Intro to Psychiatry

Question 1

Fundamental aspects of to developing a therapeutic alliance in psychiatry

Answer 1

1. Listen authentically, with curiosity and without judgment
2. Protect the patient’s self-esteem
3. Show respect and compassion

Question 2

The “emergency exception”

Answer 2

Clinicians can disclose confidential information if the patient is in imminent danger of harming themselves or others.

Question 3

“Asking about asking” as a psychiatric tool

Answer 3

Sometimes it may be difficult to assess what a patient feels comfortable talking about, and simply asking for their insight on their comfort level and what they want to talk about can be a powerful tool.

This is also a method of obtaining informed consent for a line of questioning.

Question 4

“Story first, symptoms next” principle

Answer 4

Interviews are generally be more open-ended initially and will progress gradually to closed-ended or structured format

Question 5

General medical interview guidelines

Answer 5

Question 6

Psychodynamic model

Answer 6

Psychological perspective that views unconscious thoughts and feelings as powerful motivators and inhibitors of behavior

Question 7

Psychiatric interview equivalent of “What brings you in today?”

Answer 7

“How can I be of help to you?”

Question 8

Tools for evaluating the disorganized patient

Answer 8

“I have the impression that you may be having difficulty with things like concentration and memory. If it’s alright with you, I’d like to ask you some questions to clarify whether you’re having difficulties in these areas”

This is a good way to shift to cognitive of mental status exam and survey for focal deficits while maintaining rapport with a new patient.

Question 9

Past psychiatric history

Answer 9

Crucial past psychiatric history includes psychiatric hospitalizations, symptoms of psychosis and mood disorders, suicide attempts, self-injury, violence, dangerously impulsive behavior, arrests, incarcerations, substance use, and previous outpatient treatment

Question 10

Sample psychiatric screening questions

Answer 10

Question 11

No psychiatric evaluation is complete without __

Answer 11

No psychiatric evaluation is complete without an assessment of suicidal thoughts and attempts.

Question 12

Questions to elicit the minimum psychosocial hx

Answer 12

Question 13

The best way to end a psychiatric interview

Answer 13

“Is there anything you think I should have asked you but haven’t yet?”

Question 14

When a patient is told they may need to see a psychiatrist . . .

Answer 14

. . . they are hurt and they are afraid.

Mental health is still unjustly stigmatized in the US, and patients may feel shame for being told they need to see a psychiatrist.

Question 15

“follow the MAPS TO diagnosis” mnemonic for HPI information

Answer 15

Question 16

Asking about self-harm

Answer 16

Often best to ask in a matter-of-fact way:

“Have you ever intentionally hurt yourself by, for example, cutting your wrist, or burning yourself?”

Question 17

Asking about violence/aggressive behavior

Answer 17

Frame the question more as: “How do you manage your anger when you are angry or frustrated? Have you ever gotten angry or frustrated and done something that you later regreted?”

Question 18

Gathering a substance use history

Answer 18

Question 19

Gathering a substance use history

Answer 19

Question 20

Another question to ask about supplements

Answer 20

“Do you buy any supplements from the internet?”

Sometimes when you ask about supplements people think of the convenience store or something similar, so reminding them of internet purchases can sometimes ellicit more information.

Question 21

As a general rule regarding interviewing new patients on trauma, . . .

Answer 21

. . . the most important thing to know is just whether or not there was trauma and how it is currently affecting the patient. Don’t pry into the details.

In fact, often you may never pry into the details, but listen to them if the patient volunteers them. Reliving the experience by telling it is itself a source of trauma, and is not therapeutic and often not useful anyway.

Question 22

What is the most effective evidence-based treatment for mental health disorders generally?

Answer 22

Interacting with someone who has lived experience.

Always, always, always work with peer specialists.

Question 23

Mnemonic for psychiatric ROS

Answer 23

MAP-E

Mood disorders

Anxiety

Psychosis

Eating disorders

Question 24

Asking about functional impairment or legal situations?

Answer 24

Have your symptoms ever gotten you into trouble of any sort?

Question 25

If you want to ask about triggers. . .

Answer 25

. . . just ask about triggers!

Patients have a good handle on this and will often give very eloquent answers.