The Psychiatric Interview - Carlat (notes) Questions and Answers

The Psychiatric Interview - Carlat (notes) Questions and Answers what are the 4 tasks of the interview? - Ans:-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? - Ans:-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? - Ans:-to figure out treatment not to figure out a dx. what percentage drop out of tx brute they're 4th visit? - Ans:-50% ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/72 what is the most important part of the interview? - Ans:-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 - Ans:-opening: 5-10 min body: 30-40 min closing: 5-10 min explain what the 3 phases of the interview - Ans:-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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/72 - if have time: social/developmental Hx, PMHx, psych ROS closing: - discuss assessment (w/ pt education) - negotiated tx plan what to put in your office - Ans:-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 - Ans:-- 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. ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/72 - 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 - Ans:-- 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 ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/72 techniques to make the patient comfortable - Ans:-- 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 woul