THE PSYCHIATRIC INTERVIEW

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THE PSYCHIATRIC INTERVIEW

• AND THE HOMOEOPATHIC CASE RECEIVING

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THE BASIC ELEMENTS
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THE PSYCHIATRIC INTERVIEW THE PROCESS
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OBJECTIVES

• SYMPTOMS AND THE O-D-P OF THE ILLNESS IN THE
  PATIENTS OWN WORDS
• LIFE STRESSES IN PRECIPITATING THE MENTAL ILLNESS
• DETAILED REVIEW OF PATIENTS CURRENT ENVIRONMENT
  AND LIFE
• EARLY ENVIRONMENT AND FAMILY HISTORY
• PERSONAL HOMOEOPATHIC HISTORY

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METHODS

• WHAT ARE OUR NEEDS?
• WHAT ARE THE LIMITATIONS OF VERBAL COMMUNICATION?
• WHAT DO THE PATIENTS WISH TO TELL?
• TO WHOM DO THEY WISH TO TALK?
• SHOULD WE HAVE A QA V/S FREE FLOW IN THE
  INTERVIEW?

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OUR NEEDS TO KNOW THE PATIENT AS A WHOLE

• HOW DOES THE PATIENT VIEW HIS ILLNESS?
• WHAT MEANING DOES HE ATTRIBUTE TO SYMPTOMS AND
  EVENTS?
• WHAT ATTITUDE DOES HE DEMONSTRATE TO HIMSELF, TO
  HIS PEOPLE AND TO HIS WORLD?
• WHAT ARE HIS SENSITIVITIES AND VULNERABILITIES
  WHICH RESPOND TO STRESS?
• WHAT OBSERVATIONS CONFIRM THE ABOVE ASSESSMENTS?

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WHAT ARE THE LIMITATIONS OF VERBAL COMMUNICATION?

• LIMITATIONS OF DIRECT QUESTIONS IN ELICITING
  RELIABLE INFORMATION
• POOR SELF IMAGE OF A MENTALLY ILL PERSON
• NEED FOR THE GOOD OPINION OF THE PHYSICIAN
• LARGE AREAS OF MENTAL OPERATIONS OUTSIDE THE
  AWARENESS
• TRICKS MEMORY PLAYS WHEN RECALLING THE DISTANT
  PAST

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WHAT DO THE PATIENTS WISH TO TELL?...OR ASK!

• WHAT IS WRONG WITH THEM?
• WHY DO THEY SUFFER?
• WHAT CAN BE DONE FOR THEM BY THE PHYSICIAN?
• WHAT CAN THEY DO FOR THEMSELVES TO GET BETTER?
• WHAT THEY WOULD LIKE THE WORLD TO DO FOR THEM?

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TO WHOM DO THEY WISH TO TALK?

• ONE WHO SHOWS AN INTEREST IN THEM AND THEIR
  SUFFERING
• ONE WHO UNDERSTANDS THEM AND VIBRATES WITH THEIR
  FEELINGS
• ONE WHO APPEARS HELPFUL
• ONE WHO IS PATIENT AND TOLERANT
• ONE WHO IS ABLE TO RELIEVE THEIR PAINS

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THE PSYCHIATRIC INTERVIEW
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SKILLS IN A PSYCHIATRIC INTERVIEW

• What is said first and in response to a question?
• What he omits or glides over?
• Where does he speed/hesitates/blocks/forgets/confu
  ses?
• Affective links with verbal associations?
• Change in pitch/timbre of voice?

• Tension in skeletal muscles
• Changes in movements of body or limbs
• Changes in facial emotional expressions
• Changes in autonomous functioning
• Bringing on symptoms
• Typical behaviour-rubbing of eyes, swallowing,
  clearing throat, glancing away

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SETTING

• SPACE
• PRIVACY
• LIGHTING
• SEATING ARRANGEMENTS
• TIME DEVOTED FOR THE INTERVIEW
• NUMBER OF INTERVIEWS PLANNED

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RELATIONSHIP-an evolving one

• Fantasies dependent on Age and Sex
• Social role authority-succor-realistic
• Self awareness of the physician about his
  behaviour and the impact on the patient
• Change with concealed aspects of the
  personalities of both getting revealed
• Effect of Performance on correction of fantasies
• Constant evaluation essential for the dynamic
  quality to be maintained

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THE PHYSICIAN-more than a close friend

• In degree
• Helpfulness
• Tenacity and patience to sustain the relationship
• In quality
• Interest
• Acceptance
• Detachment
• Flexibility

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TECHNIQUES - to start

• Introduction of self, the reference and the
  purpose with invitation
• Guidance of the type of information needed
• Channel the conversation into less anxious areas
• Specific ask about the anxiety which appears to
  block the patient

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TECHNIQUES - to maintain

• To show interest
• To reduce anxiety of the patient
• To encourage the emotional expression
• To control garrulity and irrelevance
• To channel the interview towards topics of
  greatest importance
• To retain a general control over the interview

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TECHNIQUES - to maintain

• Patient to become aware of the interest of the
  physician
• Minimal and conscious interruptions of the flow
• Direct in areas of importance by verbal
  injunctions, repetition of the last words,
  empathizing
• To point out possible misperceptions of
  himself/role by the patient

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TECHNIQUES to guide

• Systematic utterances influence significantly
• Minimal questions since they will distort
• Careful phrasing of questions so that they do not
  influence the answer
• Avoid leading questions
• Tact and timing in opening up new areas
• Embedding sensitive questions in investigation of
  other areas
• No hesitation in making necessary queries
• Avoid interpretations and explanations prematurely

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TECHNIQUES to end

• Caution when ending an emotional
  interview-advance notice
• Ask if anything further to say
• Ask the patient to reflect on what has been
  discussed and note down the results for future
  discussion
• Discuss plans for further interviews and
  interventions
• Interview relatives of patients with their
  consent to get objective data

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TECHNIQUES mindfulness

• To become aware of ones own anxieties and
  discomforts related to the patients statements
• To become aware of ones own propensities in
  investigating areas of ones own interest
• To become aware of the need to reassure in a
  premature way
• To become aware of the reactive disturbances in
  the patient after a sensitive disclosure