Difficult Patient Flashcards
Transference
when the patient places feelings and attitudes onto the psychiatrist that were initially associated with family figures
Countertransference
when the psychiatrist places undo emotions onto the patient in response to their transference
Overcoming obstacles to obtaining a good history in patients with psychosis
maintain a nonjudgmental attitude, maintain a respectful distance, and avoid direct eye contact as it may be threatening
Overcoming obstacles to obtaining a good history in patients with depression
may require direct questioning vs open ended
Overcoming obstacles to obtaining a good history in patients with SI
important to obtain personal and family history of suicide attempts and successes, open-ended approach is helpful, determine passive vs active SI, if the latter then question what is keeping them from acting on their plan
Overcoming obstacles to obtaining a good history in patients with hostility
often in an ED setting, important to familiarize yourself with the layout (i.e. chair placement to allow both parties an unobstructed exit, safety features, security guards), avoid unnecessary stimulation and threatening postures, calm, direct, without bribery
Overcoming obstacles to obtaining a good history in patients with agitation
pacing, loud speech, threatening comments usually precede physical violence, interview may need to be ended early if safety is at risk
Overcoming obstacles to obtaining a good history in patients with violence
further assessment necessary, explore previous episodes of violence as an indicator of future episodes
Overcoming obstacles to obtaining a good history in patients with deception
Careful observation of inconsistencies in symptoms severity between self-report and collateral information may be an indicator to deception. In addition, some psychological tests can evaluate reliability
