Intro to Psychiatry Flashcards
Fundamental aspects of to developing a therapeutic alliance in psychiatry
- Listen authentically, with curiosity and without judgment
- Protect the patient’s self-esteem
- Show respect and compassion
The “emergency exception”
Clinicians can disclose confidential information if the patient is in imminent danger of harming themselves or others.
“Asking about asking” as a psychiatric tool
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.
“Story first, symptoms next” principle
Interviews are generally be more open-ended initially and will progress gradually to closed-ended or structured format
General medical interview guidelines
Psychodynamic model
Psychological perspective that views unconscious thoughts and feelings as powerful motivators and inhibitors of behavior
Psychiatric interview equivalent of “What brings you in today?”
“How can I be of help to you?”
Tools for evaluating the disorganized patient
“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.
Past psychiatric history
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
Sample psychiatric screening questions
No psychiatric evaluation is complete without __
No psychiatric evaluation is complete without an assessment of suicidal thoughts and attempts.
Questions to elicit the minimum psychosocial hx
The best way to end a psychiatric interview
“Is there anything you think I should have asked you but haven’t yet?”
When a patient is told they may need to see a psychiatrist . . .
. . . 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.
“follow the MAPS TO diagnosis” mnemonic for HPI information
Asking about self-harm
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?”
Asking about violence/aggressive behavior
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?”
Gathering a substance use history
Gathering a substance use history
Another question to ask about supplements
“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.
As a general rule regarding interviewing new patients on trauma, . . .
. . . 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.
What is the most effective evidence-based treatment for mental health disorders generally?
Interacting with someone who has lived experience.
Always, always, always work with peer specialists.
Mnemonic for psychiatric ROS
MAP-E
Mood disorders
Anxiety
Psychosis
Eating disorders
Asking about functional impairment or legal situations?
Have your symptoms ever gotten you into trouble of any sort?
If you want to ask about triggers. . .
. . . just ask about triggers!
Patients have a good handle on this and will often give very eloquent answers.
