CLINICAL INTERVIEW

Gemah Nuripah, dr. SpKJ,

M.Kes
Bagian Psikiatri
FK UNISBA
1

Two interview style :

Insight-oriented

(psychodynamic)
Symptom-oriented (descriptive)

Insight-oriented
(psychodynamic)

Infantile

conflicts become chronic

pathogens of the mind that interfere
with the patiens action, distort his
perception, and lead to symptoms,
maladjustied behavior and suffering.
Identify defense mechanisms
Discussion of patients conflicts
Goal : Psychodynamic formulation
3

Symptom-oriented
Psychiatric disorders manifest
(descriptive)
themselves in a characteristic set of

themselves in a characteristic set of

signs, symptoms and behavior.
The goal is to classify the patients
complains and dysfunctions according
to defined diagnostic categories (Axis IV) predict prognosis and treatment.
Methode : observe the patients
behavior/ translates patients
perception into symptom and sign.
4

FOUR COMPONENTS OF
INTERVIEW

Rapport

: how the interviewer

and her patient relate.
Technique : insight oriented /
descriptive
Mental status : patients general
state of mind while interviewer
talk
to him.
Diagnosing : psychodinamic
formulation / criteria diagnostic.

THREE PHASE OF INTERVIEW

Opening

phase : warms up the patients,

established rapport, prepare the patient
for the main task of interview.
Middle phase : longest time, to
emphasize the shift of interviewing goals.
End phase : closure, avoid highly
emotional topics, summarize for the
patient what has been learned and
provide an outlook for the future.
6

STRATEGIES FOR RAPPORT

Put

your patient and yourself at ease

Find the suffering show compassion
Assess insight become an ally
Show expertise
Establish leadership
Balance the role

Put your patient and yourself

at ease
First

goal is simply to get a sense

of the patient, initiate rapport, not
to arrive at an immediate
diagnosis.
Recognize signs (territorial,
behavioral, emotional, verbal).
Respond to sign.
8

Find the suffering

show compassion
Assess

the suffering :
What is bothering you?
How did that make you feel?

Respond

with empathy :
You must be awful.
I can see how that shook you up.
9

Assess insight become an

ally
Level insight :
Full insight : patient who describes his
psychiatric symptom as a result of a
disorder.
Partial insight : Lack of awareness of
being sick, deny the impact of their
illness.
No insight : complete denial that he
suffers from any illness.
10

Show expertise
Put

the illness into perspective

Show knowledge
Deal with doubt
Instill hope

11

Establish leadership
Taking

control of your interaction

with him.
Express interest in his welfare.
Motivate him to change.

12

Balance the role

1.
2.
3.

1.
2.
3.

Roles of interviewer :
The empathic listener
The expert
The authority
Roles of the patients :
Carrier of an illness
The sufferer
The VIP
13

PATIENTS IDENTITY
Name

: What is your name ?

Age : How old are you ?
Education : Tell me about your
education background
Marital status : Are you married ?
Occupation : What do you do for living?
Residence : Where do you live ?
Religion : Do you commited to a
certain
religion ?
14

CHIEF COMPLAINT
How can I help you?
HISTORY OF PRESENT ILLNESS
The date of onset
Since when this things happened?
Whether the onset was sudden or insidious
Did this thing happen suddenly or
gradually?
The precipitating factor
Was there any special event which
bothering you before all these things
happened?

