Psychiatry Interview

I. Ice-breaker (start with the easy questions!)

  • How are you feeling today?
  • Sleep
  • Appetite
  • Constipation
  • Physical concerns

II. Mental Status Exam: assessment of the patient at the present time.

A. General appearance and behaviour 

  1. Grooming, level of hygiene, characteristics of clothing
  2. Unusual physical characteristics or movements
  3. Attitude: ability to interact with interviewer
  4. Psychomotor activity: agitation or retardation
  5. Degree of eye contact

B. Affect: external range of expression, described in terms of quality, range and appropriateness

Types:

  1. Flat: absence of all or most affect
  2. Blunted or restricted: moderately reduced range of affect
  3. Labile: multiple abrupt changes in affect
  4. Full or wide range of affect: generally appropriate

C. Mood: Internal emotional tone of the patient (i.e. euphoric, dysphoric, euthymic, anxious, angry)

D. Thought Processes

  1. Use of language: quality and quantity of speech. The tone, associations and fluency of speech should be noted
  2. Common thought disorders
    a. Pressured speech: rapid speech, which is typical of patients with manic disorders
    b. Poverty of speech: minimal responses, such as answering just “yes or no”
    c. Blocking: sudden cessation of speech, often in the middle of a statement
    d. Flight of ideas: accelerated thoguhts that jump from idea to idea, typical of mania
    e. Loosening of associations: illogical shifting between unrelated topics
    f. Tangentiality: thought that wanders from the original point
    g. Circumstantiality: Unnecessary digression, which eventually reaches the point
    h. Echolalia: echoing of words and phrases
    i. Neologisms: invention of new words by the patient
    j. Clanging: speech based on sound, such as rhyming and punning rather than logical connections
    k. Perseveration: repetition of phrases or words in the flow of speech
    l. Ideas of reference: interpreting unrelated events as having direct reference to the patient, such as believing that the television is talking specifically to them

E. Thought content: hallucinations, delusions and other perceptual disturbances

Common thought content disorders

  1. Hallucinations: false sensory perceptions, which may be auditory, visual, tactile, gustatory or olfactory
  2. Delusions: fixed, false beliefs, firmly held in spite of contradictory evidence
    I. Persecutory delusions: false belief that others are trying to cause harm, or are spying with intent to cause harm
    II. Erotomanic delusions: false belief that a person, usually of higher status, is inlove with the patient
    III. Grandoise delusions: false belief of an inflated sense of self worth, power, knowledge or wealth
    IV. Somatic delusions: false belief that the patient has a physical disorder or defect
  3. Illusions: misinterpetations of reality
  4. Derealization: feelings of unrealness involving the outer environment
  5. Depersonalization: feelings of unrelaness, such as if one is outside of the body and observing his own activities
  6. Suicidal and homicidal ideation: requires further elaboration with comments about intent and planning (including means to carry out plan)

F. Cognitive Evaluation

  1. Level of consciousness
  2. Orientation: Person, place and date
  3. Attention and concentration: repeat five digits forwards and backwards or spell a five-letter word (“world”) forwards and backwards
  4. Short-term memory: ability to recall three objects after 5 minutes
  5. Fund of knowledge: ability to name past five presidents, five large cities or historical dates
  6. Calculations: subtraction of serial 7s, simple math problems
  7. Abstraction: proverb interpretation and similarities

G. Insight: ability of the patient to display an understanding of his current problems, and the ability to understanding the implication of these problems

H. Judgment: ability to make sound decisions regarding everyday activities. Judgment is best evaluated by assessing a patient’s history of decision making, rather than by asking hypothetical questions

III. Symptom check-list (e.g. DSM-5)

Depression: SIG E CAPS

S leep changes: increase during day or decreased sleep at night
I nterest (loss): of interest in activities that used to interest them
G uilt (worthless):  depressed elderly tend to devalue themselves
E nergy (lack): common presenting symptom (fatigue)
C ognition/C oncentration: reduced cognition &/or difficulty concentrating
A ppetite (wt. loss); usually declined, occasionally increased
P sychomotor: agitation (anxiety) or retardations (lethargic)
S uicide/death preocp.
  •  Mood
    • Scale of 1-10, how is your mood?
    • How often? How many days in a week? How long?
  •  Scales:
  • Suicidal ideation:
    • Do you have thoughts about harming or killing yourself?
    • If having auditory hallucinations re: suicide:
      Do you find them easy to resist? How do you manage it?

Bipolar Disorder

  • Scales:
  • If have delusions, ask things related to the delusions:
    • Do you feel that you have so-and-so super-power?
  • Mania:
    • Do you feel like your thoughts are racing, or feel that everything around you is going too slow?
    • Do you feel that you are always on the go, and have lots of plans?
    • Do you feel like you need less sleep? How many hours do you sleep?
    • Do you feel like you have a lot of energy?
    • How often do you feel this way? Daily? How many days in a week?
  • Hypomania vs Mania:
    • If hypomania, episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
    • Hypomania episodes can occur in bipolar I, but are not required for the dx of bipolar I

Schizophrenia:

  • Do you hear things that are not there? Do you hear things that are out of the ordinary?
    • When was the last time this occurred?
  • Do you see things that are not there? Do you see things that are out of the ordinary?
    • When was the last time this occurred?
  • Mood
    • Scale of 1-10, how is your mood?
    • How often? How many days in a week? How long?
  • Motivation
  • Scales:

General Questions:

  • Do you feel safe in the hospital?
    • Are people treating you well in the unit?
    • Do you feel comfortable and safe with your co-residents
  • Did you feel safe in home?
  • Do you think that something/someone is harming you?
  • Family history?
  • ADLs – DEATHSHAFT
    • Dressing, Eating, Ambulation, Toilet, Hygeine, Shopping, House=keeping, Accounting, Food Preparation, Telephone/Transportation
    • What is your source of income?
    • Any concerns about living at home? Do you feel that you need help in some areas?
    • How many meals a day do you usually eat? How do you get and prepare food?
  • Substance use
    • Substance use, especially cannabis is common in 1st episode psychosis

Questionaires/Scales to assess suicidal behaviour:

Observe:

  • Speech
    – is it pressured? hard to interrupt? (Mania)
    – Is it disorganized? difficulty in expressing thoughts? (+ symptoms of schizophrenia)
  • Affect – euthymic? irritable? flat? blunted?
  • Attention
  • Length of responses – short? long?

IV: Medications

  • Do you know the names of the medications you are taking?
    • Pull out P’net profile to assist
  • Do you know what your medications are for?
    • If no, provide a brief summary
      – e.g. Lithium is a medication that will help stabilize your mood
  • Gather medication history:
    • Do you know what medications you have tried?
    • Do you know what dose you were on?
    • How long have you tried it?
    • Did you experience any side effects from medications in the past?
      If so, which ones and what side effects?
    • Did you find that the medication was helpful for ___?
  • Are you experiencing any side effects?
  • If you start to feel different or sick, would you let your nurse know and I’ll come back to see you?
  • Assessment of SEs:

Resources:


FYI:

  • Axis I: Clinical disorders
    Other conditions that may be a focus of clinical attention
  • Axis II; Personality disorders
    Mental retardation
  • Axis III: General medical conditions
  • Axis IV: Psychosocial and environmental problems
  • Axis V: Global assessment of functioning
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s