Socio-Demographic profile
Name
Age
Sex
Educational qualification
Occupational status
Marital status
Place of residence
Date of Interview
Identification mark of the participant
Chief complaints
What brings you here today? What has been disturbing you the most? What thought has been
affecting you lately?
History of present illness (HOPI)
1. "Can you recall when you first started feeling this distress?"
2. "Are there any other events happening at the same time as this distress that might be
affecting you?"
3. “what has the magnitude of the stress felt like?”
4. "How often do you experience these distressing feelings?"
5. "Have you noticed any changes in how you feel or the symptoms you experience over
time?
Predisposing:
● Has anyone in your family (parents, siblings, grandparents) experienced similar
emotional distress, anxiety, depression, or other mental health challenges?
● Have any of your family members been diagnosed with a mental health condition?
Precipitating
● Have there been any significant losses (e.g., bereavement, breakup, job loss) that have
affected you deeply?
Triggers
● Have you noticed any particular events, situations, or environments that seem to make
your distress worse?
Perpetuating factors
● Have there been any conflicts or challenges in your relationships with family or friends
that have been particularly stressful? (perpetuating factor)
● ● Do you feel supported by those around you, or do you feel isolated in dealing with your
distress?
Mode of Onset: acute, insidious
● Can you recall when the distress started?
Course of illness
● "Have your symptoms been continuous, completely gone at times before this episode, or
ongoing with ups and downs?"
Progress-
Since your symptoms began, have you noticed them improving, getting worse, or staying the
same?
Activities of daily living (ADL)-
● How does your typical day look like?
● "Have there been any changes in your daily routine or the way you go about your usual
activities?"
● Could you elaborate on some of these changes that you have noticed
● in your day to day routine, related to college, academic chores , social life (BREAK
INTO DIFFERENT ASPECTS)
● "How have you been managing your personal care and hygiene lately?"
Negative History
● "Besides what you've described, have you noticed any other changes in how you’ve been
feeling or functioning?"
● “Are you currently undergoing any treatment, therapy, or taking medication for a
psychological or neurological condition?”
Treatment History:
● Have you sought any form of treatment or support for your concerns?
Counselling history-
● Have you ever received counseling or attended any support groups for your concerns?
○ ■ Was this a choice you made or on advise?
○ ■ How was the experience? Anything that you would like to share
Family History
● Can you tell me about your family—who are your immediate family members?"
● "What is your parents’ marital status?
● Have there been any significant changes in the family structure, such as separations,
remarriages, or deaths?"
● "How would you describe your relationships with your family members?" (including till
grandfather/mother)
● "Who do you currently live with?
● What do your parents do for a living?"
● To your knowledge, has there been any history of substance abuse, physical abuse, or
sexual abuse within your family?"
Personal History
Childhood history
● "Can you describe the atmosphere at home while growing up?
● Did you experience any behavioral, physical, or emotional difficulties during childhood?"
Scholastic and extracurricular activities-
● "How was your academic progress and involvement in extracurricular activities?
● Did you face any challenges with peers, teachers, or authority figures?
● Were you regular in attending classes, submitting assignments, and adjusting to school or
college life?"
Vocation/occupation
● Are you currently employed? If not, were you ever employed in the past?
● What was the duration of your employment?
● How would you describe your relationship with colleagues?
Menstrual history
● "At what age did you attain menarche?
● How have your menstrual cycles been—regular or irregular?"
General pattern of living
● Who do you live with? How would you describe your family's structure and dynamics?"
● "How do you manage your finances—do you have a stable income or receive
allowances?"
● What are your usual monthly expenses, and do you face any financial difficulties?"
Premorbid personality
Describe themselves, relation with friends
● Could you describe yourself as a person in the way you interact with friends?
● How has your interaction with friends been currently? (Probe: school friends, college
friends, community friends)
● First Now -> then take them go back and ask about pre-morbid
Work and leisure
● What do you enjoy doing in your free time, and how do you manage
work/studies with leisure?
Mood and expression
● How would you describe your (a) usual mood and (b) emotional state?
● Have there been any changes in your mood lately as noticed by you?
Character- reserved, timid, extroverted
● How would you describe your character/personality - in terms of social interaction?
Habits- typical
● Can you share some of your daily habits and routines, including (a) sleep patterns, (b)
eating behaviors, and any long-standing personal practices or preferences?
Food and sleep pattern
● According to you, have you been eating well?
● Has there been any change in your eating habits lately?
● According to you, have you been sleeping well?
● Has there been any change in your sleeping patterns lately?
Mental status examination
● Attention and concentration – (ask the client to perform this 40 – 3, backwards)
● Orientation- time, place and person (ask the client to whether he is aware of his
surrounding)
● For affect ask this question ‘How are you feeling right now?’.