Psychiatric Interviewing
Introduction
Several students while they study psychiatry they face a problem of
remembering and presentation of the read material as well as the clinical presentation
of a case. This little book is a trial to help for better performance.
Many medical students use mnemonics as a tool for better memory. Mnemonics
is a famous method for memory improvement and it is used by many ways in different
in different aspects of life.
Certainly you have been used it, may be while you were studying! Or to remember
phone numbers names and appointments. Even the simple classifications of a tough
scientific material or categorization are considered mainly to be a method of
simplification or a technique for mnemonics. Every year there are new books and
several researches about memory hardly one of them might neglect the role of
mnemonics. By this introduction I don’t mean to attract you to read and buy the book,
but going for I wish to have it as a challenge to you measure your performance before
and after training on mnemonics.
Mnemonics could be a done by visual imagery and commonly to be verbal
which is our main concern in this book. However we won’t neglect the role the former
method also we will explain simple and easy categorization for description of any
psychiatric disorder, which make the matter of remembering very easy for systematized
brains.
1Mnemonics written in this little book isn’t all belongs to me but I made the effort to
gather them. They belong to different authors, no doubt in their memory and their
abilities to use those techniques, on the contrary they advice it every where. / I added to
them and had to modify some of them for more convenience.
Mnemonics is a memory aid helps your memory by providing better associations, puns
and a lot of fun. You can find it lots of joy and it is the time to let you with psychiatry
to enjoy.
Best regards;
Yours
Dr. Adel Wagih Seraj Eldin
2Chapter I
Mental state examination
3History taking in psychiatry:
The clinical interview:
The diagnostic process starts from the very
moment of the initial contact with patients and as long
as you obtained the very detailed information of the
patient. The clinical interview transforms the possible
to probable and then to definite waiting for more
detailed information.
The psychiatric interview is definitely your tool to
examine and diagnose corresponding to inspection,
palpation, percussion and auscultation. Here you have
the rule of 5 vowels, which is the basic skill you should
gain during interviewing of the patient.
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RULE OF FIVE VOWELS [A, E, I, O & U]:
A AUDITION
Listens to the patients content of thoughts
E
EVALUATION
To judge reliability of the report, sorting them the relevant
from the non-relevant details matches them for the probable
diagnosis.
I
INQUIRY
To inquire and probe into the necessary areas and illicit data
not volunteered.
O OBSERVATION To note the deviations in appearance ,
Unusual behavior, mood variations and attend to non-verbal
communications.
U UNDERSTANDI
NG
To adopt an empathic posture and
Appreciate the patient condition.6
Make it easy
There is an easier way can help you to recognize the components of the
interviewing but it are less informative. Psychiatry is the art of medicine, you
should be not only skilled in this art but also an artist learns the art of interviewing.
The ART of psychiatric interview [A.R.T]
A ASSESSMENT
The most open-ended and directive questions, the patient
describe and raise concerns and interests.
R RANKING
Areas to probe into by more direct questions
that each of the ranked problem can be
Investigated thoroughly.
T TRANSITIONS
The interview is flowing smoothly and the
Patient is at ease.7
How to interview the psychiatric patient:
The primary goals:
The beginning:
To establish rapport
You should
Put the patient at ease,
Introduce yourself and possibly your
colleagues and
Show respect to the patient
During the interview:
To identify relative problems
You should
Allow the patient talks and express his
feelings
Use a proper language
Use tact in framing the questions
Move effectively from one area to another
Clarify the inconsisties
Obtain a meaningful informationAt the End of interview:
To let the patient feels satisfied
You should
Inform the patient for further steps,
Give the patient opportunity to ask
Make closing statement.
Techniques used for better communication and
interviewing:
1] Facilitation:
Encourage the patient to ventilate, (last word is repeated, question
look or direct asking)
2] Open ended questions:
No specific information.
3] Direct questions:
For specific information.
4] Support:
Interest and willing to help.
85] Empathy:
To sympathize with the patient.
6] Reflection:
Repeat, mirror, and echo a portion of what a patient has just said.
7] Silence:
Brief, give a chance to express and explore more.
8] Clarification:
For further information
9] Confrontation:
To call patient attention to his misbehavior for the antisocial or the
good for the depressed, inconsistencies and contradictions.
10] Summation:
Is to review the information is short.
11] Interoperation:
Is to formulate data.
910
Mental state examination
The MSE is the cross sectional pt.
ْ
ǖs psychological life
and presents the sum total of the psychiatrist’s
observation and impressions at the moment.
