Psych Interview Flashcards
What is the purpose of the initial psychiatric interview?
To obtain information that will establish a criteria-based diagnosis
Why is it crucial to maintain objectivity in a therapeutic relationship?
Maintaining objectivity is what differentiates empathy from identification
Define identification
When the provider not only understands a pt’s emotions but also experience it to the extent that they lose the ability to be objective.
Negatively impacts both pt and provider
Define transference
the process by which the patient unconsciously and inappropriately displacing onto individuals in his or her current life those patterns of behavior and emotional reactions that originated with significant figures from earlier in life, often childhood
Define countertransference
the process where the physician unconsciously displaces onto the patient patterns of behaviors or emotional reactions as if he or she were a significant figure from earlier in the physician’s life.
Identify the parts of the initial psychiatric interview (15)
- Identifying data
- Source and reliability
- Chief complaint
- Present Illness
- Past psychiatric history
- Substance use/abuse
- Past medical history
- Family history
- Developmental and social history
- ROS
- Mental status exam
- Physical Exam
- Formulation
- DSM-5 diagnosis
- Treatment plan
Psych ROS: Depressed mood
Sadness, tearfulness, sleep, appetite, energy, concentration, sexual function, guilt, psychomotor agitation or slowing, interest.
A common pneumonic used to remember the symptoms of major depression is SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor agitation or slowing, Suicidality).
Psych ROS: Mania
Impulsivity, grandiosity, recklessness, excessive energy, decreased need for sleep, increased spending beyond means, talkativeness, racing thoughts, hypersexuality
Psych ROS: mixed/other
Irritability, liability
Psych ROS: Anxiety
A.Generalized anxiety symptoms: Where, when, who, how long, how frequent.
B.Panic disorder symptoms: How long until peak, somatic symptoms including racing heart, sweating, shortness of breath, trouble swallowing, sense of doom, fear of recurrence, agoraphobia.
C.Obsessive-compulsive symptoms: Checking, cleaning, organizing, rituals, hang-ups, obsessive thinking, counting, rational vs. irrational beliefs.
D.Posttraumatic stress disorder: Nightmares, flashbacks, startle response, avoidance.
E.Social anxiety symptoms.
F.Simple phobias, for example, heights, planes, spiders, etc.
Psych ROS: Psychosis
A.Hallucinations: Auditory, visual, olfactory, tactile.
B.Paranoia.
C.Delusions: TV, radio, thought broadcasting, mind control, referential thinking.
D.Patient’s perception: Spiritual or cultural context of symptoms, reality testing.
Psych ROS: other d/o’s
A.Attention-deficit/hyperactivity disorder symptoms.
B.Eating disorder symptoms: Binging, purging, excessive exercising.
How do mood and affect vary?
Mood describes the internal subjective state, described in pt’s own words (angry, sad, etc)
Affect is the the physical expression of mood and described in 5 elements.
1. Quality (tone): dysphoric, happy, euthymic, irritable, angry, agitated, tearful, sobbing, flat.
2. Quantity: measure of intensity, mildly vs severely
3. Range: restricted, normal, labile. Flat refers to severely restricted range
4. Appropriateness: how the affect relates to the setting (ie laughing at a horrific story/funeral, etc)
5. Congruence: congruent vs incongruent w/ description of mood (saying they’re depressed while laughing/smiling)
What do perceptual disturbances include?
Hallucinations, illusions, depersonalization and derealization.
Hallucinations include: visual, auditory (most common) tactile, olfactory, gustatory.
- in North America non-auditory halluciations often clues to neurologic, medical or substance withdrawal issue rather than psych.
Formal thought d/o’s include (8)
Circumstantiality. Overinclusion of trivial or irrelevant details that impede the sense of getting to the point.
Clang associations. Thoughts are associated by the sound of words rather than by their meaning (e.g., through rhyming or assonance).
Derailment. (Synonymous with loose associations.) A breakdown in both the logical connection between ideas and the overall sense of goal directedness. The words make sentences, but the sentences do not make sense.
Flight of ideas. A succession of multiple associations so that thoughts seem to move abruptly from idea to idea; often (but not invariably) expressed through rapid, pressured speech.
Neologism. The invention of new words or phrases or the use of conventional words in idiosyncratic ways.
Perseveration. Repetition of out of context words, phrases, or ideas.
Tangentiality. In response to a question, the patient gives a reply that is appropriate to the general topic without actually answering the question. Example:
Doctor: “Have you had any trouble sleeping lately?”
Patient: “I usually sleep in my bed, but now I’m sleeping on the sofa.”
Thought blocking. A sudden disruption of thought or a break in the flow of ideas.
What are the elements of cognitive functioning that should be assessed in the psych interview?
Alertness, orientation, concentration, memory (short and long-term), calculation, fund of knowledge, abstract reasoning, insight and judgment
