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teaching:1-psych-interview [on May 30, 2020]
teaching:1-psych-interview [on February 1, 2024] (current)
psychdb [Primer]
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 The **Psychiatric Interview** involves a balance of being empathetic, asking the right questions, and thinking about the diagnostic criteria carefully for psychiatric disorders. Remember, everyone has a different way of interviewing,​ but every question you ask should have a //​purpose//​. Are you trying to elicit symptoms? Understand someone'​s life history? Understand their safety risks? Just as a good surgeon makes no unnecessary incisions on the patient during a surgery, a good psychiatrist should ask no unnecessary questions during the interview. This does not mean that your interview be devoid of substance or empathy, but that you make every question //count//. Below is a template to guide you. The **Psychiatric Interview** involves a balance of being empathetic, asking the right questions, and thinking about the diagnostic criteria carefully for psychiatric disorders. Remember, everyone has a different way of interviewing,​ but every question you ask should have a //​purpose//​. Are you trying to elicit symptoms? Understand someone'​s life history? Understand their safety risks? Just as a good surgeon makes no unnecessary incisions on the patient during a surgery, a good psychiatrist should ask no unnecessary questions during the interview. This does not mean that your interview be devoid of substance or empathy, but that you make every question //count//. Below is a template to guide you.
- 
-== Tips == 
-  * Ask neutral questions early 
-  * Ask "​threatening/​challenging questions"​ later: psychotic symptoms, suicide/​homicide,​ substance use history, cognitive testing 
-  * Be careful of using leading questions and piggybacking multiple symptoms along. (e.g. - "​How'​s your sleep, appetite, and mood?"​) 
 </​WRAP>​ </​WRAP>​
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 <​HTML>​ <​HTML>​
 <div id="​amazon">​ <div id="​amazon">​
-<div class="​ribbon"><​i class="​fa fa-star"></​i>​ Recommended Reading</​div>​ +<div class="​ribbon"><​i class="​fa fa-star"></​i>​ Recommended Reading</​div><​a href="​https://​amzn.to/3SENRC6" target="​_blank"><​img ​style="​max-width:​ 50%" ​border="​0"​ src=" 
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 </p> </p>
 <​small>​ <​small>​
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-== Subspecialty ​== +==== General Tips ==== 
-<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:geriatric-psych-interview]]** and **[[teaching:child-adol-psych-interview]]**</alert>+<WRAP group> 
 +<WRAP half column>​ 
 +  * Ask neutral questions early (e.g. - age, workplace, medical history, medications) 
 +  * Ask "​threatening/​challenging" ​questions later (e.g. psychotic symptoms, suicide/​homicidal thoughts, substance use, trauma, [[:​cognitive-testing|cognitive testing]] questions) 
 +  * Be careful of using leading questions and piggybacking multiple symptoms along. (e.g. "​How'​s your sleep, appetite, and mood?";​ ask each individual item separately) 
 +  * Remember, the one of the main goals of the interview is generate a diagnosis: you have one brain, and you can only have so many diseases/​diagnoses going on at the same time. 
 +    * [[https://​en.wikipedia.org/​wiki/​Occam%27s_razor|Occam'​s Razor]] should be in the back of your mind. 
 +  * It is always a good idea to have a balance of open-ended and close-end questions. This allows you to have some balanced of control over the interview. 
 +    * Open-ended questions are questions that cannot be answered with a simple "​yes"​ or "​no"​ response (e.g. - "Tell me about your childhood."​) 
 +    * Closed-ended questions can be answered from multiple choices or a "​yes"​ or "​no"​ response (e.g. - "On a scale of 1 to 10, how would you rate your mood?"​) 
 +</​WRAP>​ 
 +<WRAP half column>​ 
 +<callout title="​Emergency Room Interviewing Tips" icon="​true" type="danger"> 
 +For patients in crisis: 
 +  ​Avoid using reflexive words/​phrases like "​OK"​ or "I understand..."​ in the ER. 
 +    ​They may tell you "​It'​s not OK!" (because it really isn't "​OK"​ for them right now), or tell you "No, you don't understand!"​ (because you really don't //​actually//​ understand everything that is happening. How could you? You just met them today!) 
 +    * Watch out for these verbal "​tics"​! 
 +  * Try to instead address the elephant in the room (//the affect//): 
 +    * e.g. "I can see you are very upset/very angry/​pissed off, etc..."​ 
 +  * Or be radically honest: 
 +    * e.g. "I can't even pretend to understand what you're going through right now, but I will do my best to listen and //try// to understand."​ 
 +  ​Other questions to consider asking: 
 +    ​"Why here, and why now?" (the reason they came to the ER or reason for the crisis event) 
 +    ​"What can we do for you? What were you hoping we could do for you?"​ 
 +    ​Acknowledge that the ER may not be a time to be making major life decisions: 
 +      * e.g. "Not making a decision is also a decision in and of itself."​ 
 +    ​Show empathy! 
 +    ​Identify your patient'​s strengths and coping skills throughout the interview 
 +</​callout>​ 
 +</​WRAP>​ 
 +</WRAP>
  