15

Emotional changes
Is there any changes in your mood?
Behaviour changes
Is there any changes in your behaviour?
Somatic symptoms
Do you have any physical complains (such
as pain, tinnitus, blurring of vision,
palpitation, excessive sweating, dry
mouth, fatigue, or difficulty in swallowing)?
16

Vegetative symptoms
Is there any changes in your sleep, appetite,
body weight, urination, libido, menses?
Cognitive symptoms
Do you have any problem with concentration?
Patients functioning
Do you still doing your tasks as usual?
Do you have any problem with personal
hygiene?
How involved are you with the social life
around you?
17

Assess the patients orientation to :

Time

:
Can you tell me what is todays date?
(the day, month, year)
Place :
What is the name of the place that
we are in now?
Person :
Do you know who is . ?
18

Assess the patients memory

1. Immediate memory
Now I will mention three objects. Please
repeat them after I have mentioned
them. (mention 3 different object and
let the patient repeat them)
2. Recent memory
How did you come to this place?
3. Remote memory
Where do you live when you were a
kid?
19

Assess the patients thought :

Obsession

Have you ever been bothered by certain

thoughts or images that came into your
mind over and over even thought you
tried to ignore or stop them?
Phobia
Social phobia
Have you ever been so afraid of
embarrasing yourself in public that you
would not do certain things most people
do, like eating in restaurant, using a
public restroom, or speaking out in a
room full of people?
20

 Simple

phobia
Have you ever been much more afraid
of things that the average person is
not afraid of? like flying, heights, small
animals, receiving an injection, or
seeing blood, so you prefer to avoid
such things?
Somatic complaint
Is there any problem with your
physical health which the doctors
cannot explained?
Suicide idea
Have you had any thoughts about
ending your life?

21

Assess the patients mood

How is your mood?
If the patient cannot describes his / her
mood spontaneously, ask :
Depressive
Do you feel depressed, sad or unhappy?
If the answer is no, ask:
Do you lost your interest or pleasure?
22

Anxious
Do you feel worried, nervous, anxious or tense?
Panic attack
Have you ever had sudden spells or attacks of
nervousness, panic, or a strong fear that just
seems to come over you all of sudden, or for
no particular reason?
Euphoric
Do you feel high or excited?
Irritable
Do you get angry easily?

23

 Assess

the patients insight of

illness :
Would you say that you had a
psychiatric or mental problem?

24

Assess the patients psychomotor

behaviour:
Compulsion

Have you ever felt you had to repeat

certain act over and over even
thought it did not make much sense,
like hand washing, ordering,
checking or counting?
25

OBSERVATION
Observe the patients appearance:
face feature, nutritional status, body
type, hygiene, clothes, eye contact
Observe the patients consciousness
Observe the patients affect
Observe the patients attention
Observe the patients psychomotor
behaviour: posture, movements
26

 CLOSING

According to interview and

examination I conclude that you
suffer from distress and you need
take medications, and Ill give a
prescription for a week.
Would you come again next week?

27

Clinical interview of psychiatric

disorders

28

Assess the patients perception

Auditory

hallucination
Do you sometimes hear things that
others dont hear?

Visual

hallucination
Do you sometimes have visions or
see things that others dont see?
29

 Olfactory

hallucination
Do you sometimes smell things that
are unusual or that others dont
smell?

Gustatory

hallucination
Do you sometimes taste things that
are unusual?

Tactile

hallucination
Do you sometimes feel any strange or
unusual sensation in your skin?

30

Assess the patients thought :

Paranoid delusions :
Delusion of persecution
Does anyone ever spy on you or plot
against you?
Delusion

of reference
Did it ever seem that people were
talking about you or taking special
notice of you?

31

 Delusion

of grandeur
Do you have talents or abilities that
other people dont have?

Delusion

of self accusation
Do you bothered by guilt feeling
about something you may have done
in the past that deserve
punishment?
32

 Delusion

of control
Do you believe there is something
control you ?

Somatic

delusion
Is there any problem with your
physical health which the doctors
cannot explained?

33

Thought withdrawal
Are your thoughts ever taken out of
your head ?
Thought insertion
Are thoughts that were not your own
ever put into your head ?

34

Thought broadcasting
Do you sometimes feel as if your
thoughts were being broadcast out
loud so that other people could
actually hear what you were thinking?
Thought control
Do you sometimes feel that someone
or something outside yourself
controls your thoughts or action
againts your will?
35