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    Psychiatric Interview Template

    Uploaded by

    Naomi Liang
    This psychiatric interview covers the patient's history of present illness, past psychiatric history, substance use history, medical history, mental status exam, and assessment and plan. The 34-year-old African American female presented with disorganized behavior and medication noncompliance related to schizophrenia and cocaine use disorder. Notable aspects of her history include previous psych hospitalizations and a history of suicidal thoughts.

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    © All Rights Reserved
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    Psychiatric Interview Template

    Uploaded by

    Naomi Liang
    554 views1 page
    This psychiatric interview covers the patient's history of present illness, past psychiatric history, substance use history, medical history, mental status exam, and assessment and plan. The 34-year-old African American female presented with disorganized behavior and medication noncompliance related to schizophrenia and cocaine use disorder. Notable aspects of her history include previous psych hospitalizations and a history of suicidal thoughts.

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    Psychiatric Interview template

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    This psychiatric interview covers the patient's history of present illness, past psychiatric history, substance use history, medical history, mental status exam, and assessment and plan. The 34-year-old African American female presented with disorganized behavior and medication noncompliance related to schizophrenia and cocaine use disorder. Notable aspects of her history include previous psych hospitalizations and a history of suicidal thoughts.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    554 views1 page

    Psychiatric Interview Template

    Uploaded by

    Naomi Liang
    This psychiatric interview covers the patient's history of present illness, past psychiatric history, substance use history, medical history, mental status exam, and assessment and plan. The 34-year-old African American female presented with disorganized behavior and medication noncompliance related to schizophrenia and cocaine use disorder. Notable aspects of her history include previous psych hospitalizations and a history of suicidal thoughts.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 1

    Psychiatric Interview

    CC: SOCIAL Hx:


    Education

    HPI (When was onset of current episode? When did it happen? What happened Employment
    before? What was causing this situation?
    34 y/o AA F/M, single/married, domiciled/homeless, unemployed, Living situation
    With PPH of Schizophrenia and cocaine use disorder
    BIBEMC after he was found on the street disorganized, yelling and Single/marriage/divorced/kids
    exposed himself in the context of medication noncompliance. Legal hx

    PAST PSYCH Hx Has this happened to you before? When? hx trauma/abuse

    Have you ever seen a psychiatrist?

    Previous psych hospitalizations? MSE


    I. APPEARANCE: □ appears his/her stated age □ appears younger/older than the
    stated age □ groomed □ disheveled □ poor hygiene □ well hygiene □ thin
    Suicidal hx overweight □ obese □ unshaven □ tobacco-stains on the hands □ tatto
    Posture: □ awkward □ staggering □ shuffling □ rigid □ trembling with intentional
    movement □ trembling at rest □ TD
    Violence hx
    BEHAVIOR AND PSYCHOMOTOR ACTIVITY: □ cooperative □ engaged □ guarded □
    Screening Questions: reluctant □ hostile □ withdrawn
    Suicidal □ thought □ plans □ intentions Relatedness/ Attitude: □ well □ fairly □ oddly □ distantly □ minimally
    Eye contact: □ good □ fair □ limited □ avoids
    Depression (insomnia, angedonia, low energy level)
    MOOD: □ irritable □ depressive □ anxious □ angry □ agitated □ lethargic □
    Mania (grandiosity, racing thoughts, ) dysphoric □ labile
    AFFECT: □ appropriate □ congruent □ inappropriate □ incongruent □ labile□ intense
    Anxiety □ expansive □ constricted □ blunted □ flat

    Obsessions/compulsions Speech: □ rapid □ slow □ dysprosodic rhythm □ low volume □ loud □ productivity
    (rambling, pressured, paucity, impoverished, latent, dysarthric, aphasic)
    Psychosis (AVH)
    THOUGHT process
    PTSD Thoughts content: □ liner □ logical □ relevant □ circumstantial □ tangential □
    derailment □ disorganized □ blocking □ racing thoughts □ concrete □ alogia □
    impoverished □ bradyphrenic
    PMH:
    Suicidal □ thought □ plans □ intentions
    Medications:
    Delusions: □ paranoid □ grandiose □ somatic □ bizarre □ erotomanic □ jealous □
    overvalued ideas □ loose associations □ flight of ideas □ ideas of reference □
    Allergies: illogical thinking □ grandiosity □ magical thinking □ ideation □ confabulation □ IOR
    □ obsessions □ preoccupation □ depressogenic □ anxiogenic

    SUBSTANCE USE Hx
    Tobacco Illusions and Hallucinations: □ presence □ absence □ denied but showed signs of
    them during interview □ denied while taking medications
    Alcohol □ visual □ auditory □ olfactory □ gustatory □ tactile □ proprioceptive □ nociceptive
    □ thermoceptive □ hypnagogic (falling asleep) □ hypnopompic (waking up) □
    Cannabis derealization □ depersonalization

    Cocaine LOC: □ alert □ sleepy □ lethargic

    Other illicit drugs Orientation: □ person □ place (state, city, hospital, floor) □ time (year, season,
    date, day, month) □ situation
    FAMILY PSYCH Hx:
    Mental illnesses: JUDGMENT: good □ poor □ fair □ strong

    Suicidality:
    A/P: Psych d/o or Substance abuse
    Substance abuse: Possible maladaptive personality traits
    Current medical problems
    Homelessness, poor social support, unemployed

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