 +
 +==== Subspecialty ====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See also: **[[teaching:​geriatric-psych-interview]]** and **[[teaching:​child-adol-psych-interview]]**</​alert>​
 +If assessing a child, adolescent, or older adult, the interview and assessment will be significantly different. See the pages above.
 ===== Patient ID ===== ===== Patient ID =====
-Ask pertinent social history upfront: this allows you to frame the interview and know your patient'​s social situation. ​+Ask the pertinent social history upfront: this allows you to frame the interview and understand ​your patient'​s social situation. ​
 <WRAP col2> <WRAP col2>
   * Name   * Name
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-== Approaching the HPI == 
   * Start with close ended questions, do not ask leading questions. Make them direct!   * Start with close ended questions, do not ask leading questions. Make them direct!
   * Who brought you here? Who sent you here?   * Who brought you here? Who sent you here?
-  * Allow your patients to tell you the story. Doctors have a bad habit of interrupting patients.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC1490080/​|Dyche,​ L., & Swiderski, D. (2005). The effect of physician solicitation approaches on ability to identify patient concerns. Journal of general internal medicine, 20(3), 267-270.]])]+  * Allow your patients to tell you the story. Doctors have a bad habit of interrupting patients ​within the first few minutes of meeting a patient.[([[https://​www.ncbi.nlm.nih.gov/​pmc/​articles/​PMC1490080/​|Dyche,​ L., & Swiderski, D. (2005). The effect of physician solicitation approaches on ability to identify patient concerns. Journal of general internal medicine, 20(3), 267-270.]])]
   * You should focus on their symptoms for the past month (and up to 1 year if necessary)   * You should focus on their symptoms for the past month (and up to 1 year if necessary)
     * Anything further in the past should be considered as past psychiatric history     * Anything further in the past should be considered as past psychiatric history
 </​WRAP>​ </​WRAP>​
 <WRAP half column> <WRAP half column>
-== Chronology of events ==+<callout type="​tip"​ title="​Always Establish the Chronology of Events"​ icon="​true">​
 Timing is everything. Use these questions to help you get a sense of the timeline: Timing is everything. Use these questions to help you get a sense of the timeline:
   * "How do you feel now?", "How do you feel compared to your well self?",​ "When did you last feel '​normal/​well'?"​   * "How do you feel now?", "How do you feel compared to your well self?",​ "When did you last feel '​normal/​well'?"​
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   * Are there any acute stressors presently?   * Are there any acute stressors presently?
   * What are their coping strategies?   * What are their coping strategies?
 +</​callout>​
 </​WRAP>​ </​WRAP>​
 </​WRAP>​ </​WRAP>​
-== Depression ==+ 
 +==== The Psychiatric Review of Systems ==== 
 +  * Key questions on a psychiatric review of systems includes asking questions about [[mood:​home|mood]] (both depression and [[bipolar:​home|mania]]),​ [[sleep:​home|sleep]],​ [[anxiety:​home|anxiety]],​ [[psychosis:​home|psychosis]],​ [[ocd:​home|obsessions and compulsions]],​ [[dissociative-disorders:​home|dissociative symptoms]], [[trauma-and-stressors:​home|trauma history]], [[ocd:​body-dysmorphic|body image disturbances]],​ [[eating-disorders:​home|eating disorders]],​ and [[somatic:​home|somatic]]/​[[pain-medicine:​home|pain disorders]]. 
 +  * It will be difficult to get through all these areas in a one-time assessment, and the clinician should use their clinical judgment to determine which questions will be the most helpful and high yield. 
 +  * An example of a relatively comprehensive psychiatric review of systems is detailed below, but is by no means exhaustive. Some individuals early on may find using a checklist helpful to keep themselves organized. 
 +==== Depression ==== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​ 
 +See also main articles: **[[mood:​1-depression:​home|]]**,​ **[[trauma-and-stressors:​home|]]**,​ **[[ocd:​body-dysmorphic|]]**,​ and **[[eating-disorders:​home|]]** 
 +</​alert>​ 
 +<WRAP group> 
 +<WRAP half column>
   * **Mood**   * **Mood**
     * "Tell me about your mood right now," "​How'​s your mood right now?"     * "Tell me about your mood right now," "​How'​s your mood right now?"
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     * When someone says they are "​depressed,"​ it is important to clarify what they mean by that, don't just take it at face value     * When someone says they are "​depressed,"​ it is important to clarify what they mean by that, don't just take it at face value
     * If someone says they'​ve "​always been depressed,"​ try to get them to describe what their earliest memory of being depressed was like     * If someone says they'​ve "​always been depressed,"​ try to get them to describe what their earliest memory of being depressed was like
 +</​WRAP>​
 +<WRAP half column>
 +<callout type="​tip"​ title="​Substance-induced mood/​anxiety disorder?"​ icon="​true">​
 +When there is concomitant substance use in the context of mood symptoms, ask specifically:​ did the mood symptoms appear //before//, or //after// the substance use started? Substance use can masquerade as a depression or anxiety disorder ([[mood:​substance-medication|substance-induced mood disorder]] or [[anxiety:​substance-medication|substance-induced anxiety disorder]]).
 +</​callout>​
  
