The Psychiatric Interview

The Psychiatric Interview
Shawn R. Bourne
Objectives
At the end of this session the student will be able to:
• Discuss the clinical psychiatric interview and its components
• Identify client related factors that may influence interview
• Identify Clinician related factors that may influence interview.
The Clinical Interview : Psychiatry
Setting the Environment
Seating
• Chairs should be arranged so that conversation can be maintained at
normal volume and tone.
• The interview should be conducted with both client and nurse being
at the same level.
• Providing safety and psychological comfort in terms of exiting the
room. The patient should not be positioned between the nurse and
the door, nor should the nurse be positioned in such a way that the
patient feels trapped in the room.
Environment Cont’d
• Avoiding a face-to-face stance when possible; a 90- to 120-degree
angle or side-by-side position may be less intense, and patient and
nurse can look away from each other without discomfort.
• Avoiding a desk barrier between the nurse and the patient
Definition of the Clinical Interview
• “a complex and multidimensional interpersonal process that occurs
between a professional service provider and client [or patient]. The
primary goals are (1) assessment and (2) helping. To achieve these
goals, individual clinicians may emphasize structured diagnostic
questioning, spontaneous and collaborative talking and listening, or
both. Clinicians use information obtained in an initial clinical interview
to develop a [therapeutic relationship], case formulation, and
treatment plan” (Sommers-Flanagan & Sommers-Flanagan, 2017)
Components of the Psychiatric Interview –
Biopsychosocial History
• Demographic Data :Biopsychosocial History begins with the summary
of client’s demographic information. This includes Client's age, name,
Marital Status, Gender, Religion, Occupation and Current Living
Arrangement.
The Chief Complaint
• The reason for the current contact of the client with the health care
system. Because of the symptomology associated with most Mental
Illness, this presentation may be different from the family or
evaluator’s assessment. The chief complaint usually gives valuable
insight into symptoms associated with illness.
History of Present Illness ( HPI)
A chronological account of the events leading up to the current contact
with the mental health professional encounter/ discourse.
The HPI includes a description of the evolution of symptoms that
covers:
• The onset of illness.
• The duration of symptoms
• The change of symptoms over time.
Psychiatric History
• Information concerning past psychiatric illness must be obtained to
understand the current episode, to make an accurate diagnosis and to
make a prognosis. Psychiatric Illness may be a single event, chronic or
intermittent .
Alcohol and substance use history
• Studies indicate a high co-morbidity of mental illness of substance
abuse and alcohol usage.
• Causality is often multifactorial or difficult to discern.
• Alcohol or substance abuse may precipitate an episode of mental
illness or may represent a client’s attempt to cope with a pre-existing
mental disorders.
Medical History
The nurse should assess for significant illness, injuries and treatment
received. The client must be assessed for allergies and past and
present side effect profile from medication.
• An Abnormal Involuntary Movement Scale (AIMS).
• Females: Menstrual Cycle, Pregnancies and hormone changes.
• Identify risk of fall(s), skin breakdown and the use of assistive devices.
Family History
• Bipolar, Mood deficits, schizophrenia and Attention Deficits Disorders
( ADD) has a significant genetic.
• The client’s response may be inherited as well ( Coping responses)
Developmental History
• Account of client’s infancy, childhood and adolescence.
• It may provide clues to the origin of current behaviours and aid in
diagnosis.
• Erikson used a developmental timetable to identify psychosocial
adaptation methods to be used as a guide in this assessment.
• Psychic trauma ( Neglect, abuse , loss of parent) can have a profound
impact on a individual’s brain development, which can lead to poor
impulse control, and personality disorder development.
Social History
• Inclusive of occupational functioning, Educational level, level of social
interaction, religious and value -oriented beliefs, and cultural
considerations.
Forensic History
• Gives credence to client’s exposure to prison and the legal system.
Why is this an important aspect of the biopsychosocial history?

