Test Bank For The Psychiatric Interview 4th Edition Carlat |
9781496327710
what are the 4 tasks of the interview? - ANSWER: build an alliance
obtain the Psychiatric database (hx relevant to their presentation today, PHx, Fhx, PMHx etc)
interview for dx
negotiate a tx plan
what is our intitaly first job? how do we do this? - ANSWER: to ease their suffering, this is before
making a dx. all our pts are suffering, you have to address this first.
how: depression is different for everybody and may present with different sxs. For a 24 y/o college
graduate who has been floundering around, may just need help clarifying her goals. this is what we
can help them do in their first visit. spend most of this first visit thinking about their lives and not their
dx. this alone is an alliance booster, just be sure to ask about their life and that starts it all.
what is the overall goal of the interview? - ANSWER: to figure out treatment not to figure out a dx.
what percentage drop out of tx brute they're 4th visit? - ANSWER: 50%
what is the most important part of the interview? - ANSWER: negotiating a tx plan. if they don't feel
comfortable with it then the interview might as well not have been done.
length of time for the 3 phases of the interview - ANSWER: opening: 5-10 min
body: 30-40 min
closing: 5-10 min
explain what the 3 phases of the interview - ANSWER: intro:
- learn about their life
- give a few minutes to tell why they came
body:
- est. interviewing priorities
- HPI
- Hx of depression, SI, substance abuse
- FHx
- determine whether they meet criteria
- if have time: social/developmental Hx, PMHx, psych ROS
closing:
- discuss assessment (w/ pt education)
- negotiated tx plan
what to put in your office - ANSWER: make it homie: photos of family, plants, decorations on wall
arrange seating: put clock easy for you to see ( just behind pt)
guidelines for patient contact - ANSWER: - never give home or cell phone number
- if giving a contract number specify times they may call you
- instruct what to do in emergency when you can't be contacted
- leave a voicemail system for them to call and let them know if it's emergent you'll call back within 24
hrs
- sign pts out to another clinician when you're on vacation and inform him of more severe pts or
chronically suicidal pts. change voicemail to have instruction to contact this clinician.
,- use email but this too needs ground rules (limit to scheduling needs and refills, anything more has to
be added to their EMR).
- for HIPPA add note saying: "please be aware that email communication can be intercepted in
transmission or misdirected. your use of email to communicate protected health information to us
indicate that you acknowledge and accept the possible risks associated with such communication.
please consider communicating any sensitive information by telephone, fax, or mail. if you do not
wish to have your information sent by email, please contact the street immediately."
- get pts number and email. ask if it's okay to identify yourself when you call because some people
don't want family or employers knowing they're in tx. hey contact info for energy contact people,
need consent before doing this.
rapport building techniques - ANSWER: - empathic or sympathetic statements: "you must have felt
Truckee when she left you". communicate your average and understanding of painful emotions. but
don't over use them.
- direct feeling questions: "how did you feel when she left you?"
- reflective statements: "you sound dad when you talk about her". don't overuse because it sounds
like you're stating the obvious.
- if you notice countertransference happening, see them as psychopathology and develop compassion
for them on that basis first
techniques to make the patient comfortable - ANSWER: - greet naturally: introduce yourself and make
small talk for a minute (unless in emotional distress)
- ask what they wanna be called and use their name a few times during the interview
- learn something about them so they're more comfortable sharing about themselves: "before we get
into what brought you here, if like to know a little about you as a person, where you live, what you
do, that sort of thing."
- explain what will happen in the interview: many think they're just here for psychotherapy. start by
asking if they know why they're here and then give your explanation (length of interview, what info
you'll be asking about, and follow up going forward).
- then give them 5 minutes of free speech to explain what is going on. Ask them to explain the most
troubling symptoms first and go from there. if they're giving you articulate info let them keep going
but if they aren't you have to cut them off and direct the interview more but give them the inital 5
minutes.
- after this make a goal with your patient by asking them: what would make this visit the most helpful
for you today, what would you like to get it of it?
