Psychiatric Interview: Introduction
Human behavior is multifaceted and complex. When it becomes dysfunctional because of environmental stressors or brain disease it can be mysterious and frustrating to the inexperienced clinician who must master the tasks of diagnosis and management. This is especially true of neurobehavioral disorders, which involve organically related changes in cognitive or emotional behavior that appear to fall between the boundaries of psychiatry and neurology. The clinician needs to be able to appreciate and assess the signs and symptoms of these neurobehavioral disorders with the same discernment as the more traditional physical syndromes, such as myocardial infarction or common infections.
In this chapter we discuss the psychiatric history and the mental status examination (MSE), in the context of conducting an effective psychiatric interview. We explain the steps of the interview process and describe techniques that the clinician must master in order to elicit in an orderly and complete fashion information relevant to the psychiatric history. We describe the components of the psychiatric history and the MSE in our discussion of the specific interview stage during which they would normally be obtained.
What can be achieved at the initial psychiatric interview? The outcome depends on the situation in which it is conducted and what the physician and the patient are seeking. For example, a brisk, focused interview in an emergency room contrasts with the more extensive survey appropriate to an outpatient clinic. These types of interview differ from what is possible at the bedside of a patient who is severely ill in a medical or surgical ward. Despite these observations, fundamental issues can be addressed to varying degree in any clinical situation, as illustrated in Table 8-1. We return to these issues in our discussion of the elements of the psychiatric history.