-<callout type="​tip"​ title="​Substance-induced mood disorder?"​ icon="​true"​>When there is concomitant substance use in the context of mood symptoms, ask specifically:​ did the mood symptoms appear //before//, or //after// the substance use started?</callout+</WRAP> 
- +</WRAP
-== Neurovegetative Symptoms ==+"Now I'm going to ask you about some other symptoms people might feel when they'​re depressed.":​
 <WRAP col2> <WRAP col2>
-"I'm going to ask you about some symptoms when people feel depressed.+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" ​type="​success">​ 
- +See main article: **[[sleep:​1-introduction:​home|]]** 
-  * **Sleep**+</​alert>​ 
 +  * **[[sleep:​1-introduction:​home|Sleep]]**
     * Sleep is more than just good or bad, you need to ask specific questions about the nature of the sleep:     * Sleep is more than just good or bad, you need to ask specific questions about the nature of the sleep:
       * "Tell me about your sleep"       * "Tell me about your sleep"
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       * What time do you get up?       * What time do you get up?
       * Are there night time awakenings?       * Are there night time awakenings?
-      * Are you told you snore at night? ([[sleep:​breathing:​1-osa|]])+      * Are you told you snore at night? (think about [[sleep:​breathing:​1-osa|sleep apnea]], which can cause depressive symptoms) 
 +      * Do you ever experience nightmares? (could be a [[sleep:​home|sleep disorder]] or a [[trauma-and-stressors:​home|trauma disorder]])
   * **Interest** (Anhedonia)   * **Interest** (Anhedonia)
   * **Guilt**   * **Guilt**
   * **Energy**   * **Energy**
   * **Concentration**   * **Concentration**
-    * ADHD screen may be applicable here+    * [[child:​adhd|ADHD]] screen may be applicable here
   * **Appetite**   * **Appetite**
-    * Now may be a good time to ask about eating disorders (always ask, because patients do not volunteer eating disorder information!):​+    * Now may be a good time to ask about [[eating-disorders:​home|eating disorders]] ​(always ask, because patients do not always ​volunteer eating disorder information!):​
       * How much weight loss?       * How much weight loss?
       * What is their ideal weight?       * What is their ideal weight?
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       * Compensatory behaviour: medications,​ purging, laxatives, diuretics       * Compensatory behaviour: medications,​ purging, laxatives, diuretics
   * **Psychomotor Slowing**   * **Psychomotor Slowing**
-  * **Suicide** (leave this for later, unless your patient brings it up)+  * **[[teaching:​suicide-risk-assessment-sra|Suicide]]** (leave this for later, unless your patient brings it up)
 </​WRAP>​ </​WRAP>​
-== Anxiety == +==== Anxiety ​==== 
-  * Always ask about anxiety and depression at the same time since these symptoms often overlap and are "​co-morbid."​+<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: ​**[[anxiety:​gad|]]**</​alert>​ 
 +Always ask about anxiety and depression at the same time since these symptoms often overlap and are "​co-morbid." ​Key questions to ask include: 
 +  * Find your worry is difficult to control? 
 +  * Do you easily blanking out or have difficulty concentrating?​ 
 +  * Easily fatigued? 
 +  * Sleep changes (difficulty falling or staying asleep, or restless, unsatisfying sleep)? 
 +  * Feel keyed up, on edge, or restless? 
 +  * Feel irritable, or others comment on it? 
 +  * Experience muscle tension when you are worried? 
 +  * Would you describe yourself as a worrier? 
 +==== Mania ==== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[bipolar:​bipolar-i]] and [[bipolar:​bipolar-ii]]**</​alert>​
  
