Psychiatric Interview

Allan Tasman, MD, is Professor and Chair of the Department of Psychiatry at the University of Louisville.  An internationally known educator and psychoanalyst, he has received numerous national and international academic awards. He is the founding Senior Editor of Psychiatry, an internationally acclaimed comprehensive textbook. He is past president of the American Psychiatric Association and the Pacific Rim College of Psychiatrists. He recently completed service as Secretary for Education of the World Psychiatric Association and now leads the WPA Section on Psychotherapy. Dr. Kay is a Fellow of the American College of Psychiatrists and Distinguished Life Fellow of the American Psychiatric Association and has served as the chair of the APA Committee on Medical Student Education, the Council on Medical Education and Career Development, the Vestermark Award Board, and the Committee on the Practice of Psychotherapy. He chairs the World Psychiatric Association Task Force on Undergraduate and Post Graduate Curriculum as well as the APA Committee on College Mental Health. Dr. Kay is the immediate past chair of the Psychiatry Residency Review Committee of the ACGME and the Founding Editor of the Journal of Psychotherapy Practice and Research and Associate Editor of the American Journal of Psychotherapy. He has published extensively on the topics of medical and psychiatric education, medical ethics, child psychiatry, psychoanalysis, psychotherapy, the neurobiology of psychotherapy, and psychosocial aspects of AIDS and of cardiac transplantation, and has edited numerous books. Dr. Kay serves as the Associate Director of the Comprehensive Neuroscience Center at Wright State University. He received the 2001 APA Seymour Vestermark Award for contributions to psychiatric education. Dr. Kay's current research examines fMRI in borderline personality disordered patients with self-harm behavior.

“This book is not only a first rate introduction for psychiatric residents and medical students interested in psychiatry but arguably should be a mandatory reading for all medical students given the importance of general interviewing skills, the prominence of psychiatric issues throughout medicine, and the importance of the techniques presented for building the foundations of the physician-patient relationship.”  (Journal of Nervous and Mental Disease, 1 December 2014)

• Contributors ixPreface xiAcknowledgments xiiiChapter 1 Listening to the Patient 1Listening: The Key Skill in Psychiatry 1The Primary Tools: Words, Analogies, Metaphors, Similes, and Symbols 3How Does One Hear Words in This Way? 4Listening as More Than Hearing 6Common Blocks to Effective Listening 7Crucial Attitudes That Enable Effective Listening 10Theoretical Perspectives on Listening 14Using Oneself in Listening 16To Be Found: The Psychological Product of Being Heard 18Listening to Oneself to Listen Better 20Listening in Special Clinical Situations 23Growing and Maturing as a Listener 26Chapter 2 Physician–Patient Relationship 31Formation of the Physician–Patient Relationship 34Special Issues in the Physician–Patient Relationship 42The Physician–Patient Relationship in Specific Populations of Patients 44Conclusion 46Chapter 3 The Cultural Context of Clinical Assessment 47Introduction: The Cultural Matrix of Psychiatry 47What Is Culture? 48Culture and Gender 50The Cultural Formulation 51Ethnocultural Identity 52Illness Explanations and Help-Seeking 53Psychosocial Environment and Levels of Functioning 55Clinician–Patient Relationship 56Overall Assessment 57Cultural Competence 57Working with Interpreters and Culture-Brokers 60Conclusion: The Limits of Culture 62Chapter 4 The Psychiatric Interview: Settings and Techniques 65Goals of the Psychiatric Interview 66The Psychiatric Database 75Database Components 77Mental Status Examination 81Conduct of the Interview: Factors That Affect the Interview 83General Features of Psychiatric Interviews 85Chapter 5 Psychiatric Interviews: Special Populations 103Randon Welton and Jerald KayPsychiatric Interview in Special Circumstances 104Psychiatric Interview in Special Patient Populations 115Conclusions 131Chapter 6 Formulation 135Allison Cowan, Randon Welton and Jerald KayBiological Contributions 136Social Factors 138Psychological Factors 140Summary 146Chapter 7 Clinical Evaluation and Treatment Planning: A Multimodal Approach 147Psychiatric Interview 147Identifying Information 149Chief Complaint 149History of Present Illness 150Past Psychiatric History 150Personal History 150Family History 151Medical History 152Substance Use History 152Mental Status Examination 153Physical Examination 157Neurological Examination 158Psychological and Neuropsychological Testing 159Structured Clinical Instruments and Rating Scales 159Laboratory Assessments 159Neurophysiologic Assessment 159Brain Imaging 162Special Assessment Techniques 163Assessment of Risk 164Suicide Risk 164Differential Diagnosis 167Initial Treatment Plan 170Conclusion 171Chapter 8 Professional Ethics and Boundaries 173Introduction 173Ethical Behavior and Its Relationship to the Professional Attitude 174WPA Guidelines on Euthanasia 176WPA Guidelines on Torture 177WPA Guidelines on Sex Selection 177WPA Guidelines on Organ Transplantation 177WPA Guidelines on Genetic Research and Counseling in Psychiatric Patients 177WPA Guidelines on Ethnic Discrimination and Ethnic Cleansing 178WPA Guidelines on Psychiatrists Addressing the Media 178The Coherent Treatment Frame and the Role of Therapeutic Boundaries in Effective Psychiatric Treatment 178Boundary Violations 179Components of the Coherent Psychiatric Frame 180Stability 181Avoiding Dual Relationships 182Autonomy and Neutrality 183Coherent and Noncollusive Compensation 183Confidentiality 184Anonymity 184Abstinence 185Self-respect and Self-protection 186Summary 187Index 191