Psych Interview -Heh

Question 1

What should be included in the identification data of a psych interview?

Answer 1

Patient’s age, race, gender, marital and occupational status

Self referred, BIB family, referred by PCP

Other informants and how reliable patient and informants are.

Question 2

What should be included in the psych HPI?

Answer 2

Concise history of difficulty, problem or illness that brought patient in for evaluation.

What difficulties the patient is personally experiencing and how it is specifically impacting his/her life.

What are the symptoms and when they started, duration, nature of onset, evolution of symptoms, precipitants, life events or triggers.

Document pertinent symptoms and the absence of certain symptoms keeping the DSM IV diagnostic criteria mind .

Document the degree of incapacity thus far and important effects on self, family, work, school and social functioning.

Always keep alcohol and drugs in mind and if they played a role in HPI

Any treatments thus far for this present illness. Hospitalization, day treatment, group therapy, couples therapy, individual psychotherapy, pastoral counseling, herbal, self help, medications, document dose, length treatment, outcome.

Question 3

What should be included in the pt’s past psychiatric history?

Answer 3

all of the pt’s treatments (inpatient and outpatient and therapy-based), including dates

past med use, compliance, dosage and benefit?

Question 4

What should be included in past medical history?

Answer 4

all medical problems.

falls, head trauma, seizures and injuries with loss of consciousness, as far back as childhood

Question 5

What should be included in the pt’s personal hx?

Answer 5

prenatal environment, premature, delivery type, place of birth, where grow up, temper tantrums, night terrors, relationship with parents and siblings, separations, abuse, neglect, trauma. Environment at home any alcohol, drugs or violence. Adjustment to school, school phobia, special ED, delinquency, truancy, gangs, grades, friendships, ability to identify with peer group, experimentation with drugs, sexual development, age of first sexual experience, heterosexual, homosexuality. Familial religious or cultural factors that may impact present illness. Educational hx, number of years of schooling, degree, interests, work hx, military hx, criminal hx, incarcerations, jail time.

Question 6

What should be addressed in the social hx?

Answer 6

marital status, job status, number of jobs, hx of being fired, arrests/probation, pending disability claims, who they live with, significant relationships,

ask about specific drugs!!

alcohol (how much, often when, hx of detox, DUIs, DTs, liver problems)

Question 7

What should be addressed in the family hx?

Answer 7

family hx of mental illness and tx

family hx of response to meds

family hx of drug or alcohol use

family hx of medical illness

(especially if young pt with no evidence of trauma or abuse)

Question 8

What common food is a p450 inhibitor?

Answer 8

grapefruit and grapefruit juice

Question 9

What common medications can increase the amount of lithium in the blood?

Answer 9

NSAIDS (aspirin, ibuprofen, naproxen, ketoprofen, nabumetone)

Question 10

What are the different components of the mental status exam? (10)

Answer 10

appearance/attitude (include hygiene, eye contact, cooperative or angry, appropriate dress?)

motor activity (agitated, fidgety, catatonic, tremor)

speech (volume, quality, speed, poverty of content(talk a lot but don’t say anything), poverty of speech (don’t talk much))

thought process (loose association, derailment, flight of ideas, vague, blocking)

thought content (suicidal, homicidal ideation, hallucinations, illusion, delusions,obsessions, phobias)

mood/affect and whether they are congruent or not

sensorium/cognition (Level of consciousness, orientation, concentration (serial 7s), reading (tell the pt to read a sentence and then follow the command), verbal fluency (name words that start with F in 1 minute (normal >11)), visual spatial ability (clock), memory (short term and long term-remember 3 things and birthdate)

abstraction (ex: how are an apple and an orange alike?)

FON (fund of knowledge) (IQ estimation)

judgement/insight (what would you do if you found a stamped envelope on the ground? do you think you have a problem?)

Question 11

What is the difference between mood and affect?

Answer 11

mood is the sustained emotion that a patient is feeling (happy, down, anxious, irritable, apathetic)

affect is how emotion is conveyed or perceived (appropriate, inappropriate, flat, blunted, expansive, labile)