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11/13/24, 8\:08 PM Guide | Anxiety history

Anxiety history

Table of contents

Tips

Some general tips when taking a history of anxiety\:
Allow lots of gaps to allow the patient to speak freely and use the space in the way they choose
Use active listening skills like head nodding and open posture to show the patient that you are engaged in conversation
even when you’re not speaking
Talking about mental health problems can be upsetting for patients, so make sure you have some tissues ready and give the
patient space to express their emotions as needed

What is anxiety?

Anxiety is de
. While everyone will feel anxious
occasionally, it becomes a medical issue when these feelings are constant, uncontrollable and/or impacting daily life.
There are several types of anxiety disorders, including generalised anxiety disorder (GAD), phobic anxiety disorders, and
panic disorder. For more information, see the Geeky Medics guide to anxiety disorders.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient, including your name and role.
Con
Ask the patient if they’d be happy to talk with you about their current issues.
General communication skills
It is important you do not forget the general communication skills which are relevant to all patient encounters.
Demonstrating these skills will ensure your consultation remains patient-centred and not checklist-like (just because
you’re running through a checklist in your head doesn’t mean this has to be obvious to the patient).
Some general communication skills which apply to all patient consultations include\:
Demonstrating empathy in response to patient cues\: both verbal and non-verbal.
Active listening\: through body language and your verbal responses to what the patient has said.
An appropriate level of eye contact throughout the consultation.
Open, relaxed, yet professional body language (e.g. uncrossed legs and arms, leaning slightly forward in the chair).
Making sure not to interrupt the patient throughout the consultation.
Establishing rapport (e.g. asking the patient how they are and o
Signposting\: this involves explaining to the patient what you have discussed so far and what you plan to discuss next.
Summarising at regular intervals.
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Presenting complaint

Use open questioning to explore the patient’s presenting complaint\:
“ H o w a r e y o u t o d a y ?”
“ H o w h a v e y o u b e e n f e e l i n g r e c e n t l y ?”
“ W h a t’ s b r o u g h t y o u i n t o s e e m e t o d a y ?”
“ T e l l m e a b o u t t h e i s s u e s y o u’ v e b e e n e x p e r i e n c i n g.”
Provide the patient with enough time to answer and avoid interrupting them.
Facilitate the patient to expand on their presenting complaint if required\:
“ O k , c a n y o u t e l l m e m o r e a b o u t t h a t ?”
Open vs closed questions
History taking typically involves a combination of open and closed questions. Open questions are e
consultations, allowing the patient to tell you what has happened in their own words. Closed questions can allow you to
explore the symptoms mentioned by the patient in more detail to gain a better understanding of their presentation.
Closed questions can also be used to identify relevant risk factors and narrow the di

Exploring symptoms of anxiety

Often, patients will refer to experiencing anxiety as “attacks” of symptoms. However, di
Tip\: By using the language that the patient uses, you demonstrate that you’re listening to what they’re saying and can also put
them at ease. Try to listen to what speci
Symptoms often include a combination of psychological and physical symptoms.

Psychological symptoms

Psychological symptoms of anxiety include\:
Feeling nervous or restless/tired or fatigued
Sense of impending doom
Di
Feeling to urgent need to leave a situation
Low sense of self-worth
“ H o w d o e s i t f e e l w h e n y o u h a v e a n a t t a c k ?”

Physical symptoms

Physical symptoms of anxiety include\:
Feeling very hot and sweating/very cold and shivering
Hyperventilation
Rapid heart rate or palpitations
Headache
Nausea
Shortness of breath
Pins and needles
“ W h e n y o u f e e l a n x i o u s , h o w d o e s y o u r b o d y f e e l ?”
If the patient is struggling to put into words how they feel when they feel anxious, you can help by asking about the speci
symptoms listed above\:
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“ D o y o u n o t i c e a c h a n g e i n y o u r b r e a t h i n g w h e n y o u f e e l a n x i o u s ?”
“ D o y o u n o t i c e a n y c h a n g e s i n t e m p e r a t u r e ?”
When asking questions about speci
patient may feel inclined to say yes if they feel certain symptoms are required to receive help (e.g. “do you feel sick?”)

