The Psychiatric Interview as a Diagnostic Assessment Tool

1
The Psychiatric Interview as a Diagnostic
Assessment Tool

• Carlos E. Berganza
• Chair, Section on Classification
• World Psychiatric Association

2
Introduction

• The single most important tool by most textbooks
  of psychiatry
• Means to establish rapport
• Elucidating data
• Observing the patients behavior
• Course of the clinical condition
• E.g., biography, personality, adaptation

3
Formats Determinants

• Purpose of the interview
• Theoretical loyalties
• Medical model
• Psychodynamic concepts
• Systemic considerations
• Nature of the clinical condition

4
Goals and Purposes

• Engaging the patient as a reliable partner
• Collecting essential (valid) information
• Understanding of the patient
• Developing appropriate diagnostic hypotheses
• Preparing the patient
• Further procedures diagnosis or treatment

5
Engaging the Patient

• Physician-patient relationship
• Core of medical (and psychiatric) practice
• Rapport promotes a constructive therapeutic
  relationship
• It may uncover issues of basic trust in early
  development
• Source of strength for the patient

6
Collecting Essential Information

• Probably most structured part
• Complement information provided spontaneously
• Explore consistency of patients discourse
• Confirm or rule out initial diagnostic hypotheses
• Complete mental status examination

7
Understanding the Patient

• Genuine understanding (Jaspers)
• Attention to the subjective experience
• Conveying empathic intent to connect
• Validate internal experience as valid, unique and
  meaningful
• Address concerns
• Symptoms, Labels, Stigma, Causes of illness

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Appropriate Diagnostic Hypotheses

• Organize the database into sensible list of
  clinical problems leading to treatment
• Influenced by school of thought
• Ideally to be agreed upon with patient and family
• Consider the complex nature of problems
• Multiple determinants
• Various axes of assessment
• Multiple strategies of treatment

9
Preparing for Further Procedures

• More than one interview usually needed
• First meeting critical for engagement
• Determinant for the future approach to diagnostic
  or therapeutic needs

10
Techniques of Effective Interviewing

• Setting and time allocation
• Developing and maintaining rapport
• Attitudes conducive to mutual understanding
• Cultural issues
• Language barriers
• Systematic anamnesis
• Promote self-esteem, autonomy and hope

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Setting and Time Allocation

• Select setting according to circumstances
• Comfortable for both patient and clinician
• Protect privacy
• Minimize external distractions
• Time agreed upon with the patient
• Keep length of time previously accorded
• Agree on further sessions if needed
• Be respectful of patients time

12
Developing and Maintaining Rapport

• Poor rapport leads to clinical failures
• Beware subtleties of communication
• Transference and counter-transference
• Empathy and unconditional positive regard
• Facilitates trust and openness
• Be aware of your own emotions
• Feelings, not usually the problem ignoring them
  will surely be

13
Building Mutual Understanding

• Interview a dynamic process
• Leading to mutual understanding
• Patient-Clinician
• Without blurring respective roles
• Attitudes of clinician are important
• Attentive interested listening
• Conveying respect at all times
• Cultural issues must be considered
• Including potential language barriers

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Systematic Anamnesis

• Information on major problems
• Onset and course
• Time frame, mode, circumstances
• Clinical signs and symptoms
• Concomitant functional difficulties
• Contextual factors
• Treatments received and effects upon illness
• Additional efforts to restore health

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Closing the Interview

• By the end further steps ought to be specified
  and agreed upon
• Diagnostic and therapeutic
• Interviewing relatives and others
• Reviewing documentary sources of information
• Supplementary assessment procedures
• Closure must promote
• Self-esteem, sense of hope, cooperation and
  clarity of goals

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Final Comments

• Psychiatric interviewing is a skill
• Art and technique (science)
• Compassion and systematic thinking
• Allows therapeutic alliance
• For understanding the problems
• Delineating treatment
• Single most important diagnostic tool