Psychiatric interview
A psychiatric interview is a crucial component of the psychiatric evaluation process, aimed at gathering information and building a therapeutic relationship between the clinician and the patient. Typically conducted with new patients, this structured interview seeks to achieve a comprehensive understanding of the individual's mental health concerns, which includes topics such as sleep patterns, energy levels, feelings of guilt, appetite changes, and suicidal thoughts or behaviors. The interview often begins with open-ended questions to facilitate discussion about the patient's reasons for seeking help, allowing the clinician to discern cognitive function and emotional state based on the patient's responses.
To ensure objectivity and accuracy, standardized formats may be utilized, enabling trained non-clinicians, such as nurses, to conduct interviews effectively. Alongside questions about current symptoms, clinicians delve into the patient’s medical and family history, social circumstances, and previous interactions with mental health professionals. This holistic approach includes observations of the patient's behavior, speech, and physical appearance, which can provide further insight into their mental state. By documenting these elements, the clinician can formulate an accurate diagnosis and collaboratively develop a tailored treatment plan that respects the patient’s individual context and experiences.
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Psychiatric interview
A psychiatric interview is part of the evaluative process in psychiatry. Its goals are to collect data and establish a relationship between the clinician and the patient to aid in making an accurate diagnosis. The interview is typically conducted with new patients but may also take place later when a complete psychiatric history is not available. To be most effective, the interview should follow a standardized format. Uniformity may permit non-clinicians such as nurses to conduct the psychiatric interview with the proper training. Topics likely to be included are sleep, reduced interest, guilt, energy levels, ability to concentrate, changes in appetite, and suicidality, which includes both thoughts of suicide and attempts made.
The psychiatric interview is necessary to develop an objective description of the patient’s experience. With this, the clinician can work with the patient on diagnosis of the problem and development of a treatment plan.
Overview
A study published in 1972 pointed to the need for more standardized evaluation of psychiatric patients. The researchers looked at the hospitalization of patients in the United States and the United Kingdom for mental health issues and documented how clinicians used very different methods of diagnosing patients. The field of psychiatry needed to develop objective assessments, which led to the creation of standardized structured interviews and the development of diagnostic standards.
One goal of a psychiatric interview is to develop a relationship of trust between the clinician and the patient. To this end, the clinician often begins with open-ended questions about the reason the patient is seeking aid or has been referred. The patient’s response to a general question, such as, “What brings you here today?” can provide valuable clues. For example, a patient who is unable to answer clearly may have cognitive difficulties or be experiencing psychosis. A patient may answer cordially, angrily, or fearfully, among other responses. The clinician can then seek to draw more details with follow-up questions. The interview will also include narrowly focused questions, such as whether the patient has thought about dying, and questions about family and medical history, including substance use.
The interviewer will attempt to document a history of the current concern as well as background information. Information such as when the present illness developed and if and when prior episodes occurred can help with diagnosis. The clinician should ask about previous experiences with psychologists, social workers, or similar professionals.
Exploration of the patient’s social history includes an examination of family and adult relationships, parents and prenatal history, and sources of emotional support. Social history information includes school progress and childhood relationships and work environments and relationships. The clinician should address future plans, such as career and education goals. Questions should be formed with care to avoid appearing to judge the patient or indicate bias. As an example, an interviewer might ask about long-term adult relationships rather than inquire as to whether the patient is or has been married. The clinician should also ask rather than make assumptions about sexuality.
Questions should seek to identify symptoms that the patient may not recognize that are related to the illness, such as difficulty concentrating. The clinician may ask how the patient felt or what he or she was thinking during episodes.
The psychiatric interview involves more than questions and answers. The clinician should document the patient’s behavior, including movement and speech, and physical appearance, including hygiene. Over the course of the interview, the clinician will record evidence of the patient’s thought processes and external signs of his or her emotional state.
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