The Psychiatric Interview - Carlat (notes)
Questions and answers.
what are the 4 tasks of the interview? - (correct answer) - build an alliance
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obtain the Psychiatric database (hx relevant to their presentation today, PHx, Fhx, PMHx etc)
hg hg hg hg hg hg hg hg hg hg hg hg hg
interview for dx hg hg
negotiate a tx plan hg hg hg
what is our intitaly first job? how do we do this? - (correct answer) -
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to ease their suffering, this is before making a dx. all our pts are suffering, you have to address this fir
hghg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
st.
how: depression is different for everybody and may present with different sxs. For a 24 y/
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
o college graduate who has been floundering around, may just need help clarifying her goals. this is w
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hat we can help them do in their first visit. spend most of this first visit thinking about their lives and n
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ot their dx. this alone is an alliance booster, just be sure to ask about their life and that starts it all.
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
what is the overall goal of the interview? - (correct answer) -
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to figure out treatment not to figure out a dx.
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what percentage drop out of tx brute they're 4th visit? - (correct answer) - 50%
hg hg hg hg hg hg hg hg hg hg hg hg hg hghg
what is the most important part of the interview? - (correct answer) -
hg hg hg hg hg hg hg hg hg hg hg hg
negotiating a tx plan. if they don't feel comfortable with it then the interview might as well not have
hghg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
been done. hg
length of time for the 3 phases of the interview - (correct answer) - opening: 5-10 min
hg hg hg hg hg hg hg hg hg hg hg hg hg hghg hg hg
body: 30-40 min hg hg
closing: 5-10 min hg hg
explain what the 3 phases of the interview - (correct answer) - intro:
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- learn about their life
hg hg hg hg
- give a few minutes to tell why they came
hg hg hg hg hg hg hg hg hg
,body: hg
- est. interviewing priorities
hg hg hg
- HPIhg
- Hx of depression, SI, substance abuse
hg hg hg hg hg hg
- FHxhg
- determine whether they meet criteria
hg hg hg hg hg
- if have time: social/developmental Hx, PMHx, psych ROS
hg hg hg hg hg hg hg hg
closing:
- discuss assessment (w/ pt education)
hg hg hg hg hg
- negotiated tx plan
hg hg hg
what to put in your office - (correct answer) -
hg hg hg hg hg hg hg hg hg
make it homie: photos of family, plants, decorations on wall
hghg hg hg hg hg hg hg hg hg hg
arrange seating: put clock easy for you to see ( just behind pt)
hg hg hg hg hg hg hg hg hg hg hg hg
guidelines for patient contact - (correct answer) - - never give home or cell phone number
hg hg hg hg hg hg hg hghg hg hg hg hg hg hg hg
- if giving a contract number specify times they may call you
hg hg hg hg hg hg hg hg hg hg hg
- instruct what to do in emergency when you can't be contacted
hg hg hg hg hg hg hg hg hg hg hg
-
leave a voicemail system for them to call and let them know if it's emergent you'll call back within 24
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
hrs
-
sign pts out to another clinician when you're on vacation and inform him of more severe pts or chroni
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
cally suicidal pts. change voicemail to have instruction to contact this clinician.
hg hg hg hg hg hg hg hg hg hg hg
-
use email but this too needs ground rules (limit to scheduling needs and refills, anything more has to
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
be added to their EMR).
