The Psychiatric Interview: Evaluation and Diagnosis

Contributors ix

Preface xi

Acknowledgments xiii

Chapter 1 Listening to the Patient 1

Listening: The Key Skill in Psychiatry 1

The Primary Tools: Words, Analogies, Metaphors, Similes,

and Symbols 3

How Does One Hear Words in This Way? 4

Listening as More Than Hearing 6

Common Blocks to Effective Listening 7

Crucial Attitudes That Enable Effective Listening 10

Theoretical Perspectives on Listening 14

Using Oneself in Listening 16

To Be Found: The Psychological Product of Being Heard 18

Listening to Oneself to Listen Better 20

Listening in Special Clinical Situations 23

Growing and Maturing as a Listener 26

Chapter 2 Physician–Patient Relationship 31

Formation of the Physician–Patient Relationship 34

Special Issues in the Physician–Patient Relationship 42

The Physician–Patient Relationship in Specific Populations

of Patients 44

Conclusion 46

Chapter 3 The Cultural Context of Clinical Assessment 47

Introduction: The Cultural Matrix of Psychiatry 47

What Is Culture? 48

Culture and Gender 50

The Cultural Formulation 51

Ethnocultural Identity 52

Illness Explanations and Help-Seeking 53

Psychosocial Environment and Levels of Functioning 55

Clinician–Patient Relationship 56

Overall Assessment 57

Cultural Competence 57

Working with Interpreters and Culture-Brokers 60

Conclusion: The Limits of Culture 62

Chapter 4 The Psychiatric Interview: Settings and Techniques 65

Goals of the Psychiatric Interview 66

The Psychiatric Database 75

Database Components 77

Mental Status Examination 81

Conduct of the Interview: Factors That Affect the Interview 83

General Features of Psychiatric Interviews 85

Chapter 5 Psychiatric Interviews: Special Populations 103

Randon Welton and Jerald Kay

Psychiatric Interview in Special Circumstances 104

Psychiatric Interview in Special Patient Populations 115

Conclusions 131

Chapter 6 Formulation 135

Allison Cowan, Randon Welton and Jerald Kay

Biological Contributions 136

Social Factors 138

Psychological Factors 140

Summary 146

Chapter 7 Clinical Evaluation and Treatment Planning: A Multimodal Approach 147

Psychiatric Interview 147

Identifying Information 149

Chief Complaint 149

History of Present Illness 150

Past Psychiatric History 150

Personal History 150

Family History 151

Medical History 152

Substance Use History 152

Mental Status Examination 153

Physical Examination 157

Neurological Examination 158

Psychological and Neuropsychological Testing 159

Structured Clinical Instruments and Rating Scales 159

Laboratory Assessments 159

Neurophysiologic Assessment 159

Brain Imaging 162

Special Assessment Techniques 163

Assessment of Risk 164

Suicide Risk 164

Differential Diagnosis 167

Initial Treatment Plan 170

Conclusion 171

Chapter 8 Professional Ethics and Boundaries 173

Introduction 173

Ethical Behavior and Its Relationship to the Professional Attitude 174

WPA Guidelines on Euthanasia 176

WPA Guidelines on Torture 177

WPA Guidelines on Sex Selection 177

WPA Guidelines on Organ Transplantation 177

WPA Guidelines on Genetic Research and Counseling in Psychiatric Patients 177

WPA Guidelines on Ethnic Discrimination and Ethnic Cleansing 178

WPA Guidelines on Psychiatrists Addressing the Media 178

The Coherent Treatment Frame and the Role of Therapeutic Boundaries in Effective Psychiatric Treatment 178

Boundary Violations 179

Components of the Coherent Psychiatric Frame 180

Stability 181

Avoiding Dual Relationships 182

Autonomy and Neutrality 183

Coherent and Noncollusive Compensation 183

Confidentiality 184

Anonymity 184

Abstinence 185

Self-respect and Self-protection 186

Summary 187

Index 191