The Psychiatric Interview In Clinical Practice ((FULL))
It has been nearly a half-century since the inaugural edition of The Psychiatric Interview in Clinical Practice, and the book's status as a classic was again validated with the second edition a decade ago. This new, third edition maintains the book's reputation with thoroughly updated content that reflects changes brought about by the publication of DSM-5. The book presents the psychiatric interview in the context of the enormous and ongoing progress that has been made in biological and descriptive psychiatry. In addition, the book emphasizes the shift in the social relationship between patient and clinician, recognizing that the therapeutic alliance has become the foundation of all medical treatment efforts and that patients are now better informed and seek active involvement in treatment decisions. The text reflects this growing equality and supports the clinician's efforts to nurture the relationship for optimum therapeutic outcomes. The chapter on the traumatized patient has been completely updated for this edition, and a chapter on the patient with dissociative identity disorder has been added. Clinicians familiar with the previous edition will be pleased that its commonsense, easy to-use structure has been retained even as its content has been thoroughly revised. The Psychiatric Interview in Clinical Practice will benefit mental health clinicians, both seasoned and in training, ensuring that their skills are current and their knowledge cutting-edge.
The Psychiatric Interview in Clinical Practice
The Psychiatric Interview involves a balance of being empathetic, asking the right questions, and thinking about the diagnostic criteria carefully for psychiatric disorders. Remember, everyone has a different way of interviewing, but every question you ask should have a purpose. Are you trying to elicit symptoms? Understand someone's life history? Understand their safety risks? Just as a good surgeon makes no unnecessary incisions on the patient during a surgery, a good psychiatrist should ask no unnecessary questions during the interview. This does not mean that your interview be devoid of substance or empathy, but that you make every question count. Below is a template to guide you.
During the interview, you should pay attention to the mental status examination (MSE). The MSE is a systematic way of describing a patient's mental state at the time you were doing a psychiatric assessment.
The COVID-19 pandemic has forced to rapidly encourage the use of face masks during medical consultations, with significant implication for psychiatry. This study examined the opinions and attitudes of psychiatrists toward the impact of wearing a face mask on the psychiatric interview. 513 psychiatrists and trainee psychiatrists completed an electronic survey about the impact of wearing a face mask on the psychiatric interview. Less efficiency in capturing clinical signs/symptoms, emergence of false inferences in patients and altered patient-clinician interactions were commonly reported negative impacts of face mask (66-96%). The quality of the therapeutic alliance was reported as affected by the mask by 47% of the sample. Results were mixed on the use of telepsychiatry as a potential solution to mask-related inconvenience. The use of face masks has significant negative effects on the psychiatric interview. Providing specific training to clinicians could be a potential solution for masks-induced biases.
Because of the COVID-19 pandemic, many health care systems around the world were forced to rapidly encourage the use of face masks during all psychiatry visits. This unprecedented scenario provided a unique opportunity to assess the opinions and attitudes of psychiatrists toward the impact of wearing a face mask on the psychiatric interview.
The survey followed the CHERRIES statement for online surveys [6]. Practices in the pandemic context starting from the beginning of the first nationwide lockdown on 17th March 2020 in France were qualitatively explored. The survey included 23 questions about the impact of wearing a face mask on the medical practice in the context of COVID-19, as well as questions about telepsychiatry that allows interactions without masks (the survey is available in online supplement S1 and S2). The survey completion time was around 5-minutes. The weblink to the online questionnaire was sent through email listings of psychiatric hospitals, social networks and federative associations of French psychiatrists and trainee psychiatrists.
Five hundred and thirteen (N=513) respondents returned the survey, with a response rate of 3% of estimated eligible respondents. Characteristics of the respondents are described in the online supplement S3. Briefly, respondents were distributed across all age groups (mean 33.8 years old, range: 24-69 years), 73% (N=373) were female, with the majority being young psychiatrists (less than 15 years of practice: N=459, 90%). The majority of respondents were adult psychiatrists and trainee psychiatrists. A large range of psychiatric disorders was represented across practices, as well as both in- and outpatients. Numbers of weekly seen patients ranged mostly between 10-30 (N=239, 47%) and 30-50 (N=131, 26%).