-== Mania == +<WRAP group> 
-<​WRAP ​col2+<​WRAP ​half column
-  ​* ​"Now I'm going to ask you about some symptoms when people feel the opposite of depressed."​+"Now I'm going to ask you about some symptoms when people feel the opposite of depressed."​
   * **Distractibility**   * **Distractibility**
      * "Found if easy to jump from one idea to another?"​ (more of a physical observation in the patient)      * "Found if easy to jump from one idea to another?"​ (more of a physical observation in the patient)
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       * "​Talking more rapidly?"​       * "​Talking more rapidly?"​
 </​WRAP>​ </​WRAP>​
-== Bipolar History ==+<WRAP half column>​ 
 +Key questions to ask about bipolar symptoms and course of illness: 
 +  * Do you spend most of your time feeling depressed or manic? 
 +  * Do you tend to get psychotic symptoms when you have depressive or manic symptoms? (think: either [[mood:​1-depression:​psychotic|depression with psychotic features]], or [[bipolar:​bipolar-i|mania]] with psychotic features) 
 +  * Was there a period of time (>2 weeks) where you did not feel depressed/​manic,​ but still had psychotic symptoms? (think [[psychosis:​schizoaffective|schizoaffective disorder]]) 
 +  * When was your first manic/​depressive episode? (The index event is important, this informs you: what is the natural history of the illness in the person? Do they tend to have a depressive or manic presentation?​) 
 In patients with a history of multiple manic and depressive episodes, it can often be overwhelming and not practical to ask about the course of each specific episode. It is useful to obtain in broad strokes the following details instead: In patients with a history of multiple manic and depressive episodes, it can often be overwhelming and not practical to ask about the course of each specific episode. It is useful to obtain in broad strokes the following details instead:
  
-<panel title="​Key ​features ​of a good bipolar disorder history" no-body="​true">​+<panel title="​Key ​Features ​of a Good Bipolar Disorder History" no-body="​true">​
 ^ Mania                         ^ Depression ​                        ^ ^ Mania                         ^ Depression ​                        ^
 | # of lifetime manic episodes ​ | # of lifetime depressive episodes ​ | | # of lifetime manic episodes ​ | # of lifetime depressive episodes ​ |
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 | Triggers/​precipitants ​        | Triggers/​precipitants ​             | | Triggers/​precipitants ​        | Triggers/​precipitants ​             |
 </​panel>​ </​panel>​
 +</​WRAP>​
 +</​WRAP>​
  
-Key questions to ask about bipolar symptoms and course of illness: 
-  * Do you spend most of your time feeling depressed or manic? 
-  * Do you tend to get psychotic symptoms when you have depressive or manic symptoms? 
-  * Was there a period of time (> 2 weeks) where you did not feel depressed/​manic,​ but still had psychotic symptoms? 
-  * When was your first manic/​depressive episode? (The index event is important, this informs you: what is the natural history of the illness in the person?) 
  
