01 Interviewing

8/9/2019 01 Interviewing

1/11

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC,

Gabbard GO. 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org1

Slide show includes

Topic Headings

Tables

Key Points

The Psychiatric Interview andMental Status ExaminationLinda B. Andrews, M.D.

The American Psychiatric Publishing

TEXTBOOK OF PSYCHIATRYFifth EditionEdited by Robert E. Hales, M.D., M.B.A., Stuart C. Yudofsky, M.D., Glen O. Gabbard, M.D.

2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org

CHAPTER 1


2/11



CHAPTER 1 Topic Headings

THE MENTAL STATUS EXAMINATION

General AppearanceOrientation

Speech

Motor Activity

Affect

Mood

Thought Production

Thought Content

Perceptual Disturbances

Suicidal and Homicidal Ideation

Attention, Concentration, and MemoryAbstract Thinking

Insight/Judgment

DIAGNOSTIC FORMULATION AND TREATMENT

PLANNING

CONCLUSION

REQUISITE PHYSICIAN PREPARATION

CONDUCT OF THE PSYCHIATRIC INTERVIEW

Goals and Purpose

Guidelines for the Interview

Pre-Interview Contact

PROCESS OF THE PSYCHIATRIC INTERVIEW

CONTENT OF THE PSYCHIATRIC INTERVIEW

Chief Complaint and History of Present Illness

Past Psychiatric History

Family Psychiatric HistoryMedical History

Social History

Developmental History

Review of Systems


3/11



CHAPTER 1 Tables

Table 11. Tasks for the therapist conducting a psychiatric interview

Table 12. Outline of the psychiatric interview

Table 13. Outline of the mental status examination

Table 14. Steps in developing a diagnostic formulation and treatment plan

Table 15. DSM-IV-TR multiaxial assessment and differential diagnosis

Summary Key Points


4/11



TABLE 11. Tasks for the therapist

conducting a psychiatric interview

The firstand perhaps most

importanttask in the psychiatric

interview is to establish rapport with the

patient (Table 11). Establishing an

effective working relationship will be

necessary to accomplish all of the otherobjectives of the interview.


5/11



TABLE 12. Outline of the psychiatric interview

Once the introductions, instructions, and consents have been completed, the psychiatrist may focus

on obtaining information from the patient (Table 12). If time allows, the interviewer should cover all

key elements of the psychiatric history and mental status examination.


6/11



TABLE 13. Outline

of the mental status

examination

The psychiatric interviewer completes the mental status examination by combining a series of

observations with a series of formal questions (Table 13). The purpose of the mental status

examination is to provide as clear a picture as possible of the patients actual mental state at the

time of the psychiatric interview or evaluation.


7/11



TABLE 14. Steps in developing

a diagnostic formulation and

treatment plan

The steps involved in consolidating a diagnostic formulation and developing a treatment plan are

listed in Table 14.


8/11



TABLE 15. DSM-IV-TR

multiaxial assessment and

differential diagnosis

The psychiatrist must develop a working diagnosis using the five-axis classification system

delineated in DSM-IV-TR (Table 15).

Source. Adapted from American Psychiatric

Association 2000, pp. 2733.


9/11



CHAPTER 1 Key Points

Establish rapport and communicate respect. Introduce yourself, use patients

name, make eye contact, and limit interruptions.

Use empathic connection to guide and adjust interview to match the particular

patient and situation.

- Follow the patients leads or cues whenever possible and use open-

ended questions to increase depth of understanding and information

gathered (fewer topics covered, greater depth).

- Use focused questions to increase breadth of understanding andinformation gathered (more topics covered, less depth).

- Increase focus of questions for patients with disturbances of thought

content or production, perceptual disturbances, or cognitive deficits.

- Abbreviate the interview for acutely agitated, dangerous, or medically

compromised patients.

- Use words that the patient can understand-avoid medical jargon; assessthe patients education, language, and cultural needs; and use a

translator when necessary.

- Clarify and verify that the patient understands you and that you

understand the patient.(continued)


10/11



Assess the patients safety, including assessment of suicide risk in every

patient.- Assess dangerousness early and often during an interview with a

potentially dangerous patient.

Take notes to record necessary data, but do not let note taking interfere with

your ability to establish and maintain rapport with the patient.

- Review available medical records and test results before completing yourassessment and developing your treatment plan.

- Interview other relevant persons in the patients life.

Cover all key elements of the psychiatric history and mental status

examination.

- Psychiatric history includes chief complaint, history of present illness,

past psychiatric history, past medical history, social history,developmental history, family psychiatric and medical history, and review

of systems.

CHAPTER 1 Key Points (continued)

(continued)


11/11

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC,Gabbard GO. 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org

11

CHAPTER 1 Key Points (continued)

- For the mental status examination, observe or assess the following

aspects of behavior and thought: general appearance; orientation;speech; motor activity; affect and mood; thought production; thought

content; perceptual disturbances; suicidal or homicidal ideation;

attention, concentration, and memory; abstract thinking; and

insight/judgment.

Formulate the data gathered during psychiatric interview and develop abiopsychosocial formulation and a thorough differential diagnosis, including

information for all five DSM-IV-TR axes.

- Develop a treatment plan that includes appropriate biological,

psychological, and social interventions and considers the patients

overall prognosis.

- Ensure that the patient understands the treatment goals and plan, and

verify that the patient can afford the treatment recommendations.

- Document if the patient refuses treatment.

- Establish follow-up plans (e.g., next appointment, tests to complete).

Documents

01 Interviewing