Clinical Interview

Question 1

lnterview

Answer 1

detailed talk with the patient

Question 2

Assessment

Answer 2

asking/observing/ obtaining all information to allow you to form a diagnosis and make a plan

Question 3

History

Answer 3

information on what the problem is and what has happened

Question 4

Mental state examination (MSE)

Answer 4

-snapshot exam of the patient
-describing someone infront of you in a concise and strict way

Question 5

how to set up psychiatric Interview

Answer 5

• Setting
  
  • home, practice, A&E
• Safety
  
  • mental stare? danger to your or others?
• Sensitivity/Compassion
• Simple language
• Curiosity/ open/ explorative
  
  • family life?
• Therapeutic?
  
  • encourage self help
  • medication?
  • therapy?
• Take notes

Question 6

describe the Basic Format: Calgary-Cambridge Observation Guide

Answer 6

• Whilst there are other tasks associated with the consultation, the Guide is based on six communication skills tasks. These are:
  
  • lnitiating the consultation
  • Gathering information
  • Providing structure to the consultation
  • Building the relationship
  • Explanation and planning
  • Closing the consultation

Question 7

key points of clinical interview

Answer 7

• introduce
• Consent
• Open question and the golden minute
• Other open questions (who, what, when, why, how)
• Clarify points or ask patient to elaborate
• Then closed questions- become more focused
• Be flexible yet structured

Question 8

Psychiatric assessment

Answer 8

• History*
• Mental State Examination*
• Risk Assessment*
• Physical examination/investigations
• Formulation
• Diagnosis
• Management
• FOCUS OF INTERVIEW QUESTIONS

Question 9

Psychiatric history

Answer 9

• Circumstances of referral/ Presenting Complaint
• History of Presenting Complaint
  
  • sudden or gradual?
• Past Psychiatric History
• Current and Past Medical and Surgical History
  
  • from birth..?
• Current Medication
• Alcohol and drug use
  
  • e.g. drug induced psychosis
• Family History
  
  • twin studies in SZ
• Personal History
  
  • Early Development, Education, Occupation, Sexual Relationships, Pre Morbid Personality, forensic history
  • premature birth? family ? school?
• Social history

Question 10

Circumstances of referral/presenting complaint

Answer 10

• Patient’s view as to why they are seeing you
  
  • NB Patient may deny any problems
  • Compare with Circumstances of Referral
• What sort of problems may people report?
  
  • Unusual and distressing beliefs
  • Abnormal thoughts
  • Disordered feelings and emotions
  • Unusual perceptions
  • Problematic behaviour

Question 11

History of Presenting Complaint

Answer 11

• Create a time line
• Onset, duration and changes over time - open and then closed questions
• Triggers: Exacerbating and relieving factors. Life events/stressors, alcohol or drug misuse or noncompliance with prescribed interventions
• Impact on social, occupational, personal functioning and self-care
• Relapse?

Question 12

Past Psychiatric History

Answer 12

• Previous Psychiatric Treatment
• Previous hospital admissions
• Admitted under Mental Health Act?
• Previous Medications & side effects
• Psychological therapies

Question 13

Past Medical History

Answer 13

• Think about the possible impact of physical conditions
• Psychological distress
• Direct emphasis on neurological/ endocrinological
• Indirect psychiatric illness due to drug side effects
  
  • L-DOPA (PD)
  • Steroids

Question 14

Medication and Alcohol/drug use

Answer 14

• Any known drug allergies
• Drugs prescribed- do they take them as prescribed?
• Smoking/ alcohol/ other drugs
• Do they have features of drug dependence?

Question 15

Family History

Answer 15

• Who is in the family
• Mental illness in the family
• Physical illness in the family that might be relevant
• Supports?
• Dependents?

Question 16

Personal History

Answer 16

• Chronological picture of the person’s life:
  
  • Birth → Childhood → School → Jobs → Relationships → Forensic time etc…
• Looking at events that may have shaped their
  
  • Psychological development
  • Capacity to form/maintain relationships
  • View of themselves and the world around them
• Premorbid personality

Question 17

Social history

Answer 17

• Current accommodation?
• Living situation?
• Finances?
• Activities?
• Social network?

Question 18

what are the components of a Mental state examination (MSE)

Answer 18

ABS-MAT-PCI
- Appearance & Behaviour
- Speech
- Mood & Affect
- Thoughts
- Perceptions
- Cognition
- Insight

Question 19

Appearance & Behaviour

Answer 19

• Physical characteristics of patient
• Eye contact/ body language - avoiding?
• Calm or agitated?
• Reactions to you and others, eg. warm and open, hostile and guarded, frightened and avoidant
• Rapport
• psychomotor disturbances
  
  • seizures
  • due to antispsychotics- PD
    
    • stiff jaw muscle

Question 20

Speech

Answer 20

• Rate - manic and quickly, pressure of speech
• Tone - shy?
• Volume - up and down?
• Prosody - rhythmical quality
• Hesitation
• Spontaneous?

Question 21

mood & Affect

Answer 21

• Subjective mood: how the patient describes their mood
  
  • EPD
• Objective mood: what you observe their mood to be
• Affect is the patient’s changing emotional tone during the interview, as the interviewer perceives it
  
  • “Affect is related to mood as weather is related to climate’

Question 22

Thoughts

Answer 22

• Thought form
  
  • Flow and logic of thought
  • Are thoughts tangential? Derailing? Flight of ideas?
  • Thoughts interference
• Thought content
  
  • Delusions; reality perception
    
    • A false, unshakeable belief that is out of keeping with the patient’s social and cultural background
    • Themes:
      
      • control, persecution, jealousy, grandiose, religion
      • nihilistic, hypochondriac, infestation, misidentification, love
    • problematic because who decides what a ‘normal’ belief is?
      “Is anyone deliberately trying to harm you?”
  • Overvalued ideas
  • Preoccupations
  • Suicidal thoughts
    
    • Suicidal thoughts, feelings, urges, images
    • Suicidal intent
    • Suicidal plans
    • Suicidal attempts
    • Self-harm
    • Protective factors
      “How do you see the future?”
      “Do your thoughts make sense to you”

Question 23

Perceptions

Answer 23

• Hallucinations
  
  • Auditory, visual, olfactory, gustatory or tactile
• llusions
• Depersonalisation
• Derealisation

Question 24

Cognition

Answer 24

• As a minimum you should assess:
  
  • Orientation
  • Attention/concentration
  • Memory
  • e.g. dementia
• If there are concerns about cognitive impairment consider formal assessment
  
  • Language
  • Calculation
  • Visuospatial
  • Executive function

Question 25

Insight

Answer 25

• ‘What do you think is happening?’
• ‘Do you think that you are unwell?’
  
  • “what sort of illness do you think it is?’
  • ‘what sort of treatment do you think would be useful/would you accept?’
• ‘What do you think about your current treatment?’