tendency towards perfectionism, they found their compensation first in excellent studies, then in hard work. Almost all of his scientific activity, the patient was absorbed in new developments and tried to bring them to life. He showed a certain persistence in this, overcoming many obstacles. He first prepared his doctoral dissertation at the age of 32, but was not allowed to defend it then, and became a doctor of science only at the age of 45. At the same time, he noted that he always felt anxiety and awkwardness when communicating with superiors and subordinates, and during public speaking. Only hard work and the desire to prove that one was right allowed one to overcome suspiciousness and self-doubt and served as a means of self-affirmation. As a result, by the age of 50 he received well-deserved recognition, took a responsible position, and began to travel to foreign congresses. New responsibilities, combined with the beginning of the period of involution, caused decompensation of personal properties. He noted increased anxiety and lack of self-confidence; awareness of responsibility made it difficult to speak in front of a wide audience; he was afraid to say “the wrong thing” or forget the text. The slightest trouble in the service caused alarm. For the first time I was treated at the NIPNI named after. Bekhterev at the age of 52 years for 3 months. Then, after failures at work, anxiety developed, fear that they might get fired. After discharge, he maintained satisfactory performance and occasionally took amitriptyline. At that time able psycho-emotional stress There were phenomena of spastic contraction of the muscles of the face and diaphragm; I could not speak, I felt a lump in my throat, and lack of air. The conditions went away on their own after the situation was resolved. He was examined several times in neurological departments, but no organic pathology was found. At the age of 57 years, another deterioration in my condition. Then his subordinates did not fit into the schedule scientific work, there were claims from the customer. In response to the situation, anxiety developed, obsessive thoughts about dismissal appeared, I thought that after this, having lost my livelihood, I would not be able to pay for the apartment and would be evicted with my family onto the street. For no reason I became afraid to go out, most spent time in bed, at times suddenly jumped up, began to rush around the apartment, holding his head, stereotypically repeating “horror, horror.” In the hospital, anxiety persisted, reaching the level of agitation, accompanied by spastic phenomena. A positive diazepam test was revealed: after the administration of diazepam, the symptoms of spasticity went away, he could talk about his condition, the situation at work and at home, complained about the anxiety that oppressed him, said that he was worried about his place and the financial situation of his family, critically assessed the exaggeration of his fears, but noted that he could not help himself. An experimental psychological examination noted a lack of attention and memory, psychasthenic personality traits, and a tendency to form ideas of attitude. At that time, there were already strained relationships with his wife and children, and he felt like an outcast in his own family. During the treatment, positive dynamics were noted. After discharge, he returned to work and worked successfully for several months. However, then the condition worsened again: anxiety reappeared, fear of losing a job, losing an apartment. Hypochondriacal ideas of nihilistic content gradually came into play: he claimed that his intestines had atrophied and his brain had dried out. He refused to eat and brought himself to the point of exhaustion. He was hospitalized in a hospital with a diagnosis of involutional depression. Anxiety and fear for the future of the family remained resistant to therapy for a long time, he was in the hospital for more than ½ a year, received disability due to mental illness, and has not worked since then. The next hospitalization was at the age of 60, when treatment-resistant depressive symptoms with severe anxiety, fragmentary delusional ideas of guilt against the background of memory impairment, difficulties in reproducing dates, thoroughness of thinking, and bradyphrenia were noted. According to the neurologist: diffuse neurological symptoms of vascular origin. Discharged with a diagnosis of involutional depression, complicated vascular disease brain." Subsequently, he was repeatedly hospitalized in the PB with anxiety depression, delusional ideas of guilt, impoverishment, often ridiculous content (colleagues may suspect him of selling secret materials, they will open a criminal case; he accused himself of having appropriated a microscope given to him, infecting those around him with scabies; he was afraid that he would not be paid a pension, his family would end up on the street, would go hungry, etc.) Severe anxiety states were noted, reaching the level of substupor, rapid and unpredictable development of anxiety and delusional experiences. Long-term hospitalizations. Medicines at home did not always take regularly, showed helplessness in everyday matters, was constantly controlled by his wife and daughter. The latter often make claims to the patient on ordinary issues, further traumatizing him. The next hospitalization in the PB is due to the development of an anxiety-depressive state with delusional ideas of self-deprecation.