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,-
for HIPPA add note saying: "please be aware that email communication can be intercepted in transmis
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
sion or misdirected. your use of email to communicate protected health information to us indicate tha
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
t you acknowledge and accept the possible risks associated with such communication. please consider
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communicating any sensitive information by telephone, fax, or mail. if you do not wish to have your in
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
formation sent by email, please contact the street immediately."
hg hg hg hg hg hg hg hg
-
get pts number and email. ask if it's okay to identify yourself when you call because some people don'
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
t want family or employers knowing they're in tx. hey contact info for energy contact people, need con
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
sent before doing this.
hg hg hg
rapport building techniques - (correct answer) - -
hg hg hg hg hg hg hghg
empathic or sympathetic statements: "you must have felt Truckee when she left you". communicate y
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
our average and understanding of painful emotions. but don't over use them.
hg hg hg hg hg hg hg hg hg hg hg hg
- direct feeling questions: "how did you feel when she left you?"
hg hg hg hg hg hg hg hg hg hg hg
-
reflective statements: "you sound dad when you talk about her". don't overuse because it sounds like
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
you're stating the obvious. hg hg hg
-
if you notice countertransference happening, see them as psychopathology and develop compassion f
hg hg hg hg hg hg hg hg hg hg hg hg hg
or them on that basis first
hg hg hg hg hg
techniques to make the patient comfortable - (correct answer) - -
hg hg hg hg hg hg hg hg hg hghg
greet naturally: introduce yourself and make small talk for a minute (unless in emotional distress)
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
- ask what they wanna be called and use their name a few times during the interview
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
-
learn something about them so they're more comfortable sharing about themselves: "before we get i
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
nto what brought you here, if like to know a little about you as a person, where you live, what you do,
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg h
that sort of thing."
g hg hg hg
-
explain what will happen in the interview: many think they're just here for psychotherapy. start by ask
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ing if they know why they're here and then give your explanation (length of interview, what info you'll
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
be asking about, and follow up going forward).
hg hg hg hg hg hg hg
-
then give them 5 minutes of free speech to explain what is going on. Ask them to explain the most tr
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
oubling symptoms first and go from there. if they're giving you articulate info let them keep going but i
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
, f they aren't you have to cut them off and direct the interview more but give them the inital 5 minutes
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
.
-
after this make a goal with your patient by asking them: what would make this visit the most helpful f
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
or you today, what would you like to get it of it?
hg hg hg hg hg hg hg hg hg hg hg
--
if they're reluctant ask the miracle scenario: "imagine that tonight you go to bed, like you normally do
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
. Then, imagine that while you're asleep, a miracle happens and your depression (or whatever problem
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
) goes away. what will your day be like tomorrow?"
hg hg hg hg hg hg hg hg hg
techniques to help the pt elicit sensitive material - (correct answer) - Most common -
hg hg hg hg hg hg hg hg hg hg hg hghg hg hg
normalization: normalize it by introducing your question with a normalizing statement, 2 ways to do t
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
his:
-
start question by implying the behavior is normal or understandable response to mood or situation: "
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
With all the stress you've been under, I wonder if you've been drinking more lately?" or "Sometimes w
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
hen people are very depressed, they think of hurting themselves. Has this been true for you?"
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
-
describe another pt who has had this behavior to show your pt they're not alone: "I've seen a number
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
of pts who've told me that their anxiety causes them to avoid doing things, like driving on the highwa
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
y or going to the grocery store. Has that been true for you?"
hg hg hg hg hg hg hg hg hg hg hg hg
Note: do not normalize severely abnormal behaviors such as extreme violence or sexual abuse.
hg hg hg hg hg hg hg hg hg hg hg hg hg hg
Others:
-
symptom expectation: aka gentle assumption. you infer that a behavior is expected by stating your qu
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
estion implying you assume the pt is having some behavior and you won't be offended with a positive
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
response. Especially good if suspect self destructive activity like drug use or suicide. Ex: "what sorts of
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
drugs do you usually use when you're drinking?" or "what kinds of ways to hurt yourself have you tho
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ught about?" hg
Note: only use this when you suspect behavior, don't be asking every 70 y/
hg hg hg hg hg hg hg hg hg hg hg hg hg
o women what drugs they're using.
hg hg hg hg hg hg
Questions and answers.
