Psychiatric interview
Medical diagnostic method
From Wikipedia, the free encyclopedia
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 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]
| Psychiatric interview | |
|---|---|
| Purpose | psychiatric assessment |
Goals of the interview
The goals of the psychiatric interview are:
- 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]
Components of the interview
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.[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 and trauma history.[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 or Minnesota Multiphasic Personality Inventory, may also be administered during the interview.[5] The information can be gathered in any order, as the patient may become more comfortable sharing information or remember more information as the interview progresses. 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]
Considerations
Several considerations must be made depending on the presentation of the patient.
- Homicidal ideation: If a patient is expresses thoughts of harming others, the interviewer should take precautions for their own safety.[5] Possible in-patient hospitalization should be considered.[3] The provider must inquire about homicidal ideation, even if it is uncomfortable for the patient.[3] Per Tarasoff's rule, if a patient makes credible threats of harms to others during an encounter with a provider, the subject of the threats must be informed.[5]
- Agitated patients: If a patient is experiencing agitation, it is important to consider hospitalization, sedating medications, and restraints for the safety of the patient, their family and friends, and medical staff.[3] Etiology of the agitation should be determined.[3]
- Delusional patients: If a patient is delusional, it is important that the provider does not validate the delusion.[5]
Challenges
Validity refers to how the data compares to an ideal absolute truth that the interviewer needs to access and uncover. Challenges that might affect the interview validity include can be categorized as patient related factors and interviewer related factors. Patient's related factors include:
- Shame: the patient might feel ashamed to discuss some of their difficulties.[4]
- Fear of being judged: while not ashamed the patient might be reluctant to discuss some of the issues that she thinks that she can be judged for.
- Lack of awareness: patient might have distorted recollection of past events with significant emotional valence.
- Cognitive deficits: the patient might have a memory deficit that might impair his ability to correctly recall past events.
- Secondary gain: the patient decided to misrepresent fact in order to gain a certain benefit (e.g. disability benefits) or avoid a certain penalty (e.g. insanity defense).
- Education: patient's understanding of interview questions may be affected by their education level.[3]
- Language: patient's proficiency in the language the interview is conducted in may affect their responses.[3]
Interviewer related factors include:
- Powerful feelings of like or dislike that might affect the interviewer objectivity.
- Lack of experience: the interviewer lack the skills and knowledge necessary to explore a specific area of pathology.[2]
- Diagnostic bias: the interviewer is invested in a specific psychiatric diagnosis (e.g. same patient might be diagnosed with schizophrenia by a schizophrenia researcher or bipolar disorder with psychotic features by a bipolar disorder researcher).[4]
Reliability refers to how datasets collected by different interviewers or the same interview at different times compare with one another. Ideal reliability is when a dataset will be stable irrespective of changes in specifics of the data collection.
Different interview techniques have been shown to result in variations in the validity and reliability of the collected data. Open-ended question ("Tell me about your sleep.") have been shown to have better validity but less reliability than closed-ended questions("Do you have sleeping difficulties?")