Behavior
Talks
About
your
Thoughts,
Perception reveals Cognition1. BEHAVIOR:
NOTE AND OBSERVE
Appearance, gait [normal or limbing…etc], dress
[appropriate or inapp.], grooming (neat or not), facial
expression [sad; happy; depressed; anxious; panicky;
tense], eye contact, cooperation [fully cooperative or
hardly] – indifferent; defensive; sarcastic; level of
activity, [agitation, retardation,] tics, stereotype,
mannerisms]
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2-TALK:
Spontaneous or induced, rate [slow, rapid, or of
moderate speed], relevancy, to the point or off point,
fluent or dysfluent [e.g. stammering], high or low
pitched
tone,
comprehensible;
meaningful
understandable
3-AFFECT:
Appropriate, inappropriate, labile blunted; indifferent,
shallow, restricted, euphoric elated depressed.Suggestions:
Introduce your self and direct the patient. To take a
seat. Try to keep smiling at the patient. To gain his trust
and confidence always reassure and be warm.
Observe carefully in seconds the way he enters the room,
the way he walks, his dress and grooming is it going
with his social standard and education, Observe the
contact all through the setting take abbreviated notes
and writ all later on.
Observe level of activity and compare to yourself if you
aren’t anxious
13Encourage the patient. To talk and facilitate to him this
again through smiling, question look, admiration,
nodding, asks directly
” Clarify this, talk more, give me an example, let him talk
freely without interruption and listen carefully to all that
said and judge about it.
Observe non-verbal signs of emotion, body movement,
fancies, rhythm of voice
MOOD:
Steady and Sustained emotional state
Euphoric, Elated, Depressed [mildly
Moderately or severely depressed]
14Apathetic, anhedonic, fearful, tense, irritable,
4-THINKING
FORMAL THOUGH DISORDER or no evidence. It is
evidenced by loose association, poorly approximated,
circumstantial (overdetailed), logical or illogical, rational or irrational,
relevant or irrelevant, preservation, goal directed and to the point. flights of ideas,
clang association,
Content: preoccupied by
Delusions of persecutions, grandiose, infidelity, somatic, sin, guilt, nihilism,
Ideas of reference
Overvalued ideas
Control
Thought reading, broadcasting, insertion, withdrawal or block
15Stream
Fast, slow, pressure of thoughts
Ask directly ” How do you feel? Help the patient. You mean that you are sad or
depressed or happy or tense or anxious or easily provoked (i.e. Irritable) and ask
was this your mood along the
Last couple of weeks. Decide is it appropriate or inappropriate to the patient.
Situation and life stresses.
Let the patient. Talks freely for some time as we stated
on the talk decide if his talk is adequately approximated
from idea to idea till it reaches a goal; so idea 1 + 2 + 3+
4+ 5 = goal or if he has poor ideation can’t elaborate 5
ideas within 5 minutes interview, as indirectly you
question him about general issues
16Ask directly ” do you feel people want to harm you? Do
you have special power? Is any one trying to influence
you? Do you have strange sensations abnormal to you?
What about your fantasies and dreams? Are they true
or abnormal?
“Have you ever the feeling that someone can know you
thoughts or read them? Or have you ever a strange
idea have been planted or inserted into your mind.
Which idea. What do you do then? Or the contrary can
happen can any force or by any way the thoughts
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withdrawn from your mind? Why you paused. Does it
frequently happen? . Try to be skilled and ask the
question by several ways
4-PERCEPTION:
Is there is abnormal perceptual experience auditory
hallucinations
[ordering,
commenting,
arguing,
insulting and abusing]/ visual [vivid, clear] /tactile /
gustatory/ olfactory
5-COGNITIVE FUNCTIONS:
ORIENTATION
TIME, PERSON AND PLACE
[HOSPITAL, WARD, FLOOR]
ATTENTION: CONCENTRATION
SUSTAINED OR unsustained
MEMORY
IMMEDIATE
RECENT
REMOTE
When you are setting alone do you hear strange voices?
What is its source? At what times, day or nights are
they clear, what is the content? Do they order you, warn
you, threat you, and comment on that you do, argue
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with you? Do you see special or strange images, like
what, at what times, are they clear, are they true, how
can you explain them?
Have you ever-smelled
abnormal smell? What’s your explanation?
. Always
Reassure and ask the patient. Not to be afraid and trust
you and that the data are private…
” What is this place? Which department? Which floor?
Where is your room? Who am I? Yes doctor. Who is
that man yea nurse? What is the season, day, date year?Serial 7s subtraction stop after 5 [93-86-79-72-65] or
spell your name backward
Repeat 5 digits forward then backward [normal
response- Ask the patient. To recall 3 not related items
test after 5 minutes – where were you yesterday, who
were the last visitors.
Where were you born? What is the birthday of your eldest son…? Etc.
INTELLIGENCE ACCORDING TO THE GENERAL KNOWLEDGE
CLINICALLY ASSESSED TO BE BELOW AVERAGE, AVERAGE OR ABOVE
AVERAGE
INSIGHT
INSIGHTFUL OR INSIGHTLESS [PARTIAL, COMPLETE]
21 ABSTRACTION
Slightly, moderately or grossly impaired
JUDGMENT:
Adequate – impaired
Who is our prince? The capital of Emirates. The king of SA…. etc.
Are you sick? Is it psychological illness? Do you deserve Th?
Interpretation of 2-3 proverbs, similarities [orange and apple are fruits, what are
the coat and shirt]
Envelope or lost kid!
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