The below mentioned article will guide you about how to conduct a psychiatric interview.
The patient and the attendants must be helped to feel comfortable enough to give a detailed account of the disorder.
A summary of interview is given in Table 4.2:
i. Identification of the Patient:
It consists of recording:
a. Name:
Name record nicknames also for proper identification.
b. Father’s name:
Father’s name for identification of patient
c. Age and sex:
Age and sex some psychiatric disorder are more common in a particular age group or sex.
d. Literacy:
It is important for understanding the details of the psychiatric disorder and its management
e. Marital status:
Marital status an important prognostic variable in many psychiatric disorders.
f. Religion:
Religion important variable in Doctor Patient Relationship, and knowing effect of religious practices.
g. Occupation:
Occupation important variable in not only some occupational disorders but also influence their prognosis.
h. Address (Phone no.):
Address Phone no. important if patient absconds or to be discharged especially from a mental hospital.
i. 2 Identification marks and Photograph:
2 Identification marks and Photograph as the patient may not give or is unable to give the correct details of above sociodemographic variables and also if he is a medicolegal case.
j. Where the patient is seen OPD, Ward Psychiatric or other, house, Police station etc.
k. How the patient was referred.
ii. Informants:
a. Name (s):
Name for identification of the informant
b. Age:
Age the children are usually poor informants while the elderly due to senile forgetfulness, may try to confabulate.
c. Sex:
Sex the details of some of the problems can only be given by the informant of the same sex e.g., menstrual problems in females
d. Literacy:
Literacy the individuals who are educated, they are better able to verbalize the details of the illness and its treatment and prognosis
e. Marital Status:
Marital Status the individual is better able to understand and express the psychosocial stressors associated with marriage/divorce/widowhood
f. Relationship with the patient:
Relationship with the patient Mothers are able to express the details of the illness of their daughters, daughter-in-law who may give a biased history.
g. Ability to report:
Ability to report an informant who has seen the previous episodes of the disorder will be able to report in a better way
h. Familiarity with patient:
Familiarity with patient a close relative who is familiar with the patient is able to give in reliable history than a stranger.
i. Length of stay with the patient:
Length of stay with the patient an individual (may be a friend, office colleague) who is staying with the patient during the present episode is able to give an accurate details of the illness. A relative (e.g., father) may be closely related to the patient but he may not be staying with patient (due to outstation job) and thus will not able to give a detailed history.
j. Attitude towards patients illness and his admission to the hospital:
Attitude towards patients illness and his admission to the hospital the in-laws who want to get rid of daughter-in-law will exaggerate the symptoms and will be delighted to hospitalize the patient. A family which is having a chronic mental patient, may come with repeated requests for hospitalization.
k. History of physical illness:
History of physical illness Patient might be taking some drugs for management of a physical illness e.g., anticonvulsants, hypnosedatives may not be able to report the patient’s illness is an accurate way.
l. History of mental illness:
History of mental illness (or drug abuse) as some mental illnesses run in the family, a history of mental illness may make the informant unreliable.
m. Reliability of the information.
Reliability of the information the verification of the information especially factual data given by an informant can be cross-checked by talking to another informant; it is important to choose a reliable informant from attendants accompanying the patient.
n. Identification marks:
Identification marks (and address) the informant who has given the history should also be identified by marks or photograph, if possible.
iii. Chief Complaints:
a. According to patient and informant and the duration.
b. The circumstances surrounding the consultation or hospitalization.
c. Duration of incapacitation due to illness (i.e., effects on work, domestic life, leisure and social activities, family or other relationships).
d. Onset (Acute-usually in mania, Sub-acute-usually in depression).
e. Course, (Progressive e.g., in a schizophrenic type of illness. Regressive e.g., in a postpartum illness or Stationery e.g., a phobic disorder, Episodic e.g., an epileptic or panic attack).
f. Precipitating factors, (e.g., death, separation, loss, frightening experience, family physical illness or office trouble, examination, marriage etc.)
iv. History of Present Illness:
It should include:
a. Spontaneous narrative account of chronological account of development of symptoms.
b. Specific enquiry about sleep, appetite, mood, anxiety symptoms, suicidal/homicidal risk, social interaction, job efficiency, personal hygiene, memory, interests etc. as application. Enquiry from informants regarding delusions, hallucinations, ideas of sin, infidelity or jealousy and pregnancy (in female patients).
c. Intake of dependence-producing and prescription drugs.
d. Treatment taken so far for the present illness and response (Place, dates, drugs, response, allergy to any drug) Time loss between onset of illness and treatment and reason for it.
e. Legal issues with respect to the present illness (e.g., arrests, imprisonment, law suits, divorce etc.) or any other problems (truancy or suspension from job).
f. Any secondary gain (i.e., anything to be gained by the patient from the problems such as compensation or relief from the responsibilities at home, work or school).
v. Past History:
(a) Psychiatric history:
i. Dates, main complaints or diagnosis, treatment.
ii. Interim history in case of a previous psychiatric illness. Specific enquiry into completeness of recovery and socialization/ personal care in the interim period and also complications e.g., suicide/homicidal attempts.
iii. Some psychiatric disorders e.g., Mood disorders, show a complete recovery from the episodes and the patients remain normal even without any medication.
iv. History of drug abuse (Types of drugs abused, duration and the main intoxication/withdrawal symptoms).
(b) Medical history:
i. History about chronic medical illnesses (e.g., diabetes, mellitus, hypertension, angina, bronchial asthma, epilepsy etc.) sequelae and the details of medication received and the duration.
ii. History of injuries, hospitalization and operations.