what are the 4 tasks of the interview? - (correct answer) - build an alliance
hg hg hg hg hg hg hg hg hg hg hg hghg hg hg
obtain the Psychiatric database (hx relevant to their presentation today, PHx, Fhx, PMHx etc)
hg hg hg hg hg hg hg hg hg hg hg hg hg
interview for dx hg hg
negotiate a tx plan hg hg hg
what is our intitaly first job? how do we do this? - (correct answer) -
hg hg hg hg hg hg hg hg hg hg hg hg hg hg
to ease their suffering, this is before making a dx. all our pts are suffering, you have to address this fir
hghg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
st.
how: depression is different for everybody and may present with different sxs. For a 24 y/
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
o college graduate who has been floundering around, may just need help clarifying her goals. this is w
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
hat we can help them do in their first visit. spend most of this first visit thinking about their lives and n
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ot their dx. this alone is an alliance booster, just be sure to ask about their life and that starts it all.
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
what is the overall goal of the interview? - (correct answer) -
hg hg hg hg hg hg hg hg hg hg hg
to figure out treatment not to figure out a dx.
hghg hg hg hg hg hg hg hg hg hg
what percentage drop out of tx brute they're 4th visit? - (correct answer) - 50%
hg hg hg hg hg hg hg hg hg hg hg hg hg hghg
what is the most important part of the interview? - (correct answer) -
hg hg hg hg hg hg hg hg hg hg hg hg
negotiating a tx plan. if they don't feel comfortable with it then the interview might as well not have
hghg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
been done. hg
length of time for the 3 phases of the interview - (correct answer) - opening: 5-10 min
hg hg hg hg hg hg hg hg hg hg hg hg hg hghg hg hg
body: 30-40 min hg hg
closing: 5-10 min hg hg
explain what the 3 phases of the interview - (correct answer) - intro:
hg hg hg hg hg hg hg hg hg hg hg hghg hg
- learn about their life
hg hg hg hg
- give a few minutes to tell why they came
hg hg hg hg hg hg hg hg hg
,body: hg
- est. interviewing priorities
hg hg hg
- HPIhg
- Hx of depression, SI, substance abuse
hg hg hg hg hg hg
- FHxhg
- determine whether they meet criteria
hg hg hg hg hg
- if have time: social/developmental Hx, PMHx, psych ROS
hg hg hg hg hg hg hg hg
closing:
- discuss assessment (w/ pt education)
hg hg hg hg hg
- negotiated tx plan
hg hg hg
what to put in your office - (correct answer) -
hg hg hg hg hg hg hg hg hg
make it homie: photos of family, plants, decorations on wall
hghg hg hg hg hg hg hg hg hg hg
arrange seating: put clock easy for you to see ( just behind pt)
hg hg hg hg hg hg hg hg hg hg hg hg
guidelines for patient contact - (correct answer) - - never give home or cell phone number
hg hg hg hg hg hg hg hghg hg hg hg hg hg hg hg
- if giving a contract number specify times they may call you
hg hg hg hg hg hg hg hg hg hg hg
- instruct what to do in emergency when you can't be contacted
hg hg hg hg hg hg hg hg hg hg hg
-
leave a voicemail system for them to call and let them know if it's emergent you'll call back within 24
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
hrs
-
sign pts out to another clinician when you're on vacation and inform him of more severe pts or chroni
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
cally suicidal pts. change voicemail to have instruction to contact this clinician.
hg hg hg hg hg hg hg hg hg hg hg
-
use email but this too needs ground rules (limit to scheduling needs and refills, anything more has to
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
be added to their EMR).
hg hg hg hg hg
,-
for HIPPA add note saying: "please be aware that email communication can be intercepted in transmis
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
sion or misdirected. your use of email to communicate protected health information to us indicate tha
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
t you acknowledge and accept the possible risks associated with such communication. please consider
hg hg hg hg hg hg hg hg hg hg hg hg hg hg
communicating any sensitive information by telephone, fax, or mail. if you do not wish to have your in
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
formation sent by email, please contact the street immediately."