-== Psychosis ==+ 
 + 
 + 
 +==== Psychosis ==== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[psychosis:​schizophrenia-scz|]]**</​alert>​ 
 +<WRAP group> 
 +<WRAP half column>
   * "Do you ever feel things are not real?   * "Do you ever feel things are not real?
   * "Do you worry that people might be against you or after you?"   * "Do you worry that people might be against you or after you?"
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   * "Do you feel like there are special messages for you?"   * "Do you feel like there are special messages for you?"
   * Ask about hallucinations types, are they: auditory, visual, tactile, or olfactory? - this may indicate brain pathology or lesions!   * Ask about hallucinations types, are they: auditory, visual, tactile, or olfactory? - this may indicate brain pathology or lesions!
 +</​WRAP>​ 
 +<WRAP half column>
 <callout type="​tip"​ title="​Substance-induced psychosis?"​ icon="​true">​When there is concomitant substance use in the context of psychosis, ask specifically:​ did the psychotic symptoms appear //before//, or //after// the substance use started?</​callout>​ <callout type="​tip"​ title="​Substance-induced psychosis?"​ icon="​true">​When there is concomitant substance use in the context of psychosis, ask specifically:​ did the psychotic symptoms appear //before//, or //after// the substance use started?</​callout>​
 +</​WRAP>​
 +</​WRAP>​
 +==== Obsessions and Compulsions ====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​
 +See main article: **[[ocd:​1-ocd|]]**
 +</​alert>​
 +<WRAP group>
 +<WRAP half column>
 +Most individuals with OCD will have both obsessions and compulsions. High sensitivity screening questions and a good OCD history includes the following:
 +  - **Obsessions**:​ Do you ever get **//​intrusive//​** or **//​unwanted//​** thoughts, images, or impulses that repeatedly enter your mind, despite you trying to get rid of them?
 +    * e.g. - worries about dirt/germs, or thoughts of bad things happening
 +  - **Compulsions**:​ Do you ever feel **//​driven//​** to do certain things over and over again?
 +    * e.g. - repeatedly washing hands, cleaning, checking doors or work over and over, rearranging things to get it //just right//, or //repeating thoughts// in your mind to feel better?
 +  - **Does this waste significant time or cause problems in your life (//​Criterion B of DSM-5 criteria//​)?​**
 +    * e.g. - interfering with school, work, or seeing friends?
 +</​WRAP>​
 +<WRAP half column>
 +<callout type="​info"​ title="​The Relationship Between Obsessions and Compulsions"​ icon="​true">​
 +  * Compulsions are usually performed in //​response//​ to an obsession (e.g. - obsession about contamination -> compulsion of hand washing rituals; obsession about a situation being incorrect -> compulsion of repeating rituals until it feels "just right"​)
 +  * For individuals with OCD, compulsions reduce the distress triggered by the obsession, or prevent a feared event from occurring (e.g. - getting sick, hurting someone)
 +  * It is important to note that compulsions are //not// connected in a realistic way to the feared event (e.g. - arranging items in a certain colour to prevent harm to a loved one) or are significantly excessive (e.g. - washing hands for 30 minutes at a time due to fears of contamination)
 +  * Compulsions that are performed are not pleasurable! Rather, they allow the individual to experience relief from their anxiety or distress
 +</​callout>​
 +</​WRAP>​
 +</​WRAP>​
  
 ===== Safety ===== ===== Safety =====
-== Suicide ==+==== Suicide ==== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[teaching:​suicide-risk-assessment-sra|]]**</​alert>​
 <WRAP col2> <WRAP col2>
 **Asking the question** **Asking the question**
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   * What are the chronic, acute, and imminent risk factors that might lead to suicide?   * What are the chronic, acute, and imminent risk factors that might lead to suicide?
 </​WRAP>​ </​WRAP>​
-== Homicide ==+==== Homicide ==== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​ 
 +See main article: **[[teaching:​violence|]]** 
 +</​alert>​
   * Are there any threats to others due to psychotic symptoms?   * Are there any threats to others due to psychotic symptoms?
   * Are there any threats to specific individuals? ​   * Are there any threats to specific individuals? ​
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   * "If you saw [person they wanted to hurt] on the street, what would you do? Would you defend yourself? Would you want to hurt/kill them?"   * "If you saw [person they wanted to hurt] on the street, what would you do? Would you defend yourself? Would you want to hurt/kill them?"
  
