Interviewing
The Primer
Gary J Gala, MD
Interviewing
• 30 minute semi-
structured interview—
between the SKID
and psychotherapy
• History, Physical,
Labs, Imaging all in
one
Interviewing
• The result of a
syndromal medicine
• Psychiatry near the
beginning of the 19th
century
Interviewing
• Empathy: A mode of
perceiving by
vicariously
experiencing the
psychological state of
another person
• Literally ―feeling into‖
as opposed to ―feeling
with‖--sympathy
Interviewing
• Empathy: Why it
matters
• Since interview is all
we have…empathy
increases patient’s
cooperation
Interviewing—To Begin
• What brings you in
today?
• Listen for content and
form
• Now wait for the
answer—at least 2
minutes
Interviewing
• Content:
• The universe of
psychiatry
– Thought
– Mood
– Substance
– Many others but these
will get you started
Interviewing
• The drop down menu
• Once in your
provisional corner of
the universe—how to
proceed
Interviewing
• Thought
– Delusions
– Hallucinations
– Ideas of reference
– Mind reading
– Other special powers
Interviewing
• Mood
– Sleep
– Appetite
– Guilt
– Hopelessness
– Worthlessness
– Mania screen
– Suicide always!!
Interviewing
• Substance
– First use
– Amount
– Duration
– Consequences
– Tolerance
– Withdrawal Sx
Interviewing
• Form
– Logical
– Goal directed
– Disorganized
– Pressured Speech
– Flight of ideas
– Neologisms
– Etc.
Interviewing
• Include substance
Abuse with HPI
• It’s just so comorbid!!
Interviewing
• The Narrative Arc
• The next 15 minutes
– Past psych
– Family
– Social
Interviewing
• Moving back and
forth between
categories puts
patient at ease
• Creates the arc more
seamlessly
Interviewing
• Past Psych Hx
– Meds—strength and
duration
– Admissions
– Self harm—suicide
again
Interviewing
• Social History
– Living situation—
where and with whom
– Employment
– Legal Problems
– Weapons
– School history
– Relationships
– Economic problems
Interviewing
• Family History
– The usual mental
health stuff
– Ask about suicides
– Ask about substances
Interviewing
• Ten minutes Left
• What Now!!??
Interviewing
• Past Medical History
• Especially endocrine
and rheumatologic
disorders
• Don’t forget the meds
and allergies!
Interviewing
• Now it’s Time—about
5 minutes
• The Big Exam
• Your version of the
Mental Status Exam
Mental Status Examination
• Appearance
• Cooperation
• Eye contact
• Speech
• Mood
• Affect
• Thought Process
• Thought content
• Insight/ judgment
Mental State Exam
• Cognitive portion
• At least
– Orientation
– Attention
• The calendar
– Memory—short and long
– Calculating—money
– Naming
– Executive—what if you fell
down?—consider clock
drawing
Interviewing
• Anything you think is
important that I didn’t
ask?
• The chance for the
big bomb to drop
Interviewing—the tough stuff
• What if it doesn’t go so
well?
• The patient who doesn’t
talk
• The patient who talks to
much
• The grossly disorganized
patient
• The aggressive agitated
patient
Interviewing
• Aggressive/agitated
• Just get out
• Don’t bother pointing
agitation out to patient
• May need more organic
work up
Interviewing
• Won’t talk
• Difficult
• Get more specific
• Assess orientation
• May need more organic
work up
Interviewing
• Talks too much!
• Get used too
interrupting
• Get more specific
• Can they attend?
Interviewing
• Disorganized
• Get more specific
• Early MMSE
• Assess for delirium