-- if they're reluctant ask the miracle scenario: "imagine that tonight you go to bed, like you normally
do. Then, imagine that while you're asleep, a miracle happens and your depression (or whatever
problem) goes away. what will your day be like tomorrow?"
techniques to help the pt elicit sensitive material - ANSWER: Most common - normalization: normalize
it by introducing your question with a normalizing statement, 2 ways to do this:
- start question by implying the behavior is normal or understandable response to mood or situation:
"With all the stress you've been under, I wonder if you've been drinking more lately?" or "Sometimes
when people are very depressed, they think of hurting themselves. Has this been true for you?"
- describe another pt who has had this behavior to show your pt they're not alone: "I've seen a
number of pts who've told me that their anxiety causes them to avoid doing things, like driving on the
highway or going to the grocery store. Has that been true for you?"
Note: do not normalize severely abnormal behaviors such as extreme violence or sexual abuse.
Others:
- symptom expectation: aka gentle assumption. you infer that a behavior is expected by stating your
question implying you assume the pt is having some behavior and you won't be offended with a
positive response. Especially good if suspect self destructive activity like drug use or suicide. Ex: "what
sorts of drugs do you usually use when you're drinking?" or "what kinds of ways to hurt yourself have
you thought about?"
, Note: only use this when you suspect behavior, don't be asking every 70 y/o women what drugs
they're using.
- symptom exaggeration: often used with sx expectation helps clarify severity of sxs. You suggest a
frequency of a behavior that is higher than you expectation, then their lower frequency will seem not
as bad. Ex: "How often do you binge and purge each day? 5 times, 10 times?"
Note: again only do this when appropriate for the pt and only if you suspect they're already doing the
behavior.
- Reduction of guilt: begin by asking about other people (have they had friends involved in these
situations etc)
-- for domestic viol
Terms to use to be more familiar with your pts - ANSWER: Instead of = say
- Do you have a hx of IV drug use? = Have you ever shot up?
- do you smoke marijuana? = do you get high/smoke dope?
- do you use cocaine? = do you snort or smoke coke?
Note: using these terms increases honesty by 15%
Tips to improve pt recall (accurate memories) - ANSWER: Anchor Qs to memorable events: pts forget
dates of events that occurred more than 10 days in the past. We remember events in relation to
memorable events (graduations, birthdays, holidays, accidents, major purchases, seasonal events or
public events [elections]). So instead of asking how many years ago they began drinking, ask "Did you
drink when you graduated from high school?" Then just keep on going back in time in relation to
events to see when it began and if sxs began prior for example.
Tag Qs with specific examples: tag a list of examples onto the end of your question "what were the
names of the medications you took back then? was it proxac, paxil, Zoloft, Elavil etc?
Define technical terms: sometimes pts just don't understand terms you use. ex: you ask a pt when
they first felt depressed, they say they always have been depressed. You explain what clinical
depression is (seriously affects functioning), when did you first experience that? they respond with 1
month ago.
Tips for transitioning in the interview - ANSWER: smooth transition: cue off something the pt just said
to introduce a new topic
- "John has been good to me, but I can't stand the way his daughters expect me to go out of my way
to make their lives easy; after all, they're adults!" respond with "speaking of family, has anyone else in
your family been through the kind of depression you've been going through?"
Referred transition: refer to something the pt said earlier in the interview to move to a new topic.
- "My doctor tried me on some medication for a while but it didn't do much good." respond with
"Earlier, you mentioned that you didn't know how much more of this you could take. Have you had
the thought that you'd be better off dead?"
Introduced transition: introduce the next topic or series of topics before actually going into it.
