Interviewing The Primer Gary J Gala, MD

Interviewing 30 minute semi- structured interview— between the SKID and psychotherapy 30 minute semi- structured interview— between the SKID and psychotherapy History, Physical, Labs, Imaging all in one History, Physical, Labs, Imaging all in one

Interviewing The result of a syndromal medicine The result of a syndromal medicine Psychiatry near the beginning of the 19 th century Psychiatry near the beginning of the 19 th century

Interviewing Empathy: A mode of perceiving by vicariously experiencing the psychological state of another person Empathy: A mode of perceiving by vicariously experiencing the psychological state of another person Literally “feeling into” as opposed to “feeling with”--sympathy Literally “feeling into” as opposed to “feeling with”--sympathy

Interviewing Empathy: Why it matters Empathy: Why it matters Since interview is all we have…empathy increases patient’s cooperation Since interview is all we have…empathy increases patient’s cooperation

Interviewing—To Begin What brings you in today? What brings you in today? Listen for content and form Listen for content and form Now wait for the answer—at least 2 minutes Now wait for the answer—at least 2 minutes

Interviewing Content: Content: The universe of psychiatry The universe of psychiatry –Thought –Mood –Substance –Many others but these will get you started

Interviewing The drop down menu The drop down menu Once in your provisional corner of the universe—how to proceed Once in your provisional corner of the universe—how to proceed

Interviewing Thought Thought –Delusions –Hallucinations –Ideas of reference –Mind reading –Other special powers

Interviewing Mood Mood –Sleep –Appetite –Guilt –Hopelessness –Worthlessness –Mania screen –Suicide always!!

Interviewing Substance Substance –First use –Amount –Duration –Consequences –Tolerance –Withdrawal Sx

Interviewing Form Form –Logical –Goal directed –Disorganized –Pressured Speech –Flight of ideas –Neologisms –Etc.

Interviewing Include substance Abuse with HPI Include substance Abuse with HPI It’s just so comorbid!! It’s just so comorbid!!

Interviewing The Narrative Arc The Narrative Arc The next 15 minutes The next 15 minutes –Past psych –Family –Social

Interviewing Moving back and forth between categories puts patient at ease Moving back and forth between categories puts patient at ease Creates the arc more seamlessly Creates the arc more seamlessly

Interviewing Past Psych Hx Past Psych Hx –Meds—strength and duration –Admissions –Self harm—suicide again

Interviewing Social History Social History –Living situation— where and with whom –Employment –Legal Problems –Weapons –School history –Relationships –Economic problems

Interviewing Family History Family History –The usual mental health stuff –Ask about suicides –Ask about substances

Interviewing Ten minutes Left Ten minutes Left What Now!!?? What Now!!??

Interviewing Past Medical History Past Medical History Especially endocrine and rheumatologic disorders Especially endocrine and rheumatologic disorders Don’t forget the meds and allergies! Don’t forget the meds and allergies!

Interviewing Now it’s Time—about 5 minutes Now it’s Time—about 5 minutes The Big Exam The Big Exam Your version of the Mental Status Exam Your version of the Mental Status Exam

Mental Status Examination Appearance Appearance Cooperation Cooperation Eye contact Eye contact Speech Speech Mood Mood Affect Affect Thought Process Thought Process Thought content Thought content Insight/ judgment Insight/ judgment

Mental State Exam Cognitive portion Cognitive portion At least At least –Orientation –Attention The calendar The calendar –Memory—short and long –Calculating—money –Naming –Executive—what if you fell down?—consider clock drawing

Interviewing Anything you think is important that I didn’t ask? Anything you think is important that I didn’t ask? The chance for the big bomb to drop The chance for the big bomb to drop

Interviewing—the tough stuff What if it doesn’t go so well? What if it doesn’t go so well? The patient who doesn’t talk The patient who doesn’t talk The patient who talks to much The patient who talks to much The grossly disorganized patient The grossly disorganized patient The aggressive agitated patient The aggressive agitated patient

Interviewing Aggressive/agitated Aggressive/agitated Just get out Just get out Don’t bother pointing agitation out to patient Don’t bother pointing agitation out to patient May need more organic work up May need more organic work up

Interviewing Won’t talk Won’t talk Difficult Difficult Get more specific Get more specific Assess orientation Assess orientation May need more organic work up May need more organic work up

Interviewing Talks too much! Talks too much! Get used too interrupting Get used too interrupting Get more specific Get more specific Can they attend? Can they attend?

Interviewing Disorganized Disorganized Get more specific Get more specific Early MMSE Early MMSE Assess for delirium Assess for delirium