Genetic counseling aid: Questions to help identify individuals with psychiatric illness

The following questions, grouped by symptoms, can help the counselor identify individuals who may have psychiatric illness. By no means should a counselor routinely ask all of these questions. Instead, her or she should determine which of these symptoms are most relevant and ask appropriate questions based on the family/psychiatric history. The counselor should refer an individual suspected to have significant psychiatric symptoms for a psychiatric evaluation.

Mania

Have you had a period of a week or more during your life when you have felt unusually good or high? Was this clearly different from your usual mood, so much so that your relatives and friends noticed the change?

The counselor also may ask questions about the presence of irritability lasting one week or more, which is also a symptom of mania that can occur independent of high moods.

Other features that may characterize mania include a reduced need to sleep, pressured speech, racing thoughts, grandiosity, distractibility, increased energy and activity, and engagement in risky behaviors.

Depression

Have you ever had a period lasting at least two weeks when you felt depressed, sad, or hopeless day in and day out? Was there ever a sustained period when you were no longer interested in or able to enjoy your usual activities?

Other features that characterize depression include increased or decreased appetite, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, feelings of worthlessness or excessive guilt, diminished concentration, loss of interest in normal activities, reduced energy, and suicidal thoughts.

Psychosis

Have you ever had the experience of hearing people talking to you or about you when no one was present? Have you ever thought that people were following you, conspiring against you, or monitoring your activities? (The genetic counselor should attempt to determine if such an event in fact occurred.) Have you ever had thoughts that were not your own but were implanted in your mind?

Other pertinent symptoms of psychosis include:

• hallucinations in other modalities (visual, tactile, gustatory, olfactory); 
• delusions (any belief that an individual now holds or at one time held with great conviction that clearly is not true); and 
• psychotic symptoms (may include incoherent speech, avolition or amotivation, catatonia, and flat or blunted affect).

Keep in mind that psychosis can occur in depression, mania, schizophrenia, schizoaffective disorder, and brief psychotic disorder. Psychosis also can occur in the context of medical conditions such as hyperthyroidism and can result from exposure to illicit drugs or medications.

Anxiety

Symptoms of anxiety can manifest in a variety of ways, including:

Excessive worry: Do you have a tendency to worry excessively about minor things, and are you unable to stop yourself from worrying throughout the day?

Excessive worry is the core feature of generalized anxiety disorder, specifically when accompanied by other symptoms such as irritability, fatigue, tension, an inability to relax, and poor concentration.

Panic attack: The counselor might ask the client directly if he or she has panic attacks. The client may describe abrupt onset of terror occurring out of the blue and associated with a variety of physical symptoms, including heart palpitations, difficulty catching his or her breath, or a feeling that he or she will die or go crazy. Panic attacks characteristically last less than 30 minutes.

Phobia: Do you have any phobias or unusually strong fears?

Specific situations (social or situational) can result in a phobia, such as a phobia of heights or a social phobia (for example, fear of eating in public). Agoraphobia is a fear of being away from safety, with the feeling that something dreadful will happen if the individual enters an "unsafe" place.