- "now I'd like to switch gears and ask about different psychological symptoms people sometimes
have. Many of these may not apply to you at all, and that's a useful thing to know in itself"
Techniques for the reluctant pt vs talkative pt - ANSWER: reluctant:
- use open ended Qs
- use continuation techniques: "go on", "uh huh", "continue with what you were saying about...",
"really?", "wow." these are combined with positive body language showing active listening
9781496327710
what are the 4 tasks of the interview? - ANSWER: build an alliance
obtain the Psychiatric database (hx relevant to their presentation today, PHx, Fhx, PMHx etc)
interview for dx
negotiate a tx plan
what is our intitaly first job? how do we do this? - ANSWER: to ease their suffering, this is before
making a dx. all our pts are suffering, you have to address this first.
how: depression is different for everybody and may present with different sxs. For a 24 y/o college
graduate who has been floundering around, may just need help clarifying her goals. this is what we
can help them do in their first visit. spend most of this first visit thinking about their lives and not their
dx. this alone is an alliance booster, just be sure to ask about their life and that starts it all.
what is the overall goal of the interview? - ANSWER: to figure out treatment not to figure out a dx.
what percentage drop out of tx brute they're 4th visit? - ANSWER: 50%
what is the most important part of the interview? - ANSWER: negotiating a tx plan. if they don't feel
comfortable with it then the interview might as well not have been done.
length of time for the 3 phases of the interview - ANSWER: opening: 5-10 min
body: 30-40 min
closing: 5-10 min
explain what the 3 phases of the interview - ANSWER: intro:
- learn about their life
- give a few minutes to tell why they came
body:
- est. interviewing priorities
- HPI
- Hx of depression, SI, substance abuse
- FHx
- determine whether they meet criteria
- if have time: social/developmental Hx, PMHx, psych ROS
closing:
- discuss assessment (w/ pt education)
- negotiated tx plan
what to put in your office - ANSWER: make it homie: photos of family, plants, decorations on wall
arrange seating: put clock easy for you to see ( just behind pt)
guidelines for patient contact - ANSWER: - never give home or cell phone number
- if giving a contract number specify times they may call you
- instruct what to do in emergency when you can't be contacted
- leave a voicemail system for them to call and let them know if it's emergent you'll call back within 24
hrs
- sign pts out to another clinician when you're on vacation and inform him of more severe pts or
chronically suicidal pts. change voicemail to have instruction to contact this clinician.
,- use email but this too needs ground rules (limit to scheduling needs and refills, anything more has to
be added to their EMR).
- for HIPPA add note saying: "please be aware that email communication can be intercepted in
transmission or misdirected. your use of email to communicate protected health information to us
indicate that you acknowledge and accept the possible risks associated with such communication.
please consider communicating any sensitive information by telephone, fax, or mail. if you do not
wish to have your information sent by email, please contact the street immediately."
- get pts number and email. ask if it's okay to identify yourself when you call because some people
don't want family or employers knowing they're in tx. hey contact info for energy contact people,
need consent before doing this.
rapport building techniques - ANSWER: - empathic or sympathetic statements: "you must have felt
Truckee when she left you". communicate your average and understanding of painful emotions. but
don't over use them.
- direct feeling questions: "how did you feel when she left you?"
- reflective statements: "you sound dad when you talk about her". don't overuse because it sounds
like you're stating the obvious.
- if you notice countertransference happening, see them as psychopathology and develop compassion
for them on that basis first
techniques to make the patient comfortable - ANSWER: - greet naturally: introduce yourself and make
small talk for a minute (unless in emotional distress)
- ask what they wanna be called and use their name a few times during the interview
- learn something about them so they're more comfortable sharing about themselves: "before we get
into what brought you here, if like to know a little about you as a person, where you live, what you
do, that sort of thing."
- explain what will happen in the interview: many think they're just here for psychotherapy. start by
asking if they know why they're here and then give your explanation (length of interview, what info
you'll be asking about, and follow up going forward).
- then give them 5 minutes of free speech to explain what is going on. Ask them to explain the most
troubling symptoms first and go from there. if they're giving you articulate info let them keep going
but if they aren't you have to cut them off and direct the interview more but give them the inital 5
minutes.
- after this make a goal with your patient by asking them: what would make this visit the most helpful
for you today, what would you like to get it of it?
