2. 4 TASKS:
1.Build a therapeutic alliance
2. Obtain a psychiatric database
3. Interview for diagnosis
4. Negotiate a treatment plan with patient
3 PHASES:
• Opening phase
• Body
• Closing Phase
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3. • Be yourself
• Be warm,courteous and emotionally sensitive
• EMPATHY
• Place yourself in the patient’s situation
at the same time maintain objectivity
• Actively defuse the strangeness of the
situation
• Give your patient the opening word
• Project competence to gain patient's trust
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4. • Transference
• Patient unconsciously and habitually
displaces onto individuals in his current life
those patterns of behavior and emotional
reactions that originated from earlier in life
• Countertransference
• Physician unconsciously and reciprocally
involved in the displacement to the patient
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7. • Briefly state the diagnosis
• find what the patient knows about the
disorder
• give a minilecture if indicated
• ask if there are any questions
• give patient written educational materials
Treatment Plan:
• follow up appointment
• Medication trials
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8. 07
OPENING PHASE( 5-10 mins)
-meeting the patient, learning about her life situation and giving her
few minutes to tell you why she came
BODY OF THE INTERVIEW(30-40 mins)
-map out the interviewing strategy to explore topics
1. HPI
2. ask about the criteria of symptoms
3. family history
4. social history/developmental
5. medical history
6. psychiatric review of symptoms
CLOSING PHASE(5-10 mins)
-include discussion of assessment, use patient education techniques
-negotiated agreement about treatment and follow up plans
9. 1. Anchor questions to memorable events
-most people forget dates of events that
occur >10 days in the past
-ex: “Did the symptoms start when you
graduated highschool?”
“When you first started highschool”
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2. Tag questions with specific examples
-specifically for areas in which the
patient has trouble with recall
3. Describe syndromes in your patient’s terms.”
-patient may lack understanding of
technical terms
-”depressed ≠ depressed”
-clarify the terms
10. SMOOTH TRANSITION
• cue off something the patient just said
to introduce a new topic
REFERRED TRANSITIONS
• “you refer to something the patient said
earlier in the interview to move to a new
topic”
INTRODUCED TRANSITION
• introduce the next topic or series of topics
before actually launching into it
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11. • Use open-ended questions and commands to
increase the flow of information.
• Use continuation techniques to keep the flow
coming.
• Shift to neutral ground when necessary.
• Schedule a second interview when all else fails.
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12. • Use closed-ended and multiple-choice questions to
limit the flow.
• Perfect the art of the gentle interruption.
• Empathic interruption
• Educate the patient about the need to move along in
the interview
• Educating interruption
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14. oSuicidality
oViolence
oAbility to function day to day
oDo they go to work?
oDo they do anything, or just sit on the couch
all day long?
oDo they sleep?
oWhat do they eat?
oAre they concentrating OK?
o Have they always been this way, or is this a
recent change?
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“As part of my evaluation of patients, I find it
helpful to talk to someone else involved in your
life. Would that be okay with you?”
15. Educating the family about the purposes and the limitations
of inpatient psychiatric treatment
Not particularly happy with how the patient is doing
and they may be wondering if you are competent.
Meet the issue head-on
14 a short meeting will help set his or her mind at ease
