• To define the objectives of a psychiatric diagnostic interview.
• To define the different stages of a psychiatric interview.
• To appreciate the potential impact of the style of questioning

• Setting - Introduction, adequate privacy and comfort, appropriate distance from patient.
• Note-taking - make notes discreetly and legibly (important for good quality clinical records, and for effective team communication)
• Establish rapport - "bedside manner"
• Interview - data collection and organisation

• Define presenting complaint(s) - identify the chief presenting complaint(s) to include chronology, onset, duration, frequency, severity, exacerbating and relieving factors, associated factors, functional impairment (decreased ADL) if any. Note: if not impairment of ADL = subclinical illness
• Make a diagnosis - principal + differential diagnosis, revise if appropriate
• Management plan - initiate investigations and treatment

• Age
• Sex
• Occupation: work stress, educational level (determines how you speak to the Pt)
• Marital status
• Living situation: people living along are at a greater risk of stress

• Onset, duration, intensity/severity, frequency, exacerbating/relieving factors, associated factors, change in ADL

• Including family psych history. How many people, ages, occupations, relationship with them

• Place of birth, developmental (social, motor, sphincter), psychosocial history, libido, relationships

• Mood, temperament, "how would your friends describe you before you became ill"; how would you deal with stress, interests. Premorbid personality is what psych Tx is attempting to return Pt to - state before the illness
• Some personality types are more prone to psych disorders:
• Anxious: always sweaty and tremulous
• Suspicious: very sensitive, feel everything said is critical to them (increased risk of psychotic disorder)
• Negative-thinkers: increased risk of depressive disorder
• Obsessive: high standards, get the most out of everything, always checking everything in place, tidy, clean, perfectionist (increased risk of obsessive compulsive disorder)

• "Have you ever broken the law, been in trouble with the police?"
• When asking potentially difficult / embarrassing questions, can say "as a routine question..." or "I ask everyone this..."

• Apart for HCP, this is the most important. Chronology. What has/has not worked in the past. Reason: what has happened before is likely to happen again

• Pt with psych disorders are at a greater risk of medical problems (and vice versa)
• Co-morbidity common
• Pt's with chronic illnesses (carcinoma, stroke) deal with their illness better if they are psychologically well

• Psychiatrist's equivalent of a physical examination
• Aims to elicit signs from Pt that will corroborate with Hx
• Takes about 5 minutes
• If Pt gives poor Hx and doesn't want to talk, Dr will go straight to MSE
• Can be completed even if Pt won't speak to Dr (mainly observation; speech, affect, appearance, psychotic signs, cognition)

• Work out aetiology
• 3 aspects

1. Biological: 1st degree relations; can manage with medication, genetic counselling
2. Psychological: psych management, cognitive behavioural therapy
3. Socio-occupational: housing, finance, marriage

• As above, aetiology determined management

• Patients may worry that they will never be well gain
• Pt's need to know when they can be expected to go back to work
• "How am I going to do, Doctor", "Will I get better?", "Will I get sick again?"
• "What will be the impact on my life / job / family?"
• "Will I pass it onto my family?", "Is it infectious?"
• Try to give a timeframe to the Pt (eg. 87% of Pt's with your condition will improve in 3 weeks time)

If you encounter any of the following then you will have problems in eliciting a proper history

• Language barrier
• Anxious-to-please patient eg. He has every single symptom you mention plus more!
• Hostile patient eg. He won't talk to you.
• Mute patient eg. He can't talk to you.
• Confused patient eg. He also can't talk to you.
• Cognitive impaired patient eg. He has forgotten.
• Extremes of age
• Lack of insight patient eg. He thinks he hasn't any symptoms (deluded Pt)
• Uncooperative patient eg. He gives you partial or wrong information.

In any of the above problem situations, you will need to

• Interview informant
• Perhaps proceed to the MSE and P/E
• Make provisional diagnosis
• Review later

• Open question = a question that is not simply answered by "Yes" or "No" (eg. "Can you tell me how you have been sleeping recently?")
• Closed question = a question that is answered by "Yes" or "No" (eg. "Do you wake early in the morning?").
• Open questions derive more complete and accurate information, as they depend on the patient's own words. Closed questions are helpful when:
• Clarifying a point
• Time is limited
• Patient has problems in verbal expression (eg. young child, mental retardation, confused, language barrier)

• Use empathy to facilitate data collection and management, and it improves the rapport between doctor and patient. Empathy can be non-verbal (eg. Posture, gesture, facial expression) as well as verbal (eg. "That must be hard for you to bear", or " I can see that must have made you happy").
• Empathy = "ability to feel oneself into the situation of the other person" eg. the doctor felt sad when listening to the patient's tearful account of losing his wife in a road traffic accident
• Rapport = "capacity for human understanding" eg. the doctor understood /was able to sense that the patient must be distressed after such a terrible incident)

• Guide the patient but do not dominate the interview.

• Symptom = what the patient complains of (ie. subjective).
• Sign = what the doctor observes (ie. objective).

• The PC (presenting complaint) always concerns the patient's complaint(s) using his own words (eg. PC - Headache for 3 days). There is no PC if the patient feels he has no symptoms - he just feels well.
• Example - If the patient complains that his colleagues are unfairly targeting him but he is otherwise well so then the PC may just be that colleagues are being nasty to him. Or else it may be that he became so upset by his feelings of persecution that it caused him lack of sleep - then PC may be of poor sleep. If for this same patient, the clinician detects persecutory delusions and lack of insight, these are the clinical signs.

• Do not confuse the PC with the reason for referral (the reason why someone - usually a doctor or could be the relative or social worker etc. - wants the patient to be seen). They can be the same thing, or quite different.
• Example - Reason for referral: change in behaviour for a month noted by relatives.
• PC: 3 day history of inability to sleep due to being criticised by "voices" of ex-colleagues
• On MSE: Persecutory delusions and lack of insight

• Try to see patient individually
• Confidentiality, quality and quantity of information, effects of spouse/family etc.
• Pt's may say things to make other people (including the Dr) happy

• Try to summarise as you go