-- if they're reluctant ask the miracle scenario: "imagine that tonight you go to bed, like you normally
do. Then, imagine that while you're asleep, a miracle happens and your depression (or whatever
problem) goes away. what will your day be like tomorrow?"
techniques to help the pt elicit sensitive material - ANSWER: Most common - normalization: normalize
it by introducing your question with a normalizing statement, 2 ways to do this:
- start question by implying the behavior is normal or understandable response to mood or situation:
"With all the stress you've been under, I wonder if you've been drinking more lately?" or "Sometimes
when people are very depressed, they think of hurting themselves. Has this been true for you?"
- describe another pt who has had this behavior to show your pt they're not alone: "I've seen a
number of pts who've told me that their anxiety causes them to avoid doing things, like driving on the
highway or going to the grocery store. Has that been true for you?"
Note: do not normalize severely abnormal behaviors such as extreme violence or sexual abuse.
Others:
- symptom expectation: aka gentle assumption. you infer that a behavior is expected by stating your
question implying you assume the pt is having some behavior and you won't be offended with a
positive response. Especially good if suspect self destructive activity like drug use or suicide. Ex: "what
sorts of drugs do you usually use when you're drinking?" or "what kinds of ways to hurt yourself have
you thought about?"
, Note: only use this when you suspect behavior, don't be asking every 70 y/o women what drugs
they're using.
- symptom exaggeration: often used with sx expectation helps clarify severity of sxs. You suggest a
frequency of a behavior that is higher than you expectation, then their lower frequency will seem not
as bad. Ex: "How often do you binge and purge each day? 5 times, 10 times?"
Note: again only do this when appropriate for the pt and only if you suspect they're already doing the
behavior.
- Reduction of guilt: begin by asking about other people (have they had friends involved in these
situations etc)
-- for domestic viol
Terms to use to be more familiar with your pts - ANSWER: Instead of = say
- Do you have a hx of IV drug use? = Have you ever shot up?
- do you smoke marijuana? = do you get high/smoke dope?
- do you use cocaine? = do you snort or smoke coke?
Note: using these terms increases honesty by 15%
Tips to improve pt recall (accurate memories) - ANSWER: Anchor Qs to memorable events: pts forget
dates of events that occurred more than 10 days in the past. We remember events in relation to
memorable events (graduations, birthdays, holidays, accidents, major purchases, seasonal events or
public events [elections]). So instead of asking how many years ago they began drinking, ask "Did you
drink when you graduated from high school?" Then just keep on going back in time in relation to
events to see when it began and if sxs began prior for example.
Tag Qs with specific examples: tag a list of examples onto the end of your question "what were the
names of the medications you took back then? was it proxac, paxil, Zoloft, Elavil etc?
Define technical terms: sometimes pts just don't understand terms you use. ex: you ask a pt when
they first felt depressed, they say they always have been depressed. You explain what clinical
depression is (seriously affects functioning), when did you first experience that? they respond with 1
month ago.
Tips for transitioning in the interview - ANSWER: smooth transition: cue off something the pt just said
to introduce a new topic
- "John has been good to me, but I can't stand the way his daughters expect me to go out of my way
to make their lives easy; after all, they're adults!" respond with "speaking of family, has anyone else in
your family been through the kind of depression you've been going through?"
Referred transition: refer to something the pt said earlier in the interview to move to a new topic.
- "My doctor tried me on some medication for a while but it didn't do much good." respond with
"Earlier, you mentioned that you didn't know how much more of this you could take. Have you had
the thought that you'd be better off dead?"
Introduced transition: introduce the next topic or series of topics before actually going into it.
- "now I'd like to switch gears and ask about different psychological symptoms people sometimes
have. Many of these may not apply to you at all, and that's a useful thing to know in itself"
Techniques for the reluctant pt vs talkative pt - ANSWER: reluctant:
- use open ended Qs
- use continuation techniques: "go on", "uh huh", "continue with what you were saying about...",
"really?", "wow." these are combined with positive body language showing active listening