Timing of symptoms

Depending on the underlying cause of anxiety, symptoms may be triggered by speci
throughout the day, or they may be constant.
Determining when the symptoms occur can help you make the eventual diagnosis. For example, social anxiety brings about
symptoms in social situations or when thinking about social situations. In contrast, generalised anxiety disorder (GAD) tends to
be more constant and without a clear pattern.
Again, try to use open questions where possible\:
“ C a n y o u d e s c r i b e a p a t t e r n o f w h e n y o u ge t t h e s e s y m p t o m s ?”
“ I s t h e r e a n y t h i n g i n p a r t i c u l a r t h a t b r i n gs o n a n a t t a c k ?”
“ W h e n y o u n o t i c e y o u s t a r t f e e l i n g a n x i o u s , i s i t u s u a l l y w h e n y o u’ r e d o i n g a p a r t i c u l a r a c t i v i t y ?”

Relieving factors

For some people with anxiety, certain things can help settle their symptoms, while for others, nothing they do seems to help.
This, again, can help us determine the type of anxiety disorder they are experiencing. For example, patients with agoraphobia
(anxiety as a result of leaving the house or crowds or public places) will often
house. In contrast, patients with GAD will often say that nothing they do will stop the anxiety.
“ I s t h e r e a n y t h i n g y o u’ v e f o u n d s e t t l e s t h e a n x i e t y ?”
“ W h a t d o y o u d o , i f a n y t h i n g , t o t r y a n d s t o p a n a t t a c k ?”

Assess suicide risk

Anxiety disorders often co-exist with depression, and it is important to assess the risk of suicide. Many healthcare
professionals feel uncomfortable asking questions to determine suicide risk. However, by sensitively asking about suicidal
ideation, you are safeguarding the patient. It can help to know that asking about suicidal ideation does not increase the risk of
your patient acting on any thoughts.
Questions that can be useful to determine a patient’s risk of suicide include\:
“ H a v e y o u e v e r h a d t h o u g h t s a b o u t h a r m i n g y o u r s e l f ?”
“ D o y o u e v e r h a v e t h o u g h t s a b o u t e n d i n g y o u r o w n l i f e ?”
“ H a v e y o u e v e r a c t e d o n t h o u g h t s t o e n d y o u r l i f e o r h a r m y o u r s e l f ?”
“ I s t h e r e a n y t h i n g s t o p p i n g y o u f r o m a c t i n g o n t h e s e t h o u gh t s ?”
“ W h o m i g h t y o u t a l k t o i f y o u w e r e h a v i n g t h o u g h t s t o e n d y o u r l i f e ?”
See our suicide risk assessment guide for more details.

Screening for other psychiatric diagnoses

While anxiety can be a disorder in itself, it can also be a symptom of another underlying psychiatric condition. Anxiety is also
strongly associated with depression, and the two can co-exist. As a result, it's important to ask questions relating to general
psychiatric health such as\:
“ H o w i s y o u r m o o d ?”
“ I n t h e l a s t f e w m o n t h s , h a v e y o u f o u n d y o u r s e l f f e e l i n g l o w ?”
“ D o y o u f e e l y o u r t h o u g h t s a r e y o u r o w n ?”
“ D o y o u e v e r h e a r o r s e e t h i n g s t h a t o t h e r s m a y n o t b e a b l e t o ?”
For more information, see the Geeky Medics guide to taking a psychiatric history.
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Screening for depression
NICE guidelines recommend the questions below to brie
“ D u r i n g t h e p a s t m o n t h h a v e y o u …
”
“ F e l t l o w , d e p r e s s e d o r h o p e l e s s ?”
“ H a d l i t t l e i n t e r e s t o r p l e a s u r e i n d o i n g t h i n gs ?”
For more information, see the Geeky Medics guide to depression history taking.

Past psychiatric history

Previous episodes of anxiety\:
“ H a v e y o u e v e r h a d a n y o t h e r p e r i o d s o f f e e l i n g p a r t i c u l a r l y a n x i o u s ?”
“ H a v e y o u e v e r r e c e i v e d a n y t r e a t m e n t ( s ) f o r a n x i e t y i n t h e p a s t , a n d i f s o , General psychiatric history\:
d i d t h e y h e l p ?”
“ H a v e y o u p r e v i o u s l y h a d a n y p r o b l e m s w i t h y o u r m e n t a l h e a l t h ?”
“ H a v e y o u e v e r b e e n d i a g n o s e d w i t h a p s y c h i a t r i c c o n d i t i o n ?”
“ W h a t t r e a t m e n t ( s ) d i d y o u r e c e i v e f o r t h i s d i a gn o s i s , a n d d i d t h e y s e e m t o h e l p ?”
“ H a v e y o u e v e r b e e n a d m i t t e d t o t h e h o s p i t a l b e c a u s e o f y o u r m e n t a l h e a l t h ?”

