2. Psychiatry Interview

Question 1

What are the 8 components of an initial patient interview?

Answer 1

1. chief complaint (said in patient’s own words)
2. history of chief complaint
3. past psych hx
4. med hx
5. family hx
6. social hx
7. MSE (mental status exam)
8. Differential diagnosis (based on DSM-V)

Question 2

What does the history of chief complaint consist of?

Answer 2

-severity of the issue
-description of the chief complaint
-duration of time
-“what have you done to make it better? what makes it better or worse?”
-allows us to understand context
Ex. cc: runny nose
Hx of cc: happens everyday, clear mucus, ongoing for the last 3 months, tried taking antihistamines which help briefly, associated with persistent cough

Question 3

What does a past psych history consist of?

Answer 3

• previous diagnoses
• previous inpatient/outpatient therapies: how long? voluntary or involuntary?
• alternative therapies or medications: were they helpful

Question 4

What does a medical history consist of?

Answer 4

• medication side effects
• recent medical diagnoses (cancer, IBS, etc. that may be cause of disorder or associated with it)
• “how do you feel in the morning? are you rested?”: quality of sleep is most important thing to assess, more than amount of sleep

Question 5

What does a family hx consist of?

Answer 5

• illness in family
• drinking or hospitalizations in family
• should be limited to biological family

Question 6

What does a social hx consist of?

Answer 6

• work history
• considering aspects of non-biological family hx
• parenting issues
• drinking and substance abuse
• ex. how well did you do in school? was it a good experience? did you have friends?

Question 7

What is a Mental Status Exam?

Answer 7

-structured way of how the patient presents in front of the provider at the given moment

Question 8

What two characteristics of the interview are important to consider?

Answer 8

• cognition: what they say

- affect: how they say it

Question 9

What is important to maintain with patients?

Answer 9

Patient respectability relationship: the way we ask questions has a direct impact on how they react and answer; important not to value or judge an individual based on their response

Question 10

Why is structure important to interviews?

Answer 10

structure allows the provider to weave questions into a less stressful discussion or conversation that makes the patient feel less like this is a diagnosis

Question 11

What is a Mental Status Exam composed of?

Answer 11

• appearance
• behavior (eye contact, delay in response, repetitive movements)
• orientation x 4: place, time, purpose, person (asking: what season are we in? who are you? whats going on)
• mood: how are you feeling?
• affect: are mood and affect congruent or incongruent? (if they say they are happy does it show?)
• cognition: asking questions associated with memory
• perceptions: delusions, elusion, hallucination (Delusions are false, fixed beliefs. Hallucinations: something you see in front of you, visual or auditory hallucinations. Elusions: something they actually did see but they are minsterpreting it)
• suicide/homicidal ideation: best predictor of suicide is the past history of attempted suicide; homicidal ideation requires digging deeper
• insight/judgement: is their insight reasonable and is their judgement good?

Question 12

What is a mini-mental state examination (MMSE)?

Answer 12

MMSE has the same questions/characteristics of the MSE but asked less extensively; based on a 30 point system