-== Driving == +==== Driving ​==== 
-  * Are there any symptoms that cause dangerous driving? If patients have mania or psychosis, this is a critical safety question to ask +  * Are there any symptoms that cause dangerous driving? If patients have suicidal idea, homicidal ideation, ​maniaor psychosis, this is a critical safety question to ask 
-    * Has their license been revoked? +  * Has their license ​ever been revoked?
- +
-== The Psychiatric Review of Systems == +
-  * [[http://​www.aafp.org/​afp/​1998/​1101/​p1617.html|The Psychiatric Review of Symptoms: A Screening Tool for Family Physicians]]+
  
 ===== Medications ===== ===== Medications =====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main section: **[[:​meds|]]**</​alert>​
   * What medications are they on now?   * What medications are they on now?
   * Have they been on any psychiatric medications?​ Now? In the past? What doses?   * Have they been on any psychiatric medications?​ Now? In the past? What doses?
   * Are they using any supplements?​ (e.g. - anabolic steroids, vitamins, herbals)   * Are they using any supplements?​ (e.g. - anabolic steroids, vitamins, herbals)
 +    * Patients often forget about this, and it is important to prompt them. Certain supplements (e.g. - [[meds:​supplements:​st-johns-wort|St. John's wort]]) can have significant drug-drug interactions.
  
 == Allergies == == Allergies ==
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 ===== Substance Use History ===== ===== Substance Use History =====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main section: **[[addictions:​home|]]**</​alert>​
 <WRAP col2> <WRAP col2>
-  * Nicotine+  * **[[addictions:​nicotine-tobacco:​home|Tobacco/​Nicotine]]**
     * What age? How many packs per day? Ever use nicotine replacement therapy?     * What age? How many packs per day? Ever use nicotine replacement therapy?
-  * Opioids+  * **[[meds:​opioids:​home|Opioids]]**
     * What age? What kind? IV/PO? Naloxone?     * What age? What kind? IV/PO? Naloxone?
-  * Alcohol+  * **[[addictions:​alcohol:​home|Alcohol]]**
     * What age? How much? History of blackouts? Have you ever been a binge drinker? Alcohol withdrawal? Seizures?     * What age? How much? History of blackouts? Have you ever been a binge drinker? Alcohol withdrawal? Seizures?
     * This may be a good time to screen for alcohol use disorder (CAGE):     * This may be a good time to screen for alcohol use disorder (CAGE):
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       * "Have you ever felt bad or **guilty** about your drinking?"​       * "Have you ever felt bad or **guilty** about your drinking?"​
       * "Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (**eye-opener**)?"​       * "Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (**eye-opener**)?"​
-  * Cannabis+  * **[[addictions:​cannabis:​home|Cannabis]]**
     * What age? How much? What specific effects from the cannabis do they like or not like? Do they get paranoia?     * What age? How much? What specific effects from the cannabis do they like or not like? Do they get paranoia?
-  * Stimulants+  * **[[addictions:​stimulants:​home|Stimulants]]**
     * What age? How much? What effects?     * What age? How much? What effects?
-  * Benzos/Others+  * **[[addictions:​sedative-hypnotics:​home|Benzodiazepines/​Anxiolytics]]**/Others
     * What age? How much? What effects?     * What age? How much? What effects?
-  * Caffeine (this is important if your patient complains of anxiety!)+  * **[[addictions:​caffeine:​home|Caffeine]]** (this is important if your patient complains of anxiety!)
     * How much caffeine do they use? What time of day? How many cups?     * How much caffeine do they use? What time of day? How many cups?
 </​WRAP>​ </​WRAP>​
  
-<callout type="​tip"​ title="​Substance-induced ​psychiatric conditions?" icon="​true">​When there is substance use, always think about how it might affect an individual'​s ​mood (depression or mania), or if it might contribute to psychotic symptoms.</​callout>​ +<callout type="​tip"​ title="​Substance-induced ​Psychiatric Symptoms?" icon="​true">​When there is substance use, there can be a substance-induced [[mood:​substance-medication|mood]] ​(depression or mania), [[anxiety:​substance-medication|anxiety]], or [[psychosis:​substance-medication|psychosis]].</​callout>​
 ===== Past Medical History ===== ===== Past Medical History =====
-  ​* Any history of concussions or head injuries? +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main section: **[[cl:​home|]]**</​alert>​ 
-  * Hypothyroidism?+Various medical conditions can relate to psychiatric symptoms, and can also have medication interactions. In brief, you should always ask: 
 +  ​* Any history of [[cl:tbi|concussions or head injuries]]
 +  * Any history of [[neurology:​approach-seizures|seizures]]? 
 +  * [[cl:​thyroid-disorders|Thyroid disease or disorders]]?​ 
 +  * History of surgeries
  
