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The Psychiatric Interview: Evaluation and Diagnosis

ISBN: 978-1-119-97623-3
208 pages
July 2013, Wiley-Blackwell
The Psychiatric Interview: Evaluation and Diagnosis (1119976235) cover image

The patient interview is at the heart of psychiatric practice. Listening and interviewing skills are the primary tools the psychiatrist uses to obtain the information needed to make an accurate diagnosis and then to plan appropriate treatment. The American Board of Psychiatry and Neurology and the Accrediting Council on Graduate Medical Education identify interviewing skills as a core competency for psychiatric residents.

The Psychiatric Interview: Evaluation and Diagnosis is a new and modern approach to this topic that fulfils the need for training in biopsychosocial assessment and diagnosis. It makes use of both classical and new knowledge of psychiatric diagnosis, assessment, treatment planning, and doctor–patient collaboration. Written by world leaders in education, the book is based on the acclaimed Psychiatry, Third Edition, by Tasman and Kay et al., with new chapters to address assessment in special populations and formulation. The psychiatric interview is conceptualized as integrating the patient’s experience with psychological, biological, and environmental components of the illness.

This is an excellent new text for psychiatry residents at all stages of their training. It is also useful for medical students interested in psychiatry and for practicing psychiatrists who may wish to refresh their interviewing skills.

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Contributors ix

Preface xi

Acknowledgments xiii

Chapter 1 Listening to the Patient 1

Listening: The Key Skill in Psychiatry 1

The Primary Tools: Words, Analogies, Metaphors, Similes, and Symbols 3

How Does One Hear Words in This Way? 4

Listening as More Than Hearing 6

Common Blocks to Effective Listening 7

Crucial Attitudes That Enable Effective Listening 10

Theoretical Perspectives on Listening 14

Using Oneself in Listening 16

To Be Found: The Psychological Product of Being Heard 18

Listening to Oneself to Listen Better 20

Listening in Special Clinical Situations 23

Growing and Maturing as a Listener 26

Chapter 2 Physician–Patient Relationship 31

Formation of the Physician–Patient Relationship 34

Special Issues in the Physician–Patient Relationship 42

The Physician–Patient Relationship in Specific Populations of Patients 44

Conclusion 46

Chapter 3 The Cultural Context of Clinical Assessment 47

Introduction: The Cultural Matrix of Psychiatry 47

What Is Culture? 48

Culture and Gender 50

The Cultural Formulation 51

Ethnocultural Identity 52

Illness Explanations and Help-Seeking 53

Psychosocial Environment and Levels of Functioning 55

Clinician–Patient Relationship 56

Overall Assessment 57

Cultural Competence 57

Working with Interpreters and Culture-Brokers 60

Conclusion: The Limits of Culture 62

Chapter 4 The Psychiatric Interview: Settings and Techniques 65

Goals of the Psychiatric Interview 66

The Psychiatric Database 75

Database Components 77

Mental Status Examination 81

Conduct of the Interview: Factors That Affect the Interview 83

General Features of Psychiatric Interviews 85

Chapter 5 Psychiatric Interviews: Special Populations 103
Randon Welton and Jerald Kay

Psychiatric Interview in Special Circumstances 104

Psychiatric Interview in Special Patient Populations 115

Conclusions 131

Chapter 6 Formulation 135
Allison Cowan, Randon Welton and Jerald Kay

Biological Contributions 136

Social Factors 138

Psychological Factors 140

Summary 146

Chapter 7 Clinical Evaluation and Treatment Planning: A Multimodal Approach 147

Psychiatric Interview 147

Identifying Information 149

Chief Complaint 149

History of Present Illness 150

Past Psychiatric History 150

Personal History 150

Family History 151

Medical History 152

Substance Use History 152

Mental Status Examination 153

Physical Examination 157

Neurological Examination 158

Psychological and Neuropsychological Testing 159

Structured Clinical Instruments and Rating Scales 159

Laboratory Assessments 159

Neurophysiologic Assessment 159

Brain Imaging 162

Special Assessment Techniques 163

Assessment of Risk 164

Suicide Risk 164

Differential Diagnosis 167

Initial Treatment Plan 170

Conclusion 171

Chapter 8 Professional Ethics and Boundaries 173

Introduction 173

Ethical Behavior and Its Relationship to the Professional Attitude 174

WPA Guidelines on Euthanasia 176

WPA Guidelines on Torture 177

WPA Guidelines on Sex Selection 177

WPA Guidelines on Organ Transplantation 177

WPA Guidelines on Genetic Research and Counseling in Psychiatric Patients 177

WPA Guidelines on Ethnic Discrimination and Ethnic Cleansing 178

WPA Guidelines on Psychiatrists Addressing the Media 178

The Coherent Treatment Frame and the Role of Therapeutic Boundaries in Effective Psychiatric Treatment 178

Boundary Violations 179

Components of the Coherent Psychiatric Frame 180

Stability 181

Avoiding Dual Relationships 182

Autonomy and Neutrality 183

Coherent and Noncollusive Compensation 183

Confidentiality 184

Anonymity 184

Abstinence 185

Self-respect and Self-protection 186

Summary 187

Index 191

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Allan Tasman, MD, is Professor and Chair of the Department of Psychiatry at the University of Louisville.  An internationally known educator and psychoanalyst, he has received numerous national and international academic awards. He is the founding Senior Editor of Psychiatry, an internationally acclaimed comprehensive textbook. He is past president of the American Psychiatric Association and the Pacific Rim College of Psychiatrists. He recently completed service as Secretary for Education of the World Psychiatric Association and now leads the WPA Section on Psychotherapy.

Dr. Kay
is a Fellow of the American College of Psychiatrists and Distinguished Life Fellow of the American Psychiatric Association and has served as the chair of the APA Committee on Medical Student Education, the Council on Medical Education and Career Development, the Vestermark Award Board, and the Committee on the Practice of Psychotherapy. He chairs the World Psychiatric Association Task Force on Undergraduate and Post Graduate Curriculum as well as the APA Committee on College Mental Health. Dr. Kay is the immediate past chair of the Psychiatry Residency Review Committee of the ACGME and the Founding Editor of the Journal of Psychotherapy Practice and Research and Associate Editor of the American Journal of Psychotherapy. He has published extensively on the topics of medical and psychiatric education, medical ethics, child psychiatry, psychoanalysis, psychotherapy, the neurobiology of psychotherapy, and psychosocial aspects of AIDS and of cardiac transplantation, and has edited numerous books. Dr. Kay serves as the Associate Director of the Comprehensive Neuroscience Center at Wright State University. He received the 2001 APA Seymour Vestermark Award for contributions to psychiatric education. Dr. Kay's current research examines fMRI in borderline personality disordered patients with self-harm behavior.

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