Psychiatric interview
From Wikipedia, the free encyclopedia
| Psychiatric interview | |
|---|---|
| Purpose | psychiatric assessment |
The psychiatric interview refers to the set of tools that a mental health worker (most times a psychiatrist, psychologist, or advanced practice provider but at times social workers or nurses) uses to gather information from the patient to complete a psychiatric assessment.[1][2] A diagnosis and treatment plan is created based on the psychiatric assessment. The components of the psychiatric interview include a detailed history and mental status examination.[3]
The goals of the psychiatric interview are:
- Create a psychologically safe setting for interview.[3]
- Build rapport.[2]
- Collect data about the patient's current difficulties, past psychiatric history and medical history, as well as relevant developmental, interpersonal and social history.[1]
- Conduct mental status examination. [3]
- Diagnose the mental health issue(s).[1]
- Establishing possible differential diagnoses. [3]
- Understand the patient's personality structure, use of defense mechanisms and coping strategies.[2]
- Improve the patient's insight.[2]
- Create a foundation for a therapeutic alliance.[2]
- Foster healing.
- Gather information from collateral sources. [3]
The data collected through the psychiatric interview is mostly subjective, based on the patient's report, and many times can not be corroborated by objective measurements.[4] As such, one the interview's goals is to collect data that is both valid and reliable.[1]
Interview structure
There are 2 main accepted structures a psychiatric interview may follow.[4] These formats use different approaches but aim to gather the same information.[4]
- Fully structured psychiatric interview: This interview follows a set of specific questions, asked in a specific order.[4] The questions are designed to elicit information that conforms to diagnostic criteria specified in the DSM-5.[4] Structured interviews are developed to be more reliable, and can be performed by less experienced interviewers.[4] Structured interviews rely heavily on binary yes or no answers and depend on the patient having some degree of insight into their condition prior to the start of the interview.[4] This structure of interview attempts to elicit objective data from the patient's subjective experience.[4]
- Conversational, semi-structured interview: This interview uses a conversational format in order to gather information on a predetermined list of topics.[4] Questions can be asked and answered in any order to gather this information.[4] Question format is up to the interviewer to decide as the conversation progresses.[4] If the patient responds with yes or no answers, the interviewer must seek further clarification.[4] This style of interview requires an experienced interviewer.[4] This structure of interview attempts to elicit the patient's full, subjective narrative of their condition.[4]
Components of the interview
The psychiatric interview can be an experience that causes the patient shame, so it is important to start the interview by creating a space of psychological safety.[4] The interviewer elicits the patient's chief complaint, or the reason the patient appeared for psychiatric evaluation, as well as symptoms the patient is currently experiencing and possible precipitating factors.[3] The interviewer asks about pertinent medical history, including past medical diagnoses, family history of medical conditions, current medications, and allergies.[3] The interviewer asks about psychiatric history, including psychiatric diagnoses, past psychiatric medication trials, current psychiatric medications, past suicide attempts, past in-patient psychiatric hospitalizations, out-patient psychiatric provider, and family history of psychiatric conditions.[3][5] The interviewer will ask about social history, including drug use, alcohol use, occupation, family and social support, living situation, trauma history, and stressors.[3] Mental status exam or mini-mental status exam is completed.[3] Based on the information that is gathered, other indicated testing, such as an IQ test, Minnesota Multiphasic Personality Inventory, or Rorschach test, may also be administered during the interview.[5] In a fully structured psychiatric interview, information is gathered in a predetermined order, whereas a conversational interview, information can be gathered in any order, as the patient may become more comfortable sharing information or remember more information as the interview progresses.[4] Information is gathered through the observation of patient behavior, as well as through the information shared by the patient.[3] The gathered information is used to complete a psychiatric assessment in order to determine a diagnosis, differential diagnoses, and treatment plan.[3] Diagnosis is made primarily based on the DSM-5-TR and ICD criteria.[5][6]
