The Life Course Method: Get a Story
This method basically involves getting a good, solid clinical history from the beginning. I usually start with the question: When did you first start experiencing mood symptoms? Then I proceed chronologically, with special attention to mood episodes and significant life events. I like to divide the history into academic/occupational time periods, or epochs: How was high school? How was college? Your first job? Patients in their mid-twenties often have excellent recall for events during school years. Moreover, asking about whether an event occurred in freshman versus sophomore year of college is often easier than asking about 1994 or 1995. For older patients, life events such as marriage/divorce, job changes, periods of disability, or geographic relocations can help anchor the history. In addition, these life events may be concurrent with manic or hypomanic episodes. Behavioral changes, such as increased risky pleasurable behaviors or pressured speech, are often better markers for manic/hypomanic episodes than patient recall of mood elevations (Akiskal HS and Benazzi F, J Clin Psychiatry 2005;66:914–921), so ask for behavior changes first, then follow up with mood inquiries to nail down the diagnosis.
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