An appropriate setting for the psychiatric interview shouldbe selected or
arranged within the circumstances available.It should be as comfortable as
possible for both patient andinterviewer, protect privacy, and minimise
external distractions.
A trusting rapport with the patient should be established byintroducing
oneself, greeting the patient appropriately, explainingthe purpose of the
interview, ensuring confidentiality to theextent possible, and communicating
an intention to be of help.
The interview is a dynamic process, which should lead to mutual
understanding between clinician and patient without blurringtheir respective
roles. The clinician should adopt an attentive,interested, listening
attitude, convey respect for the patient'swishes and dignity, strive to
create a natural conversationalflow, and facilitate the engagement of the
patient in the interview(Fig.
2.1).
Cultural considerations should inform the conduct of the interview.The
clinician and patient should discuss cultural issues andopportunities for
advancement, as well as language barriers,and agree on ways to deal with
them. Whenever necessary, competentand thoughtful translators and cultural
consultants (who canbe trusted not to undermine the clinician-patient
engagement)should be enlisted.
The clinician should explore the circumstances leading to thepresentation
for evaluation, and the patient's expectationsfor care. Gaining an
understanding of the patient's life historyand concerns for quality of life
is also important. Patientsshould be encouraged to express themselves in the
way theyprefer.
Through anamnesis, information should be systematically gatheredon the
major mental health problems of the patient, includingthe time frame, mode
and circumstances of onset, clinical signsand symptoms, dangerous behaviours,
concomitant functionaldifficulties, relevant contextual factors, illness
course,treatment received, and efforts to restore health and qualityof life
(from physical well-being to spirituality).
The clinician should obtain systematic information on otherimportant
aspects of the patient's clinical background, includingfamily, developmental,
social, occupational, substance use,and general medical histories.
Towards the end of the interview the subsequent diagnostic andtherapeutic
steps should be specified. Further diagnostic effortsmay include - as
appropriate, and with the patient's consentto the fullest possible extent -
interviewing family membersand other individuals knowledgeable about the
patient's condition,as well as using supplementary assessment instruments and
procedures.
The clinician should work with the patient towards closing theinterview in
a manner that promotes in the patient greaterself-esteem, a sense of hope,
cooperation, and clarity on goals,expected progress and the process to
follow.
Anderson, A. K. & Lynch, T. (1996)Listening. Oxford: Oxford University
Press. Deniker, P. & Féline, A. (1990) Le
premier contact et l'observation in psychiatrie [The first contact and
observation in psychiatry]. In Précis de Psychiatrie
Clinique de l'Adulte (eds P. Deniker, T. Lempériere &
J. Guyotat). pp. 5-11. Paris: Masson. Barcia-Salorio, D. & Muñoz-Pérez, R.
(1991) The interview in psychiatry. In The
European Handbook of Psychiatry and Mental Health (ed. A. Seva),
pp. 443-458. Saragossa: Saragossa University
Press. Shea, S. C.. (1988)Psychiatric
Interviewing: The Art of Understanding (2nd edn). Philadelphia,
PA: Saunders. Ward, N. G. & Stein, G. (1975) Reducing
emotional distance: a new method of teaching interviewing skills.
Journal of Medical Education,
50,
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