CLINICAL INTERVIEW Gemah Nuripah Two interview style l

CLINICAL INTERVIEW Gemah Nuripah

Two interview style : l Insight-oriented (psychodynamic) l Symptom-oriented (descriptive)

Insight-oriented (psychodynamic) l Infantile conflicts become chronic pathogens of the mind that interfere with the patien’s action, distort his perception, and lead to symptoms, maladjustied behavior and suffering. l Identify defense mechanisms l Discussion of patient’s conflicts l Goal : Psychodynamic formulation

Symptom-oriented (descriptive) l Psychiatric disorders manifest themselves in a characteristic set of signs, symptoms and behavior. l The goal is to classify the patient’s complains and dysfunctions according to defined diagnostic categories (Axis I-V) predict prognosis and treatment. l Methode : observe the patient’s behavior/ translates patient’s perception into symptom and sign.

FOUR COMPONENTS OF INTERVIEW l Rapport : how the interviewer and her patient relate. l Technique : insight oriented / descriptive l Mental status : patient’s general state of mind while interviewer talk to him. l Diagnosing : psychodinamic formulation / criteria diagnostic.

THREE PHASE OF INTERVIEW l Opening phase : warms up the patients, established rapport, prepare the patient for the main task of interview. l Middle phase : longest time, to emphasize the shift of interviewing goals. l End phase : closure, avoid highly emotional topics, summarize for the patient what has been learned and provide an outlook for the future.

STRATEGIES FOR RAPPORT l Put your patient and yourself at ease l Find the suffering – show compassion l Assess insight – become an ally l Show expertise l Establish leadership l Balance the role

Put your patient and yourself at ease l First goal is simply to get a sense of the patient, initiate rapport, not to arrive at an immediate diagnosis. l Recognize signs (territorial, behavioral, emotional, verbal). l Respond to sign.

Find the suffering – show compassion l Assess the suffering : “What is bothering you? ” “How did that make you feel? ” l Respond with empathy : “You must be awful. ” “I can see how that shook you up. ”

Assess insight – become an ally Level insight : l Full insight : patient who describes his psychiatric symptom as a result of a disorder. l Partial insight : Lack of awareness of being sick, deny the impact of their illness. l No insight : complete denial that he suffers from any illness.

Show expertise l Put the illness into perspective l Show knowledge l Deal with doubt l Instill hope

Establish leadership l Taking control of your interaction with him. l Express interest in his welfare. l Motivate him to change.

Balance the role l 1. 2. 3. Roles of interviewer : The empathic listener The expert The authority Roles of the patients : Carrier of an illness The sufferer The “VIP”

PATIENT’S IDENTITY l Name : What is your name ? l Age : How old are you ? l Education : Tell me about your education background l Marital status : Are you married ? l Occupation : What do you do for living? l Residence : Where do you live ? l Religion : Do you commited to a certain religion ?

CHIEF COMPLAINT How can I help you? HISTORY OF PRESENT ILLNESS The date of onset Since when this things happened? Whether the onset was sudden or insidious Did this thing happen suddenly or gradually? The precipitating factor Was there any special event which bothering you before all these things happened?

Emotional changes Is there any changes in your mood? Behaviour changes Is there any changes in your behaviour? Somatic symptoms Do you have any physical complains (such as pain, tinnitus, blurring of vision, palpitation, excessive sweating, dry mouth, fatigue, or difficulty in swallowing)?

Vegetative symptoms Is there any changes in your sleep, appetite, body weight, urination, libido, menses? Cognitive symptoms Do you have any problem with concentration? Patient’s functioning Do you still doing your tasks as usual? Do you have any problem with personal hygiene? How involved are you with the social life around you?

Assess the patient’s orientation to : l Time : Can you tell me what is today’s date? (the day, month, year) l Place : What is the name of the place that we are in now? l Person : Do you know who is ……………. …… ?

Assess the patient’s memory 1. Immediate memory Now I will mention three objects. Please repeat them after I have mentioned them. (mention 3 different object and let the patient repeat them) 2. Recent memory How did you come to this place? 3. Remote memory Where do you live when you were a kid?

Assess the patient’s thought : l Obsession Have you ever been bothered by certain thoughts or images that came into your mind over and over even thought you tried to ignore or stop them? l Phobia l Social phobia Have you ever been so afraid of embarrasing yourself in public that you would not do certain things most people do, like eating in restaurant, using a public restroom, or speaking out in a room full of people?

l Simple phobia Have you ever been much more afraid of things that the average person is not afraid of? like flying, heights, small animals, receiving an injection, or seeing blood, so you prefer to avoid such things? l Somatic complaint Is there any problem with your physical health which the doctors cannot explained? l Suicide idea Have you had any thoughts about ending your life?

Assess the patient’s mood How is your mood? If the patient cannot describes his / her mood spontaneously, ask : Depressive Do you feel depressed, sad or unhappy? If the answer is no, ask: Do you lost your interest or pleasure?

Anxious Do you feel worried, nervous, anxious or tense? Panic attack Have you ever had sudden spells or attacks of nervousness, panic, or a strong fear that just seems to come over you all of sudden, or for no particular reason? Euphoric Do you feel high or excited? Irritable Do you get angry easily?

l Assess the patient’s insight of illness : Would you say that you had a psychiatric or mental problem?

Assess the patient’s psychomotor behaviour: l Compulsion Have you ever felt you had to repeat certain act over and over even thought it did not make much sense, like hand washing, ordering, checking or counting?

OBSERVATION Observe the patient’s appearance: face feature, nutritional status, body type, hygiene, clothes, eye contact Observe the patient’s consciousness Observe the patient’s affect Observe the patient’s attention Observe the patient’s psychomotor behaviour: posture, movements

l CLOSING According to interview and examination I conclude that you suffer from distress and you need take medications, and I’ll give a prescription for a week. Would you come again next week?

Clinical interview of psychiatric disorders

Assess the patient’s perception l Auditory hallucination Do you sometimes hear things that others don’t hear? l Visual hallucination Do you sometimes have “visions” or see things that others don’t see?

l Olfactory hallucination Do you sometimes smell things that are unusual or that others don’t smell? l Gustatory hallucination Do you sometimes taste things that are unusual? l Tactile hallucination Do you sometimes feel any strange or unusual sensation in your skin?

Assess the patient’s thought : Paranoid delusions : l Delusion of persecution Does anyone ever spy on you or plot against you? l Delusion of reference Did it ever seem that people were talking about you or taking special notice of you?

l Delusion of grandeur Do you have talents or abilities that other people don’t have? l Delusion of self accusation Do you bothered by guilt feeling about something you may have done in the past that deserve punishment?

l Delusion of control Do you believe there is something control you ? l Somatic delusion Is there any problem with your physical health which the doctors cannot explained?

Thought withdrawal l Are your thoughts ever taken out of your head ? Thought insertion l Are thoughts that were not your own ever put into your head ?

Thought broadcasting l Do you sometimes feel as if your thoughts were being broadcast out loud so that other people could actually hear what you were thinking? Thought control l Do you sometimes feel that someone or something outside yourself controls your thoughts or action againts your will?