Upon inspection: Generally oriented correctly. Looks older than his age, low nutrition. Sits in a mournful pose, shoulders and head bowed, trying not to look at the interlocutor. Motor and ideational inhibition is inhibited, answers questions in monosyllables, after long pauses. Depressed mood, tense, anxious. He says that because of him, his “family will end up on the street,” because he is a “responsible tenant”, but he is being treated in hospital and “will not be discharged.” He accuses himself of raising his grandson “wrong,” and he will grow up “ignorant” and “end up badly.” Believes that he is sick with some kind of “contagious” disease, because... he sees that those around him “look askance” and shy away from him, he realized this when one of his neighbors in the ward did not let him sweep the floor, saying that “there are enough healthy people for this.” He sees no prospects for the future and blames himself for all troubles. No criticism of the condition.

Diagnosis: Psychotic depressive disorder due to mixed diseases(vascular, involutional)

Anamnesis: Born in Leningrad. The patient's mother suffered from dementia in old age, the father, according to the patient, died of cancer in psychiatric hospital, where I ended up after learning about my diagnosis. As a child, he did not lag behind his peers in development. Graduated from 10th grade school, Mining Institute. He worked as a mining engineer at a mine for about 10 years. Then he studied in graduate school, but did not defend his degree. He worked at a research institute as a researcher. More than 12 years retired. Disabled person of group 2 due to general illness (GB). Married, has 2 adult sons. Lives with his wife in a separate apartment. Past illnesses: childhood infections, colds. Long time suffers from hypertension with high blood pressure, ischemic heart disease, and angina pectoris. Suffers from gastric ulcer and chronic cholecystitis. He suffered a head injury in 1953 and 1987, both times he was treated as an inpatient.

History of the disease: Relatives always note the patient’s inherent anxiety, “moody”, need for attention from others, and increased concern for their health. These features, in combination with mild dysmnestic disorders, emotional lability, viscosity of thinking, rigidity, intensified in last years against the background of the flow of headache. About 3 years before his current admission, after the death of his sister from cancer, his mood decreased, he became afraid that he was also sick, and saw symptoms of stomach and intestinal cancer. He sought a comprehensive examination and said that he would die soon. A year ago, there was a fear that he and his wife were paying their rent incorrectly and that they might be evicted. He received inpatient treatment at the Department of Psychiatry of the Military Medical Academy. Positive dynamics were noted. At home I took maintenance therapy for some time. The condition changed 2 months before the actual hospitalization: anxiety intensified, it seemed that some kind of illness incurable disease, suffered from constipation. He constantly demanded attention from his wife, made many demands on her, was afraid to let her leave the house, did not want to be left alone, said that he would soon learn how to do it. The wife tried to fulfill the wishes of the patient, but he remained dissatisfied and accused his wife and sons of not taking good care of him. Soon he began to suspect his wife of wanting to get rid of him. I was frightened by the plumber's visit and decided that it was his wife who had invited an accomplice to help her. He noticed that in his absence, his things (for example, stamps) were in disarray, and he suspected that someone had broken into their apartment. When I came to him new doctor from the clinic, he was afraid that he was a “dummy” and might poison him with some medicines, he did not rule out that he was the lover of his wife (she is 72 years old). He began to suspect meetings with men as the reasons for his wife’s absences from home. Over the past few weeks, I noticed that their windows were being watched from the house opposite, I saw suspicious people, and the flickering of binocular glasses. There were thoughts that they wanted to somehow neutralize him and his wife, as elderly and defenseless people, and take possession of the apartment. He said that we need to contact the FSB. Then I came to the conclusion that these people are connected with his wife, and their goal is to get rid of him.

On the day of hospitalization, he again felt unwell, was anxious, and demanded that his wife be near him. In the window opposite, I saw a man allegedly watching their window, then noticed that his wife came to the window and straightened her hair, which, in the patient’s opinion, caused special sign to that man. Felt it strong fear seemed to be dying. He called emergency services himself. Doctor emergency care, having listened to the patient’s concerns, called an ambulance psychiatric care. Hospitalized in the PB.

On admission: He is comprehensively oriented, anxious, fussy, and verbose. He is hypochondriacal, lists his many illnesses, says that he is seriously ill and must die, and will not live a day in the hospital. Regarding other experiences, he is difficult to approach, only after establishing a confidential contact with the doctor, he tells him that at home he felt that “they were watching around and something was going to happen,” he talks about constant surveillance from the house opposite, however, what caused it does not want to explain . He speaks warily about his wife, believes that without him she will leave the city to “rest.” The thinking is thorough, there are some dysmnestic disorders. No criticism. Referring to his somatically weakened health, he refused to give consent to hospitalization and treatment, and involuntary hospitalization was formalized under Article 29, paragraph B of the Russian Federation Law on Psychiatric Care.