Past medical history

Ask if the patient has any medical conditions\:
“ D o y o u h a v e a n y m e d i c a l c o n d i t i o n s ?”
“ A r e y o u c u r r e n t l y s e e i n g a d o c t o r o r s p e c i a l i s t r e gu l a r l y ?”
Some medical conditions can cause symptoms of anxiety (organic causes)\:
Hyperthyroidism
Pheochromocytoma
Hypoparathyroidism
Angina
Arrhythmias
Understanding your patient’s medical history can also help you understand them as a whole and formulate an appropriate
treatment plan that considers their co-morbidities. For example, a patient with asthma would usually not be prescribed beta-
blockers.
Chronic illness is also a major risk factor for anxiety disorders (e.g. chronic pain, cancer, etc).
Allergies
anaphylaxis).
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

Drug history

Ask if the patient is currently taking any prescribed medications or over-the-counter remedies\:
“ A r e y o u c u r r e n t l y t a k i n g a n y p r e s c r i b e d m e d i c a t i o n s o r o v e r-t h e-c o u n t e r t r e a t m e n t s ?”
If the patient is taking prescribed or over the counter
medications, document the medication name, dose, frequency, form and route.
Ask the patient if they’re currently experiencing any side e
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“ H a v e y o u n o t i c e d a n y s i d e e
Examples of relevant medications
There are links between anxiety and certain prescription medications. Medications which can cause or worsen anxiety
include\:
Corticosteroids
Levothyroxine
Methylphenidate
Pseudoephedrine (found in decongestants)
While many people diagnosed with anxiety have no apparent cause, it’s important to assess whether medications or other
substances can be causative. If a possible pharmacological cause is found, it may be appropriate to suggest changes to
medication.

Family history

Ask the patient if there is any family history of psychiatric disease in
“ H a v e a n y o f y o u r p a r e n t s o r s i b l i n g s h a d p r o b l e m s w i t h t h e i r m e n t a l h e a l t h ?”
“ D o y o u k n o w w h a t t y p e o f m e n t a l h e a l t h p r o b l e m s t h e y h a d ?”
Anxiety disorders can have a genetic component, and a strong family history of anxiety disorders or other psychiatric disorders
can further support a diagnosis of an anxiety disorder. However, this is not required for diagnosis.

Social history

Explore the patient’s social history to understand their social context and identify potential psychiatric risk factors.
General social context
Explore the patient’s general social context including\:
the type of accommodation they currently reside in (e.g. house, bungalow) and if they have any adaptations to assist them
(e.g. stairlift)
who 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)
Assess the impact of patient’s anxiety symptoms on their relationships and work\:
“ H a s y o u r a n x i e t y a
“ A r e y o u a b l e t o s o c i a l i s e r e g u l a r l y w i t h o t h e r s ?”
“ A r e y o u i n a r e l a t i o n s h i p a t t h e m o m e n t ? H o w h a s t h i s b e e n a
“ H a v e y o u t o l d a n y f r i e n d s / f a m i l y / a n y o n e h o w y o u a r e f e e l i n g?”
“ H a s y o u r a n x i e t y a
“ A r e y o u a b l e t o c o n c e n t r a t e o n t a s k s a t w o r k ?”
“ H a s y o u r m o o d c a u s e d y o u t o t a k e a n y t i m e o
Asking your patient about their day-to-day life is essential in any psychiatric history as it helps you to understand how the
patient is coping and can indicate the severity of their condition and whether they require urgent intervention.
Sleep
Patients with anxiety disorders often have disrupted sleep, either insomnia or sleeping too much\:
“ H o w a r e y o u s l e e p i n g ?”
“ D o y o u
“ D o y o u s t r u g g l e t o f a l l a s l e e p ?”
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“ D o y o u f e e l t i r e d d u r i n g t h e d a y t i m e ?”
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.
See our alcohol history taking guide for more information.
Recreational drug use
Ask the patient if they use recreational drugs, and if so, determine the type of drugs used and their frequency of use.
The e
misuse in patients with anxiety disorders.
If a patient discloses harmful drug or alcohol use during a history taking, it’s essential to signpost them to appropriate services.
Gambling
Ask the patient if they gamble and if they feel this is a problem.
Gambling addiction is also more prevalent in patients with anxiety disorders, and can not only worsen symptoms but can
cause signi
gambling addiction are more at risk of substance misuse.
Problematic gambling can be assessed via the Problem Gambling Severity Index (PGSI).

Closing the consultation

Ask the patient if they have any questions or concerns that have not been addressed.
Thank the patient for their time.
Dispose of PPE appropriately and wash your hands.

Reviewer

Dr Cynthia Gil-Rios
Consultant psychiatrist
Source\: geekymedics.com
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