(c) Legal history:
i. History of arrests, imprisonment or lawsuits.
vi. Family History:
a. Type of family:
Joint, nuclear or extended (The onset, exacerbation and precipitation of some psychiatric illnesses is related to family type). Antisocial (a member of family with psychopathic traits), disturbed (a member with some chronic physical or psychiatric illness), disrupted (a member has died or abandoned the family). Or inadequate (which cannot meet the economic needs of the family or parents have maladjustment).
b. Parents:
Ages at death, causes of death, education, health (Mental/physical), occupation, social position, personality and relationship with patient.
c. Siblings:
Siblings Ages, Sex, marital status, education, health, occupation, social position and personality.
d. Family Dynamics:
Family History of mental illness, personality disorder, epilepsy, alcoholism, suicide, renouncing world, drug dependence or important medical disorders in grandparents, parents, aunts, first cousins, siblings etc.
e. Family relationships:
Family relationships and the influence these had on patients from childhood to the present time.
f. Family events:
Important family events on patient’s early years.
g. Other factors e.g.:
Living arrangement, social status, religious denomination, child rearing, number of dependents, sources of income etc.
vii. Personal History:
a. Birth:
Date and place of birth; Home or hospital delivery (Preterm/postdated) Prenatal, natal and postnatal complications if any (history of any drug intake during first trimester).
b. Early development:
Age at weaning, Developmental milestones (explore at least age at first word, three-word sentence, sitting and walking), Neurotic traits (Nail-biting, bedwetting, phobias etc.) Illnesses and injuries in childhood (e.g., encephalitis, epilepsy, measles etc.)
c. Educational history:
Age at beginning schooling, highest class completed. Academic record in school (give chronologically for each important exam) whether changed schools frequently or not. Relationship with teachers and classmates (discipline problems, peer relationship and group participation), hobbies, special abilities, reasons for discontinuing etc.
e. Occupation:
Age when first started earning. Circumstances under which job was taken (certain forced condition or after completion of educational order). Period elapsed between completion of education and getting job. Is he satisfied with the job (If no, why?) Present relationship with his colleagues (friendly and cooperation, indifferent, uncooperative and hostile). Specific difficulties, promotions, suspension or reasons for change of jobs (e.g., schizophrenic patient may have difficulties with colleagues and may change jobs frequently because of delusions). Current financial situation.
f. Menstrual History:
Age of menarche. Reaction towards it. Regularity and duration of menses. Psychic and physical change (Pain or any other). Date of last disturbances.
g. Sexual inclination and Practice:
At what age the patient obtained information about sex? Source of sex information. What attitude developed after this information? Incidence of any perversion and its frequency, also masturbation and associated guilt feelings). Any guilt feeling resulted out of pervert activity. Any premarital heterosexual relationship. Any guilt feelings resulted? Any sexual problems or sexually transmitted disease. Any contraceptive practice.
h. Marital History:
Patients:
Age of the patient at marriage.
Marriage:
Type of marriage Arranged with/without approval of parents Choice-with/without approval of parents.
Spouse:
Age of the spouse, Health of the spouse, Occupation of the spouse, Personality of the spouse, Hobbies.
Relationship:
Marital and sexual adjustment with spouse (quality of marital relationship). Adjustment of spouse with in-laws. Details of live birth/still births. Children’s ages, sex, names, health and personality.
Religion:
Religion and sect, Level of participation, any sudden changes in interest in religion.
Legal record:
Any imprisonment or arrests (cause, duration etc.).
viii. Premorbid Personality:
Personality traits:
a) Anxious:
Anxious worrying over trivial and minor things, high strung, irritable, panicky
b) Aggressive:
Aggressive dominant, assertive, irritable, impulsive
(c) Hypomanic:
Hypomanic Always happy, cheerful, happy- go-lucky type, witty and jovial, extroverted
c) Hysterical
Hysterical Attention seeking, immature, exhibitionist, dramatizing, manipulative, emotionally immature, suggestible
d) Inadequate:
Inadequate shunning the responsibilities diffident
e) Dysthymic:
Dysthymic Self-depreciative, pessimistic outlook and philosophy, depressed and sad
f) Obsessive:
Obsessive Rigid in habits and outlook, perfectionist, conscientious, fond of cleanliness, regularity, discipline and punctually, parsimonious
g) Paranoid:
Paranoid extremely suspicious, jealousy prone, doubters, complaining, filing legal suits or police complaints
h) Sociopathic:
Sociopathic Antisocial traits like lying, stealing etc., non-conformist, not observe the codes of morality, ethics and culture, lack of shame, guilt or repentance, unstable and superficial emotional relationships, pleasure seeking, impulsive etc.
i) Schizoid:
Schizoid Shy, reserved, asocial, poor mixers, have few friends, introverted.
j) Mixed:
Mixed when an individual has a mixture of different personality traits.
k) Habits, hobbies:
Habits, hobbies Food fads, Tobacco, Caffeine and other eating, sleep and excretory habits and other interests.
l) Beliefs and Attitudes:
Beliefs and Attitudes Religious, moral and attitudes towards health.
m) Social relations:
Social relations Ability to make friends and relate to those in authority, Membership of societies etc.
n) Lifelong coping resource:
Lifelong coping resource usual capacity to cope with life’s stresses in the past; ability to cope with life’s stresses in the past; ability to maintain and keep friendships or close relations.
o) Alcohol or drug abuse.
p) Any Criminal behaviour.
ix. Checklist of History Obtained:
a) Is the history you have reliable?
b) Is it complete or there are any omissions?
c) Is there need to contact more informants?
d) What are the areas in which you have to concentrate on the subsequent mental status examination (and physical examination)?