 ===== Past Psychiatric History ===== ===== Past Psychiatric History =====
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 </​WRAP>​ </​WRAP>​
 ==== Trauma ==== ==== Trauma ====
-While obtaining your social history, this is a good time to touch lightly ​on any possible history of trauma. ​good open-ended question ​to ask is+<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main articles: **[[psychotherapy:​trauma|]]** and **[[teaching:​childhood-trauma-aces|]]**</​alert>​ 
 +While obtaining your social history, this is a good time to touch on any possible history of trauma. 
 +  * It is good to have a non-threatening opener, such as"​Stressful life experiences can affect your health, and it can be helpful for us as healthcare providers to understand this. You can skip these questions if you don't want to answer them, and they are non-mandatory."​
   * "Have you ever experienced anything in your life that you would consider traumatic?," ​   * "Have you ever experienced anything in your life that you would consider traumatic?," ​
   * Or more point-blank,​ "Have you ever experienced any physical, emotional, or sexual abuse?"​   * Or more point-blank,​ "Have you ever experienced any physical, emotional, or sexual abuse?"​
  
 ==== Personality Traits/​Disorders ==== ==== Personality Traits/​Disorders ====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main section: **[[:​personality|]]**</​alert>​
 This is a good time to screen for things like [[personality:​borderline|borderline personality disorder]]: This is a good time to screen for things like [[personality:​borderline|borderline personality disorder]]:
   * Ask about self-esteem,​ sense of self, impulsivity   * Ask about self-esteem,​ sense of self, impulsivity
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   * "Do you frequently feel empty inside?"​   * "Do you frequently feel empty inside?"​
   * "Do you ever harm yourself such as cutting or burning?"​   * "Do you ever harm yourself such as cutting or burning?"​
- 
   * Remember, you cannot diagnose someone with a personality disorder while they are having a primary mental disorder going on (e.g. - depression, psychosis, mania, etc.)   * Remember, you cannot diagnose someone with a personality disorder while they are having a primary mental disorder going on (e.g. - depression, psychosis, mania, etc.)
   * Being able to tease out personality disorders can help you differentiate between diagnoses (i.e. - cluster B traits vs. bipolar disorder)   * Being able to tease out personality disorders can help you differentiate between diagnoses (i.e. - cluster B traits vs. bipolar disorder)
- 
 ==== Legal/​Forensic History ==== ==== Legal/​Forensic History ====
   * "Any issues with the law? Or being in jail?"   * "Any issues with the law? Or being in jail?"
   * Past arrests, incarceration,​ court dates, murder, assault, violence?   * Past arrests, incarceration,​ court dates, murder, assault, violence?
  
-===== Interview ​Tips ===== + 
-  * Remember, the one of the goals of the interview is diagnosis: you have one brain, and you can only have so many disease/​diagnoses going on at the same time[[https://​en.wikipedia.org/​wiki/​Occam%27s_razor|Occam'​s Razor]] should ​be in the back of your mind. +===== Closing the Interview ===== 
-  * It is always ​good idea to have balance ​of open-ended and close-end questions. This allows you to have some balanced of control over the interview +  * Close with: 
-  * "​Did ​you have any thoughts on how we might be able to help you today?"​+    * "​Did ​you have any thoughts ​on how we might be able to help you today?"​ 
 +    * "Did we go through the main concerns that you hoped to talk about today?"​ 
 +    * Thank the patient for their time and sharing a "​snippet"​ of their life with you today 
 + 
 +===== Mental Status Examination (MSE) ===== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[teaching:mental-status-exam-mse|]]**</​alert>​ 
 + 
 +During the interview, you should ​pay attention to the mental status examination (MSE)The MSE is a systematic way of describing a patient'​s mental state at the time you were doing a psychiatric assessment. 
 + 
 + 
 + 
 +===== Diagnosis and Biopsychosocial Formulation ===== 
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main articles: **[[teaching:​2-diagnosis|]]** ​and **[[teaching:​biopsychosocial-case-formulation|]]**</​alert>​ 
 +Now that you have finished gathering information,​ the next steps will be to establish a diagnosis and to formulate the patient.
  
