The Psychiatric Diagnostic Interview

Question 1

In Nussbaum’s 30 min interview, what should you cover during MINUTE 1?

Answer 1

• Introduce yourself
• Ask how they want to be addressed
• Set expectations (how long we have, what we want to accomplish)
• Ask why they are there

Question 2

In Nussbaum’s 30 min interview, what should you do during MINUTES 2-4?

Answer 2

LISTEN! Try to allow the pt to talk w/o interruption. Uninterrupted speech shows mental status, guides your Hx taking, & builds alliance.

Question 3

In Nussbaum’s 30 min interview, what should you do during MINUTES 5-12?

Answer 3

HPI, Past Psych Hx, Safety

Question 4

What are some questions that should be asked in the psych HPI?

Answer 4

• Qs that follow DSM-5 criteria
• Why now?
• When did this start?
• When did you last feel well?
• Can you ID any precipitating events?
• How do you view your current lvl of functioning & how has it changed?
• When did they first notice symptoms?
• When did they first seek treatment?
• Did they ever experience full recovery?

Question 5

In Nussbaum’s 30 min interview, what should you do during MINUTES 13-17?

Answer 5

ROS (include Cross-Cutting Symptom measures here)

Question 6

In Nussbaum’s 30 min interview, what should you do during MINUTES 18-23?

Answer 6

PMHx, PFHx, Social Hx

Question 7

What should be asked in the psych PMHx interview?

Answer 7

Previous dx
Surgeries
Allergies

Hospitalizations
(Have they ever been hospitalized? How many times? What was the reason for the hospitalization? Do they receive outpatient mental health treatment?)

Medications
(Do they take any medications for a mental illness? Which medications have helped the most? Did they ever have any side effects from any medications? What was the reason for stopping prior medications? For how long and how often did they take prior medications?)
(Do they know the name, strength, and number of doses per day for any medications they are currently taking?)

Question 8

What should be asked in the social Hx for psych interview?

Answer 8

Diet, exercise, living situation, occupation (how do you support yourself?), tobacco, Alcohol (CAGE form), recreational drugs

Question 9

In Nussbaum’s 30 min interview, what should you do during MINUTES 24-28?

Answer 9

Mental Status Exam (i.e. many ppl dealing w/stress have some difficulty concentrating or remembering, have you had problems like that?)
OR
MMSE

Question 10

In Nussbaum’s 30 min interview, what should you do during MINUTES 29-30?

Answer 10

• Any follow up questions
• Ask if there is anything they wanted you to know about that you didn’t cover
• Thank pt for their time
• Move onto PE

Question 11

What ‘tool’ do you use to present a case?

Answer 11

SBAR (situation, background, assessment, recommendations)

Question 12

What should you include in your SBAR presentation?

Answer 12

• pt by name, age, gender, CC
• HPI (DSM-5 criteria w/pertinent psych ROS as well as bio/social/psych predisposing factors & stressors)
• Steps to obtain/maintain safety
• How pts health affects Tx?
• Indicated psych Tx
• Social/cultural needs, strengths/obstacles
• Prognosis

Question 13

What psych disorders predispose youth to early CVD?

Answer 13

Major depressive d/o & bipolar d/o

Question 14

What is the 10th leading cause of death in the US?

Answer 14

Suicide

Question 15

How common is autism in the US?

Answer 15

1 out of 8 children by 8 y/o

Question 16

Prevalence of d/o in adults?ADHD, depression, Alcohol, bipolar, schizophrenia, anxiety)

Answer 16

18% - anxiety
7.2% - alcoholism
6.7% - major depression
4.1% - ADHD
1.6% - bipolar d/o
1% - schizophrenia

Question 17

Prevalence of d/o in teens? (ADHD, depression, Alcohol)

Answer 17

9% - ADHD

3. 4% - alcoholism
4. 3% - major depression

Question 18

What type of population is most likely to get mental illness in the US adult population? (i.e. gender, age, race) Least likely?

Answer 18

Female, 26-49 y/o, American Indian/Alaskan Native

Male, 50+, Asian

Question 19

What is the general prevalence of mental illness in the US adult population?

Answer 19

18.5%

Question 20

What is the cross-cutting SSx measure?

