Communication Skills for Psychiatry Lucie Bankovská Motlová

Basic Skills Observe Listen Inquire Judge

Generall Skills in Inteviewing eye contact relaxed posture not appear hurried picking-up verbal and non-verbal cues of distress dealing with over-talkativeness dealing with reslessness and agression

Establishing Rapport welcome the patient state purpose of the meeting privacy basic human comforts calming and respectful demeanor encourage open communication acknowledge and validate patient´s distress/concerns

Phases of the Interview Warm-up Screening of the problem Follow-up of preliminary impressions Completion of data base Feedback Treatment contract

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

Interviewing Techniques Let the patient talk freely enough to observe how tightly the thoughts are connected. Use a mixture of open-ended and closed-ended questions. Ask about suicidal thoughts. Give the patient a chance to ask questions at the end of the interview. Conclude the initial interview by conveying a sense of confidence and, if possible, of hope.

Supportive Interventions Encouragement. Patient: I am not very good at putting things into words. Doctor: I think you have described the situation very well. Reassurance. Doctor: I can understand how those experiences must have frightened you, but I think it is very likely they'll respond to treatment. Acknowledging emotion. Doctor: Even now it brings tears to your eyes when you talk about your mother. Nonverbal communication. Body posture and facial expression that convey interest, concern, and attentiveness.

Obstructive Interventions Closed-ended „double“ questions Doctor: Have you experienced any change in your appetite and sleeping? Judgmental questions. Doctor: How do you think your wife felt when she found out about your affair? Not following the patient's lead. Patient: I have trouble sleeping through the night. Doctor: Any change in appetite? Patient: I keep waking up out of nightmares about my daughter. Doctor: Do you have less energy than usual? Minimization or dismissal. Patient: I'm not able to keep my checkbook balanced the way I need to. Doctor: Oh, I wouldn't worry about it. Lots of people don't even try. Premature advice. Patient: Work is almost unbearable. My supervisor watches me like a hawk and criticizes the tiniest little mistake I make. Doctor: Why not write her a memo and outline your grievances?" Nonverbal communication. Yawning, checking one's watch. Patients can often detect an interviewer's inattention by the absence of facial expression or body movement.

Special Clinical Skills Acute psychosis Acute psychosis with agression Dementia Mania Depression Suicidal patient Stupor

Acute Psychosis Video: „Nemesis“

Psychotic patient: Rules for Communication howwhy Use short sentencesShort attention span One sentence, one informationInformation processing disorder Use models, draw, write and repeat frequently Memory and attention problems Do not speak out delusions, pay attention to emotional problems connected to delusion Delusion cannot be corrected by reasoning, but usually is distressing

Dealing with Acute Psychosis with Agression Video: Management and treatment of acute psychosis

Dementia: Rules for Communication Dementia screening: „What is your birthday?“ „How old are you?“ Close-ended short questions Useful tests: Clock Test MMSE (Mini Mental State Examination) Video: Mr B with Bartoš

Clock Test: 2:45 Normal Moderate Cognitive Disorder Mild Cognitive Disorder Severe Cognitive Disorder Video Clock test: 0 point

Mania Video: Renata

Mania: Rules for Communication Keep calm, low voice Do not argue with the patient If patient uses vulgar expressions, ask him not to do so If patient does not cooperate, do not continue with the interview

Depression: Rules for Communication Structured communication, short sentences Do not regret the patient and do not try to tell him jokes to make him laugh Ask about apetite, loss of weight and sleeping pattern Ask about hopelessness feelings Ask about suicidal thougts, ideas and plans

Suicide: Questions Have you ever felt that life was not worth living? Did you ever wish you could go to sleep and just not wake up? Have things ever reached the point where you ´ve thought about harming yourself? When did you first notice such thoughts? Have you made a specific plan to harm or kill yourself? If so, what does the plan include? Source: APA Practice Guidelines for Assessment of Patients with Suicidal behaviors

Risk of Suicide Assessment S sex: male A age: >45, <19 D depression P previous attempts E ethanol abuse R rational thinking loss (psychosis?) S social suppot lacking O organized plan N no spouse S sickness (somatic illness with pain)

Management Each positive answer = 1 point 0-2: low risk 3-4: medium risk; outpatient treatment, observation 5-6: high risk; hospitalization, especially in cases without social support 7-10: very high risk; hospitalization Write it to the medical record!

Stupor Somatic condition Dehydration, bedsores, embolia