hg hg hg hg hg hg hg hg
-
get pts number and email. ask if it's okay to identify yourself when you call because some people don'
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
t want family or employers knowing they're in tx. hey contact info for energy contact people, need con
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
sent before doing this.
hg hg hg
rapport building techniques - (correct answer) - -
hg hg hg hg hg hg hghg
empathic or sympathetic statements: "you must have felt Truckee when she left you". communicate y
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
our average and understanding of painful emotions. but don't over use them.
hg hg hg hg hg hg hg hg hg hg hg hg
- direct feeling questions: "how did you feel when she left you?"
hg hg hg hg hg hg hg hg hg hg hg
-
reflective statements: "you sound dad when you talk about her". don't overuse because it sounds like
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
you're stating the obvious. hg hg hg
-
if you notice countertransference happening, see them as psychopathology and develop compassion f
hg hg hg hg hg hg hg hg hg hg hg hg hg
or them on that basis first
hg hg hg hg hg
techniques to make the patient comfortable - (correct answer) - -
hg hg hg hg hg hg hg hg hg hghg
greet naturally: introduce yourself and make small talk for a minute (unless in emotional distress)
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
- ask what they wanna be called and use their name a few times during the interview
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
-
learn something about them so they're more comfortable sharing about themselves: "before we get i
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
nto what brought you here, if like to know a little about you as a person, where you live, what you do,
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg h
that sort of thing."
g hg hg hg
-
explain what will happen in the interview: many think they're just here for psychotherapy. start by ask
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ing if they know why they're here and then give your explanation (length of interview, what info you'll
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
be asking about, and follow up going forward).
hg hg hg hg hg hg hg
-
then give them 5 minutes of free speech to explain what is going on. Ask them to explain the most tr
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
oubling symptoms first and go from there. if they're giving you articulate info let them keep going but i
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
, f they aren't you have to cut them off and direct the interview more but give them the inital 5 minutes
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
.
-
after this make a goal with your patient by asking them: what would make this visit the most helpful f
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
or you today, what would you like to get it of it?
hg hg hg hg hg hg hg hg hg hg hg
--
if they're reluctant ask the miracle scenario: "imagine that tonight you go to bed, like you normally do
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
. Then, imagine that while you're asleep, a miracle happens and your depression (or whatever problem
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
) goes away. what will your day be like tomorrow?"
hg hg hg hg hg hg hg hg hg
techniques to help the pt elicit sensitive material - (correct answer) - Most common -
hg hg hg hg hg hg hg hg hg hg hg hghg hg hg
normalization: normalize it by introducing your question with a normalizing statement, 2 ways to do t
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
his:
-
start question by implying the behavior is normal or understandable response to mood or situation: "
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
With all the stress you've been under, I wonder if you've been drinking more lately?" or "Sometimes w
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
hen people are very depressed, they think of hurting themselves. Has this been true for you?"
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
-
describe another pt who has had this behavior to show your pt they're not alone: "I've seen a number
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
of pts who've told me that their anxiety causes them to avoid doing things, like driving on the highwa
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
y or going to the grocery store. Has that been true for you?"
hg hg hg hg hg hg hg hg hg hg hg hg
Note: do not normalize severely abnormal behaviors such as extreme violence or sexual abuse.
hg hg hg hg hg hg hg hg hg hg hg hg hg hg
Others:
-
symptom expectation: aka gentle assumption. you infer that a behavior is expected by stating your qu
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
estion implying you assume the pt is having some behavior and you won't be offended with a positive
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
response. Especially good if suspect self destructive activity like drug use or suicide. Ex: "what sorts of
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
drugs do you usually use when you're drinking?" or "what kinds of ways to hurt yourself have you tho
hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg hg
ught about?" hg
Note: only use this when you suspect behavior, don't be asking every 70 y/
hg hg hg hg hg hg hg hg hg hg hg hg hg
o women what drugs they're using.
hg hg hg hg hg hg