Answer 20

Screening tool for the pt to complete before an initial eval for mental health.
Adult: 23 qs, 13 domains
Child: 25 qs, 12 domains

Question 21

What d/o are the questions below from cross-cutting targeting?

• Do you have little interest/pleasure in doing things?
• Are you feeling down, depressed, hopeless?

Answer 21

Depression

Question 22

What d/o is the question below from cross-cutting targeting?

-Are you feeling more irritated, grouchy, or angry than usual?

Answer 22

Anger

Question 23

What d/o are the questions below from cross-cutting targeting?

• Are you sleeping less than usual, but still have a lot of engery?
• Have you started lots more projects than usual or are doing more risky things than usual?

Answer 23

Mania

Question 24

What d/o are the questions below from cross-cutting targeting?

• Feeling nervous, anxious, frightened, worried, or on edge?
• Feeling panic or being frightened?
• Avoiding situations that make you anxious?

Answer 24

Anxiety

Question 25

What d/o are the questions below from cross-cutting targeting? - Unexplained aches & pains (i.e. head/back/joints/abdomen/legs)? - Feeling that your illnesses are not being taken seriously enough

Answer 25

Somatic SSx

Question 26

What d/o are the questions below from cross-cutting targeting? -Thoughts of actually hurting yourself?

Answer 26

Suicide

Question 27

What d/o are the questions below from cross-cutting targeting? - Hearing things that other people couldn't hear (voices, even when no one was around)? - Feeling that someone could hear your thoughts, or that you could hear what another person was thinking?

Answer 27

Psychosis

Question 28

What d/o are the questions below from cross-cutting targeting? -Problems with sleep that affected your sleep quality overall?

Answer 28

Sleep problems

Question 29

What d/o are the questions below from cross-cutting targeting? -Problems w/memory (i.e. learning new info) or with location (i.e. finding way home)?

Answer 29

Memory

Question 30

What d/o are the questions below from cross-cutting targeting? - Unpleasant thoughts, urges, images that repeatedly enter your mind? - Feeling driven to perform certain behaviors or mental acts over and over?

Answer 30

Repetitive Thoughts and Behaviors

Question 31

What d/o are the questions below from cross-cutting targeting? -Feeling detached/distant from yourself, your body, your physical surroundings, or your memories?

Answer 31

Dissociation

Question 32

What d/o are the questions below from cross-cutting targeting? - Not knowing who you really are or what you want out of life? - Not feeling close to other people or enjoying your relationships with them?

Answer 32

Personality functioning

Question 33

What d/o are the questions below from cross-cutting targeting? - Drinking at least 4 drinks of any kind of alcohol in a single day? - Smoking any cigarettes/cigar/pipe/snuff/etc? - Using meds or drugs?

Answer 33

Substance use

Question 34

How do you know what to ask to get to the correct diagnosis/underlying problem?

Answer 34

DSM-5 to guide Improves Dx accuracy by measuring severity of d/o, aligning it with ICD system, & incorporating recent advances in neuroscience

Question 35

Symptoms vs. signs?

Answer 35

Symptoms: pts subjective report Signs: objective findings Signs more telling than symptoms

Question 36

How does the DSM-5 classify a psych Dx? What factors are at play here?

Answer 36

Disorder! Disturbance in physical & psychological functioning Biological, Social, Cultural, Psychological

Question 37

What must a diagnosis have and what does it determine?

Answer 37

Must have clinical utility | -prognosis, tx plans, potential tx outcomes for pt

Question 38

What is a “A syndrome characterized by a clinically significant disturbance in an individual’s cognition, emotional regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning"?

Answer 38

Mental disorder

Question 39

What is it up to the clinician to decide regarding diagnosing mental d/os?

Answer 39

Is it clinically significant! Does it affect and to what extent the person's cognition, emotions, behavior -How did they function before compared to now?

Question 40

How do you establish therapeutic alliance?

Answer 40

Asking questions!

Question 41

What are some alliance building questions?

Answer 41

What do you think caused your problem? Why do you think it started when it did? What do you think your sickness does to you? How does it work? How severe is your sickness? Will it have a short or long course? What kind of treatment do you think you should receive? What are the most important results you hope to receive from this treatment? What are the chief problems your sickness has caused for you? What do you fear most about your sickness?