During the first days of treatment in the hospital, he remained in severe anxiety; he stated that he was seriously ill, that he was about to die, that he had “atherosclerosis everywhere,” and that his “intestines had atrophied.” He continued to claim that they were following him and wanted to kill him. It was difficult to fit into the department regimen, he was intrusive with requests, constantly complained of constipation, there were significant fluctuations in blood pressure, against the background of which anxiety intensified. During the course of treatment, he became calmer, although for a long time there remained a hypochondriacal fixation on the functioning of internal organs and a decreased mood level. Gradually I gained an appetite and became physically stronger. The patient’s experiences became available, he spoke about his suspicions about his wife, claimed that his wife had taken a younger and healthier lover and decided to get rid of him. Subsequently, criticism of these experiences appeared, and then my mood leveled out, I began to actively take walks, watched TV, made no complaints, and cordially greeted my wife on visits. Before discharge, his condition remained stable. There is no depression. Thorough, viscous, rigid in judgment. Prone to anxious reactions to everyday issues. Doesn't express crazy ideas. No suicidal or aggressive tendencies are detected. Sleep and appetite are normal. Criticism of the disease is formal. IN satisfactory condition discharged home, accompanied by his wife, who asked for the patient to be discharged.

Somatic status: ischemic heart disease, angina pectoris 2 f.k., hypertension 2 degrees, peptic ulcer stomach and 12 p.c.

Neuropathologist: CVB, DE 2nd degree.

EEG moderately expressed diffuse changes BEA

Psychologist: moderate changes in mental processes of an organic typeseverity (decreased ability to generalize, disorders of fixation memory moderate degree severity), a slight asthenic component is noted. Among the characteristics of the emotional response at the time of the examination, clinically expressed anxiety was revealed, depression was not detected.

Treatment: Zyprexa VSD 5 mg, phenazepam VSD 2 mg, Sonapax VSD 50 mg, Stimaton VSD 100 mg.

Anamnesis of life anamnesis vitae. Information about the patient's life is great importance to clarify the nature of the present disease and establish the causes and conditions of its occurrence.

Information about the patient’s life history is collected according to a specific plan:

I. General biographical information:

• place of birth (some diseases are more common in certain areas, such as endemic goiter);
• the age of the patient's parents at birth;
• about the nature of the pregnancy itself (threat of miscarriage, infectious diseases, use of medicinal substances etc.);
• about childbirth (at term, degree of term, which child and from which birth);
• about feeding (breast or artificial);
• about premorbid conditions (hypo- or hypertrophy, rickets or other “background” diseases);
• about general conditions life in childhood and adolescence (locality, family circumstances, living conditions, nutrition);
• about the characteristics of physical and mental development;
• about puberty;
• causal factors of the disease and conditions that distinguish the course and outcome of the disease (insufficient physical education and hardening, poor care, irrational daily routine, poor nutrition, non-compliance with the epidemiological regime, etc.).

II. Information about previous infections:

• childhood infectious diseases (measles, scarlet fever, diphtheria, mumps, chicken pox, rubella, etc.), the severity of their manifestations, the presence of complications;
• frequent colds (acute respiratory infections, flu, etc.), the nature of their manifestations, the presence of complications. For example, frequent sore throats with prolonged feverish conditions, swelling and tenderness of the joints (development of the rheumatoid process) can cause the development of complications from the respiratory and excretory systems;
• congenital infectious diseases(syphilis, listeriosis, etc.) Travel to countries in Africa, Asia, South America etc. (to detect malaria, leishmaniasis, trypanosomiasis and many other infections); contacts with the surrounding nature and domestic animals, livestock. So, in the case of the development of an infectious pathology, for example, with HFRS ( hemorrhagic fever With renal syndrome) the source is a virus transmitted by mouse-like rodents; for brucellosis (mainly a disease of workers Agriculture) Brucella infection occurs from large and small cattle. Chronic foci of infection in the patient are identified: sinusitis, dental caries, etc.

III. Information about the hazards of production: chemical (toxic chemicals, pesticides, etc.), radioactive, etc.

IV. Information about social bad habits: tendency to alcoholism, drug addiction, smoking, substance abuse, etc.

V. Family and hereditary history allows you to find out the health status of relatives and thereby helps to recognize diseases in a given patient.

If there is a family member with tuberculosis, there is a risk of infection of all family members.

When collecting a family hereditary history, it is important to identify not only possible sources of infection in the patient’s environment, but also a predisposition to the development of a certain pathology, such as hypertonic disease, atherosclerosis, cholelithiasis, gastric ulcer and duodenum etc. These diseases are not hereditary, but phenotypic, that is, those in which not the disease itself is inherited, but only a predisposition to it, which can manifest itself into a disease under the influence of certain external conditions(stress, infections, etc.).

