PSYCHIATRIC INTERVIEW

I. Management of Time Initial consultation = 30 min. to 1 hour Psychotic or medically ill patients = brief interviews Patient’s management of appointment time

II. Seating Arrangements Both chairs should be of approximate equal heights Place chairs with no furniture between Potentially dangerous patients = leave door open

III. Psychiatrist’s Office Can tell about psychiatrist’s personality Professional attire

IV. Note taking For legal and medical reasons Process notes Extensive vs no note taking

V. Subsequent Interviews Allow the patient to correct any misinformation provided in the first meeting Ask thoughts and reactions with the first interview

INTERVIEWING SITUATIONS

A. Depressed and potentially suicidal patients Ask specifically about history and symptoms Do not reassure prematurely Inquire presence of suicidal thoughts Risks: suicide note, family history of suicide, previous suicidal behavior, impulsivity, pervasive pessimism Imminent risks for suicide --> hospitalization

B. Violent Patients Indicate that you are capable of dealing with patient’s capacity for violence Help patient stay in control Impaired reality testing --> medicate Decide when physical restraint is safe to be removed Should not interview patient alone Avoid confrontation Specific questions: previous acts of violence, violence experienced as a child

C. Delusional Patients Patient’s delusion should never be directly challenged Patient’s defensive and self-protective, but maladaptive, strategy against overwhelming anxiety, lowered self- esteem, and confusion Focus on feelings, fears and hopes

D. Interviewing Relatives Issues of confidentiality

COMMON INTERVIEWING TECHNIQUES

1. Establish rapport as early as possible. 2. Determine the patient’s chief complaint. 3. Use the chief complaint to develop a provisional differential diagnosis. 4. Rule the various diagnostic possibilities out or in by focused and detailed questions. 5. Follow up on vague or obscure replies with enough persistence to accurately determine the answer to the question.

6. Let the patient talk freely enough to observe how tightly the thoughts are connected. 7. Use a mixture of open-ended and closed- ended questions. 8. Don’t be afraid to ask about topics that you or the patient may find difficult or embarrassing. 9. Ask about suicidal thoughts. 10. Give the patient a chance to ask questions at the end of the interview. 11. Conclude the initial interview by conveying a sense of confidence and, if possible, of hope.

GENERAL STRATEGY IN EVALUATING PATIENTS

I.Self-Protection Know as much as possible about the patients before meeting them. Leave physical restraint procedures to those who are trained to handle them. Be alert to risks for impending violence. Attend to the safety of physical surroundings. Have others present during the assessment. Have others in the vicinity. Attend to developing an alliance with the patient.

II. Prevent Harm Prevent self injury and suicide. Use whatever methods are necessary to prevent patients from hurting themselves during the evaluation.

Prevent violence towards others. During evaluation, briefly assess the patient for the risk of violence. If the risk is deemed, consider the following options: > inform the patient that violence is not allowed > approach the patient in a non-threatening manner > reassure and calm the patient or assist in reality testing

> offer medication > inform the patient that physical restraint or seclusion will be used if necessary > have teams ready to restrain the patient > when patients are restrained, always closely observe them and frequently check their VS. Isolate restrained patient from agitating stimulus. Immediately plan a further approach-- medication, reassurance, medical evaluation.

III.Rule out Cognitive Disorders caused by general medical condition.

IV. Rule out impending psychosis