Psychiatric Interview PDF

WE MAKE DOCTORS The Psychiatric Interview Ana Isabel Ariza MD Objectives o Outline the significant stages in the mental exam. o Review the purpose and meaning of the psychiatric interview o Address challenges in interviewing Psychiatric Interview Used as a method for evaluating mental...

WE MAKE DOCTORS The Psychiatric Interview Ana Isabel Ariza MD Objectives o Outline the significant stages in the mental exam. o Review the purpose and meaning of the psychiatric interview o Address challenges in interviewing Psychiatric Interview Used as a method for evaluating mental status and as a tool for preparing the psychiatric clinical history Interview Phases ✓ Initial​ Establishes the beginning of the relationship and prepares the ground for the objective of the interview. Half​ ✓ It begins with the establishment of the reason for the consultation​ ✓ Highly emotional topics may be reached upon​ ✓ Various techniques are used to obtain information Final ✓ A summary is presented to the interviewee​ ✓ Goals are set​ ✓ Provides perspective for the future General Interview Principles ✓ Establish rapport and trust with the patient ✓ Make the interviewee feel comfortable → Investigate why they come for an assessment​ ✓ Assess from the point of view of the interviewee​ ✓ Express empathy​ ✓ Good relationship is the basis of diagnosis ✓ Gather diagnostic information ✓ Assess the patient's mental state ✓ Evaluate risk (e.g., suicide, violence) ✓ Formulate a treatment plan Elements of the Clinical History ✓ Psychobiography​ ✓ Identification file​ ✓ Sexual history​ ✓ Reason for consultation​ ✓ Physical exploration​ ✓ Current condition​ ✓ Mental Exam​ ✓ Family history​ ✓ Laboratory and Cabinet​ ✓ Non-psychiatric medical history​ ✓ Clinimetry ✓ Psychiatric history​ ✓ List of problems​ ✓ Consumption of psychoactive ✓ Prognosis​ substances​ ✓ Treatment plan Elements of the Clinical History ✓ Psychobiography​ ✓ Sexual history​ ✓ Identification file​ ✓ Physical examination ✓ Reason for consultation​ ✓ Current condition ✓ Mental Exam​ ✓ Family history​ ✓ Laboratory and Cabinet​ ✓ Non-psychiatric medical history​ ✓ Clinimetry ✓ Psychiatric history​ ✓ List of problems​ ✓ Consumption of psychoactive ✓ Prognosis​ substances​ ✓ Treatment plan  Where, with whom, how many people, how is the patient dressed? General description of the interview Movements performed by the patient o Describe everything the patient does o Where the patient directs their gaze o Describe all movements (feet, hands, head, eyes, etc.) o Which may include stereotyped movements or mannerisms (involuntary). o Describe if they follow commands, and note the presence of echopraxia. Attitude o How does the patient behave towards the physician? Mood o Euthymic, expansive, irritable, depressive, etc.  Affect o How do we perceive the patient? ✓ Emotional lability ✓ Affective flattening ✓ Constriction of affect ✓ Blunted affect Orientation ✓ Autopsychic (person) ✓ Allopsychic (time and space) Attention ✓ Active and passive (hyperprosexia, hypoprosexia) Concentration ✓ Ability to maintain attention ✓ Synthesis Higher Mental ✓ Calculation Functions ✓ Abstraction  Memory Language ✓ Immediate ✓ Tone ✓ Short-term ✓ Volume ✓ Long-term ✓ Speed ✓ Coherence ✓ Congruence Course Alterations ✓ Neologisms ✓ Word salad ✓ Circumstantiality ✓ Tangentiality ✓ Perseveration ✓ Echolalia ✓ Inappropriate responses ✓ Flight of ideas ✓ Clang associations: speaking in rhyme, thought blocking Thought ✓ Delusions: False belief inconsistent with reality, unshakeable by logic ✓ Nihilistic delusions ✓ Somatic delusions ✓ Jealous delusions ✓ Erotomanic delusions ✓ Messianic delusions ✓ Mystical-religious delusions ✓ Supernatural ideas. Content Alterations Obsession Compulsion Persistence of a Action performed thought to alleviate anxiety Phobia Irrational, nonspecific fear Paranoid complex Delusions of harm, persecution, delusions of reference, and delusions of grandeur. Thought control and manipulation, thought insertion, thought broadcasting Sensory-perceptual alterations ✓ Altered perception of reality ❑ Hallucination: Perception without an object (can be auditory, olfactory, sensory, tactile). ❑ Illusion: Distorted perception of an object. ✓ Judgment ✓ Insight ✓ Impulse control ✓ Tolerance to frustration ✓ Impression of intellectual quotient Mantras to tattoo on the students fontanel ✓ NEVER DECIDE PREMATURELY FOR A PRIMARY DIAGNOSIS ✓ EVERY PRIMARY MENTAL DISORDER IS A DIAGNOSIS OF EXCLUSION​​ ✓ THERE IS ALWAYS MORE THAN ONE DIAGNOSIS​ ✓ THE HIERARCHY OF PROBLEMS CHANGES OVER TIME References o American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. o Kaplan, H. I., & Sadock, B. J. (2015). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. o Shea, S. C. (1998). The psychiatric interview: A practical guide (2nd ed.). Philadelphia, PA: W. B. Saunders. o Morrison, J. (2014). The first interview (4th ed.). New York, NY: Guilford Press.