 ==== The Rule of Parsimony ===== ==== The Rule of Parsimony =====
 +<alert icon="​fa fa-arrow-circle-right fa-lg fa-fw" type="​success">​See main article: **[[teaching:​1-history-of-dsm|]]**</​alert>​
 Even though the DSM II was published in 1968 (!) the following excerpt is sage advice even (and especially) today. Even though the DSM II was published in 1968 (!) the following excerpt is sage advice even (and especially) today.
  
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 </​callout>​ </​callout>​
  
-==== Emergency Interview ==== + 
-<callout title="​ER Interviewing Tips" type="​danger">​ +
-  * Avoid using "​OK"​… Your patients in crisis may tell you "​it'​s not OK!" Watch out for these verbal tics! +
-  * Address the elephant in the room, //the affect// +
-    * "I can see you are very irritable/​very upset/very angry/​pissed off, etc."​ +
-  * Identify your patients strengths and coping skills throughout the interview +
-  * Show empathy! +
-  * Ask: why here, and why now? +
-  * What can we do for you? What were you hoping we could do for you +
-  * The ER is not the time to be making major life decisions, tell your patient: **"Not making is a decision is also a decision in and of itself."​** +
-</​callout>​+
  
 ===== Resources ===== ===== Resources =====
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 <WRAP half column> <WRAP half column>
 == Books == == Books ==
-  * [[https://​amzn.to/​3cUV2yO|Systematic Psychiatric Evaluation: A Step-By-Step Guide to Applying ​the Perspectives of Psychiatry]] +  * [[https://​amzn.to/​3uFO9Lh|Systematic Psychiatric Evaluation: A Step-by-Step Guide to Applying ​The Perspectives of Psychiatry]] 
-  * [[https://​amzn.to/​3eer4Gd|Psychiatric Interviewing:​ The Art of Understanding]] +  * [[https://​amzn.to/​3soF9bl|Essentials of Psychiatric Diagnosis, ​Revised Edition: Responding to the Challenge of DSM-5® ​Revised Edition]]
-  * [[https://​amzn.to/​2LX5Ctb|Essentials of Psychiatric Diagnosis, Revised Edition]]+
 </​WRAP>​ </​WRAP>​
 +
 <WRAP half column> <WRAP half column>
 == For Clinicians == == For Clinicians ==
   * [[https://​pro.psychcentral.com/​14-tips-for-the-diagnostic-interview-of-mental-disorders/​|14 Tips for the Diagnostic Interview of Mental Disorders - Dr. Allen Frances]]   * [[https://​pro.psychcentral.com/​14-tips-for-the-diagnostic-interview-of-mental-disorders/​|14 Tips for the Diagnostic Interview of Mental Disorders - Dr. Allen Frances]]
   * [[http://​www.mariayang.org/​2017/​12/​10/​the-social-history/​|Maria Yang: The Social History]]   * [[http://​www.mariayang.org/​2017/​12/​10/​the-social-history/​|Maria Yang: The Social History]]
-  * http://​www.opensourcepsychiatry.com/​psychiatric-interview.html 
   * [[https://​www.brown.edu/​Courses/​BI_278/​Other/​Teaching%20examples/​biomed-370/​articles/​hx_and_ms.pdf|R.S. Manley. Psychiatric Interview, History, and Mental Status Examination. Chapter 7.1]]   * [[https://​www.brown.edu/​Courses/​BI_278/​Other/​Teaching%20examples/​biomed-370/​articles/​hx_and_ms.pdf|R.S. Manley. Psychiatric Interview, History, and Mental Status Examination. Chapter 7.1]]
   * [[http://​thehub.utoronto.ca/​psychiatry/​|The Hub (Psychiatry)]]   * [[http://​thehub.utoronto.ca/​psychiatry/​|The Hub (Psychiatry)]]
-  * [[http://​gen.lib.rus.ec/​|Free Textbook Search (Shh...)]] 
   * [[http://​guides.library.utoronto.ca/​psychiatry|Psychiatry:​ a Resource Guide for Residents and Researchers]]   * [[http://​guides.library.utoronto.ca/​psychiatry|Psychiatry:​ a Resource Guide for Residents and Researchers]]
-  * [[http://​www.psychiatry.utoronto.ca/​on-call-resource/​|University of Toronto: On Call Resources]] +</​WRAP>​ 
-</​WRAP></​WRAP>​+</​WRAP>​ 
 {{tag>​interview}} {{tag>​interview}}