Phases of Clinical Interview ( Shea, 1998)
Proposed a 5 stage model, to be used in Psychiatric Clinical Interviews:
(1) introduction, (2) opening, (3) body, (4) closing, and (5) termination.
Introduction
• The introduction stage begins at first contact
• Central Activities : Client expectations, role induction, first
impressions, and initial rapport-building
• Mental health professionals who engage clients in ways that are
respectful and culturally sensitive are likely to facilitate trust and
collaboration, consequently resulting in more reliable and valid
assessment data (Ganzini et al., 2013).
• Technical strategies include authentic opening statements that invite
collaboration. “I hope you’ll feel comfortable asking me whatever
questions you like as we talk together today.”
Introduction cont’d
• The introduction stage also includes discussions of
(1) confidentiality,
(2) orientation, and
(3) role induction
The introduction ends when clinicians shift from paperwork and “small
talk” to a focused inquiry into the client’s problems or goals.
Opening
• The opening provides an initial focus.
• Most mental health practitioners begin clinical assessments by asking
something like, “What concerns bring you to counseling today?” This
question guides clients toward describing their presenting problem
(i.e., often referred to as the “chief complaint”).
• Positive wording is commonly used, to allow for opened ending
questions throughout the discourse
Body
• The interview purpose governs what happens during the body stage.
If the purpose is to collect information pertaining to psychiatric
diagnosis, the body includes diagnostic-focused questions.
• In contrast, if the purpose is to initiate psychotherapy, the focus could
quickly turn toward the history of the problem and what specific
behaviors, people, and experiences (including previous therapy)
clients have found more or less helpful.
Closing
• As the interview progresses, it is the clinician’s responsibility to
organize and close the session in ways that assure there is adequate
time to accomplish the primary interview goals.
• Tasks and activities linked to the closing include (1) providing support
and reassurance for clients, (2) returning to role induction and client
expectations, (3) summarizing crucial themes and issues, (4) providing
an early case formulation or mental disorder diagnosis, (5) instilling
hope, and (6) focusing on future sessions
Termination
• Termination involves ending the session and parting ways.
• The termination stage requires excellent time management skills; it
also requires intentional sensitivity and responsiveness to how clients
might react to endings in general or leaving the therapeutic
intervention.
• Dealing with termination can be challenging.
Interviewing Techniques
Non- Verbal Communication:
• Nodding in agreement and leaning forward gives client the feelings of
care and attentiveness.
• Non-judgemental facial expression and posture.
Verbal Communication
• Verbal communication should be clear and concise.
• Considerations should be made for clients age, cognitive ability
Interviewing Techniques cont’d
Choosing appropriate questions
• The client’s mental state and the subject being evaluated should
determine if open ended or closed ended questions should be
facilitated.
• Closed Ended Questions: These elicit specific and concise
information. Clients with disorganized thoughts, who are unable to
tolerate a long interview usually needed to be guided by closed ended
questions when being interviewed. Some topics such as suicidal
ideations lend themselves to direct questioning as clients may “ skirt “
around this pressing issue.
Interviewing Techniques Cont’d
• Open Ended Questions : Usually very vague, and encourages the
client to answer in many various ways. Useful in initial assessments,
where broad based information is needed in order to :
• Guide further assessment of client
• Fill in the blanks of client history.
• Give credence to diagnostic criteria
Client interview should involve both of these questioning techniques.

Interviewing Techniques – Cont’d
• Self Disclosure : Revealing information about oneself in a clinical
interview is a controversial interviewing technique.
• Involves experience, insight and sophistication on the part of the
interviewer.
• The nurse should only share personal information with a client, if after
careful evaluation the nurse believes sharing would benefit the client
and improve treatment.
Critical Thinking Question
• What kind of personal information would be appropriate to share
with a non-psychotic client on their first interview? How and in what
context would you disclose this information?
Client related factors that may influence the
interview process
Unreliable information
• Symptoms of mental illness, e.g delusions, disorganized thoughts may
alter client’s ability to communicate and change their perception of
reality.
• Lack of insight may also alter client’s perception of reality
• Client may purposefully alter information ( Give examples)
• A client who is amotivated in treatment measures, e.g a client
admitted involuntarily
Clinician related factors that may influence
the interview process
• The Nurse’s level of skill- Level of skill affects the flow of the interview
and information gathered. Interviewing skills are a combination of
intuition, critical thinking abilities, personality and communication
skills.
• The nurse’s culture, race, religion, socio-economic status and intellect
can influence the interview process.
• Transferance- Unrealistic and often inappropriate thoughts and
behaviours towards clinician.
• Countertransfereance – Inappropriate thoughts and feelings by
clinician towards client.
Clinician related factors cont’d
• Interview duration – Should be 10 to 15 Minutes in duration
• Environmental issues- noise, air temperature, uncomfortable
furniture
Scenario 1- Interview sessions
• Clinician- Mental Health student ( RMN)
• Client – 24 year old client, no psychotic features, desirous of
commencing drug rehabilitation.
• Past Psychiatric History: Client has a history of polysubstance abuse,
for the last three years as a result of relationship stress.
Scenario 2
• Clinician : Mental Health Student
• Client: 45-year-old client, presented to the Assessment Unit with with
suicidal ideations for the two days. Brought by family for assessment
and treatment
Scenario 3
• Clinician : Mental Health Nursing Student
• Client : Client’s family reported that client is a schizophrenic, who is
non- compliant with medication for the last three weeks. At clinic for
further assessment/ evaluation.

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What are the components of a psychiatric interview?

What factors can influence the interview process?

The Psychiatric Interview

Why is this an important aspect of the biopsychosocial history?

Client interview should involve both of these questioning techniques.

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