This predisposition may be based on immune and non-immune mechanisms. Thus, immunogenetics has established a connection between some alleles of the major histocompatibility complex (HLA system) and certain diseases, and the percentage of relative risk of their occurrence has been established. Thus, a person who has an allele of the HLA DR5 molecule has a 3.2% risk of developing autoimmune thyroiditis(Hashimoto's), and those with the HLA DR3 allele have a 56.4% risk of developing dermatitis herpetiformis, 13.9% risk of developing chronically active hepatitis, etc. Moreover, the disease itself is not inherited.

When considering hereditary (genotypic) diseases transmitted from generation to generation, the type of inheritance is taken into account: autosomal, recessive, dominant or sex-linked; homozygous or heterozygous carriage of genes, as well as the degree of expression of the gene in the trait, that is, its expressivity.

Main diagnostic methods hereditary pathology are genealogical analysis, the method of cytogenetics, somatic cell genetics, etc. Genetic analysis provides early diagnosis, their rational prevention, assessment of the risk of having a sick child in the family, the degree of hereditary pathology, and in some cases, the possibility of pathogenetic therapy.

Informant

Name, relationship of the patient, degree of closeness and duration of acquaintance. Impression of the reliability of the information.

By whom and for what reasons the patient was referred for consultation:

History of present illness

Symptoms; when and how they appeared. Description of the temporal relationship between symptoms and somatic disorders, as well as psychological and social problems. Impact on work, social functioning and relationships with others. Associated disorders of sleep, appetite and sexual desire, Treatments used by other doctors.

Family history

Father: Current age (if deceased, indicate the age at which death occurred and its cause); state of health, occupation, nature of relationship with the patient. Mother: Same points. Siblings: Names, age, marital status, occupation, personality characteristics, presence of mental illness, nature of relationship with the patient. Social status families; Home conditions. Mental illness in family: Mental disorder, personality disorder, alcoholism; other neurological or related diseases (for example,).

Anamnesis of life

Development at an early age: Pathology during pregnancy and childbirth; difficulties in learning useful skills and delays in development (the ability to walk, mastery of speech, control of natural functions, etc.). Separation from parents and reactions to it. Health in childhood: Severe illness, especially any central lesion nervous system, including hyperthermic convulsions. « Nervous problems"in childhood: Fears, outbursts of irritation, shyness, tendency to blush easily when embarrassed, stuttering, eating oddities, sleepwalking, prolonged bedwetting, frequent nightmares(although the meaning of such manifestations is questionable; see p. 125). School: The age at which you entered and graduated from school. Types of schools. Success in your studies. Sports and other achievements. Relationships with teachers and fellow students. Further education. Labor activity: List of places of work (in chronological order) indicating the reasons for their change. Financial situation, current job satisfaction. Military service or participation in war: Promotions and awards. Problems with discipline. Service abroad. Menstrual cycle data: The age of onset of menstruation, attitude towards them, their regularity and amount of discharge, dysmenorrhea, premenstrual tension, age of menopause and the presence of any symptoms at this time, date of the last menstruation. Marital history: Age at marriage; the duration of acquaintance with the future spouse before marriage, the duration of the engagement period. Previous connections and engagements. Data about the spouse: current age, occupation, health status, personality characteristics. Characteristics of marital relations in a real marriage. History of sexual activity: Attitude to sex; heterosexual and homosexual experience; current sexual practice, contraceptive use. Children: names, gender and age. Dates of abortions or stillbirths. Temperament, emotional development, mental and physical health children.

Current social situation

Housing conditions, family composition, financial problems.

Past illnesses

Diseases, surgeries and injuries.

Previous mental illness

The nature of the disease and its duration. Dates, duration and nature of treatment. Name of the hospital and names of doctors. Result.

Characteristics of personality according to the present disease

Contacts: Friends (few or many; same or opposite sex; degree of closeness of friendships); relationships with colleagues and superiors. Leisure activities: Hobbies and interests; membership in societies and clubs. Prevailing mood: Anxious, restless, cheerful, gloomy, optimistic, pessimistic, self-deprecating, self-confident; stable or unstable; controlled or expansive. Character: Touchy, withdrawn, timid, indecisive; suspicious, jealous, vindictive; grumpy, irritable, impulsive; selfish, self-centered; constrained, lacking self-confidence; dependent; demanding, fussy, straightforward; pedantic, punctual, overly neat. Views and foundations: Moral and religious. Attitude to health and your body. Habits: Food, alcohol, smoking, drugs.