The Psychiatric Interview

D: Hi. Let me introduce yourself I am Dr. A I am the psychiatrist on your team. Before we start, can you please tell me your full name and date of birth. [1]

:  This is the treatment team. This is everyone involved in your care and we meet here for the first business day  and then every week if you are here that long. We will go round and introduce ourselves. 

So K, can you tell me what brings you to the hospital/ why you are in the hospital.

Interview Style Dr. Tai:

Hi I am Dr. X, I am a resident doctor. This is your treatment team. We meet here the first business day after you come and every other week if we stay that long. 

Before we start can you tell us your name and date of birth (especially for psychotic confused patients or if you are not sure which patient this is. )

We will go round and introduce ourselves. 

So Y, Can you tell me why you are in the hospital?

Tease out-  How they came to the hospital (brought, came by themselves, ambulance, police, family member. What made them come to the hospital that day?

If they keep going round something that is going round for a few days/weeks. 

Ask them: How they 

Option A: Suicidal Ideation- Attempt.

Because I took some pills

• How many pills did you take? What medication was it? 

Did you take the whole bottle [ did they actually count or just finish the whole bottle- finishing would indicate a more severe attempt.]

Did you call for help? Somebody found you? 

What was going on just prior to the incident?

• Were you upset over anything? Was there an argument? What was happening that day pushed you over the edge of depression to wanting death. 

         Are you glad that you are alive? Since you have been in the hospital, are you still having suicidal thoughts. 

           Have you been having suicidal thoughts? Yes. what were they? How long?

           Did you have a plan?  (obviously planned attempts are more severe)

           To note, SI – can also be impulsive.

          Lets say patient states since the last 4 days- 

          What happened four days ago ? (Any trigger?)

          Have you hurt yourself before? When was the last time? How did you do it? Was it just ideation or attempt? 

Jump off the bridge- did you actually jump? Did you actually walk in front tof the traffic.

Note: Circumstance based additional questions: Were you intoxicated at the time? Do you have Si when under influence or also when sober. 

I took Pills because I was having AH. 

• You hear voices? – if on and off- when was the last time your heard them? Is it all day? Has the frequency increased recently (few days/ weeks)

• How long have you heard voices ?

• What do they tell you? 

• Do they feel like they are coming from your head or something that comes from outside, and you can hear it in your ears. (( insight,)

• Is it one person, multiple person? Do they talk among themselves (if multiple- more typical of psychosis) ? 

• Do they tell you to do things? If yes, what? Have you actually done them? Do you believe what they tell you? Have you ever fought back?  (I guess how gullible/vulnerable/influencable the patient is)

• Are these people you recognize, or random people you don’t know.

If patient is afraid- 

• Are you afraid something bad is going to happen?

• Do you feel people/cars are following you? Or trying to harm you?

• Do you know these people? What do you think they will do to you?

• Do you ever feel like the TV is giving you signals. 

• Ideas of reference “ Do you feel people are talking about you even when you are not in that conversation and some random external events are somewhat related to you.”

• Have you seen something happen?

Drugs:

Substance- How much, how often, 

Alcohol : How much do you drink? How often do you drink? What type of alcohol. When was the last time. 

Cannabis- street or dispensary

If suboxone, if they have a suboxone provider- note it down. 

Then go on to medications: 

Have you had treatment in the past? What were your diagnosis/ mental health issues in the past-  If yes what medications have you tried? 

Assess response to medications, adherance, adverse effects, dosage and duration. 

Are you willing to try anything right now?

If they are not adherent? Why not? They could not go the pharmacy- what stopped them, where they afraid, naxious, social issues- no car? They felt they were fine and did not need it anymore?

If they are allergic- ask them to state what the actual reaction was. 

If they wer eno adherent?- was it working when they were on it? 

Who prescribes their medications? Do they have outpateint providers ?

If yes who- PCP, Psychiatrist, Therapist. 

Chronic Psychiatric patietn who need more aids- Do you have DMH support. 

Other issues- do you have a place to go back? Source of income? Support network?

Any othe recreational drug use

Medical condition

At this time do you feel safe, any SI, HI, AVH.

How long have you been feeling suicidal

Why did it get owrse

Was something bothering you?

What about the voices.

Before a couple of weeks

Increased voices.

Any stressors

“Unmasking”

Dr Stern:

Difficulty patient.

Move from data collection.

To the process.

Why do you feel uncomfortable.?

Explain why are you asking the questions u r asking.

If they are already told before. QHy are you asking again.

How did you experience that emotionally when you find it out.

When you move to the affect?

Rearfication:

Mark – When you make a person part of government or factory, you miss the humanity f working at that line.

Preserve the humans

What was making you sad. — that dying became better than living.

The reason people come to  the treatment is because they feel terrible. Not because of what happened.

Break the cycle:

  – Why makes it so difficult to follow?

– Why do you want to come back??

Maybe I am not asking questions properly and maybe you don’t understand why I am asking

Always focus on feelings, and affects,

Always be better

You are not going to get the whole story right away

You are not going to fully understand the situation.

I kind of get

When questions pop? They are normally on target.

False Reassurance X

It pulls on, well we are here to help you. What can you do for them

If they knew if they would have not cut themselves.

Being curious and confused.

Have you been in therapy before? Hwo did it go?

Break the cycle:

Data doesn’t help if there is no bond.

Therapeutic follow up.

The truth is no one ever has been listened to me ebfore.

I know

Preparing them for . use their own views.

Not what we teach but what we learn. How do you integrate into your life.

How you use it and what it means to you?

Not the content and the processs.

What did my family mena to me.

What did choosing

To me

Write your own life experiences.

Buddhist

Alan Waltz- Eastern religious: Taosim- all focused on directly in front of us. The environment directly in front ofus .

All read the sbulimincal stuff.

Valid