The vast majority of psychiatrists wore masks during consultations at all time (N=462, 90.1%), while less than half of patients wore masks at all time (N=238, 46%). Most respondents considered that the overall quality of their consultations had deteriorated since the use of face masks (N=461, 83%). Consultation durations with face masks were mostly unchanged in comparison to without face masks (N=440, 86%, n=440). The majority of respondents reported that the wearing of a mask by the patient biases the collection of clinical signs/symptoms that involves both verbal and non-verbal cues (N=340, 66% and N=477, 93%, respectively). Similarly, most reported that the wearing of a mask by the psychiatrist biases the collection of clinical signs/symptoms that involves both verbal and non-verbal cues (N=287, 68% and N=426, 83%, respectively). The risk of false inferences or beliefs emergence associated with the wearing of a mask by both the patient and the psychiatrist was almost always considered to be present (N=494, 96%, N=489, 95%, respectively). Most respondents reported a negative impact when both the patient and the psychiatrist wear a mask on the psychiatrist-patient interaction during the clinical interview (N=370, 72.1% and N=385, 75%, respectively), while half considered that the quality of the therapeutic alliance was similar when the psychiatrist and/or the patient wear a mask in comparison to not wearing a mask (N=271, 53%; Table 1, online supplement S3).
At time of the survey, telepsychiatry using videoconferencing had been used by 41% (N=211) of the respondents while 39% (N=198) judged they gained new skills in using telepsychiatry equipment during the pandemic. In parallel, telepsychiatry was reported as useful by a vast majority of the respondents (N=502, 97%). Most telepsychiatry users reported that the clinical interview was better in person than with telepsychiatry (without masks) for a first evaluation (N=169, 80%) and for the evaluation of known unstable patients (N=163/211, 77%), while half reported that telepsychiatry was more convenient for the evaluation of known stable patients (49%, n=103/211). The majority of responders judged that telepsychiatry could be a solution for mask inconvenience through the pandemis (is a solution: N=229, 44.6%, might be a solution: N=251, 48.9%; Table 1, online supplement S3).
Our study shows that psychiatrists express an overall interest toward telepsychiatry in the context of the COVID-19 pandemic, corroborating previous results [15]. However, few patients were seen with telepsychiatry by responders, and a minority felt they had acquired telepsychiatry skills during the pandemic. Opinions were mixed on the use of telepsychiatry as a potential solution to mask inconvenience. While uncovered faces during remote consultations could facilitate the clinical interview, this results might reflects some challenges health care providers report with telepsychiatry such as inadaptability to use conference devices and lack of sense of connection with the patient [15].
Some limitations of this study need to be considered. First, our response rate was low and the majority of respondents were young clinicians. Therefore unwanted selection biases were possible, potentially hampering our efforts to capture comparisons between masked and unmasked psychiatric interviews. Second, because this was a survey study, response biases might have occurred. Longitudinal studies will be needed to assess whether face masks have any impact on outcomes for patients, including misdiagnosis, non-adherence or relapses.
Less efficiency in capturing clinical signs and symptoms, emergence of false inferences and altered patient-clinician interaction were commonly reported negative impacts of face mask on the psychiatric interview. Providing training to clinicians on the correct usage of face mimics, body postures and prosody to speak clearly through a mask [12] could be a potential solution for masks-induced biases during the psychiatric interview.
Recently, our team published several articles demonstrating that ECAs can conduct reliable and valuable clinical interviews and make psychiatric diagnoses (depression and addiction) in outpatients seen in a sleep clinic.6,7,26 In addition, we showed that a VMA was better accepted than a questionnaire displayed on a tablet to diagnose major depressive disorder (MDD).25 In this new study, we explored the impact of both the characteristics of the user and the context of the psychiatric interview covered by the VMA (for depression or addiction screening) on engagement, acceptance, and trust, and attempted to determine the threshold of acceptance and trust in VMAs that are associated with positive engagement. 041b061a72