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Psychiatric Interviewing

I. The Clinical Interview

A. Doctor-Patient Relationship

1. Introduce yourself, explain the nature of the interview and invite cooperation.

2. Form an alliance around the task of exploring the current illness.

3. Help the patient feel comfortable: Demonstrate politeness, empathy and concern, responsiveness, respect. Ask if there are any questions and respond honestly.

4. Maintain eye contact, avoid note-taking, facilitate collaboration, avoid using medical/psychiatric jargon.

B. Conducting the Interview

1. Begin with open-ended questions for about 5 minutes, then start to focus down.

2. Primary concern: present illness: symptoms, precipitants, social setting, current and past treatment, complications.

3. Listen to the patient: follow the patient' s leads, be flexible, clarify patient' s use of terms, deal appropriately with.

4. Relevant clinical data: past psychiatric history [previous disorders, therapies, hospitalizations, medications (their benefits and adverse effects), suicide, homicide, alcohol and drug use], medical history, family history, development, social history.

5. Never forget: Suicidal and homicidal potential, alcohol and drug use.

6. Mental Status Exam: Formal vs. informal cognitive exam. Have an organized, formal, brief cognitive MSE ready to perform. Always perform one if you suspect organicity or psychosis (with or without depression). If you do not perform one formally, be able to say why this wasn't necessary, eg patient was lucid, well- oriented, in his/her normal discussion there was no evidence of a thought disorder, memory, attention.

B. Conducting the Discussion

1. Begin with your formal presentation, as above.

2. Try not to get rattled by interruptions; just respond to an examiner' s questions, then continue with your organization.

3. Demonstrate first that you know the basics about psychiatric diagnosis and treatment Then, if time permits, you can discuss the fine points, controversial issues or current research data.

4. Avoid power struggles.

5. Be comfortable saying:

"I didn't get such and such data, but it would have been helpful for "

"I don' t know the answer to that question, but I would get assistance by eg, asking an expert colleague, looking up the topic in a journal, etc."

6. It's most important to explain your thinking and reasoning based on the interview data.

III. Psychological Tips

A. Lower your anxiety.

B. Lower the examiner's anxiety.

C. Endurance

D. Monitor your style under stress:

1. Argumentative

2. Non-committal and vague

3. Flip or joking

E. Use your time wisely.

F. Remember your previous exams and what worked well.