Psychiatric interview
Purposepsychiatric assessment

The psychiatric interview refers to the set of tools that a mental health worker (most times a psychiatrist, psychologist, or advanced practice provider but at times social workers or nurses) uses to gather information from the patient to complete a psychiatric assessment.[1][2] A diagnosis and treatment plan is created based on the psychiatric assessment. The components of the psychiatric interview include a detailed history and mental status examination.[3]

Goals of the interview

The goals of the psychiatric interview are:

The data collected through the psychiatric interview is mostly subjective, based on the patient's report, and many times can not be corroborated by objective measurements.[4] As such, one the interview's goals is to collect data that is both valid and reliable.[1]

Interview structure

There are 2 main accepted structures a psychiatric interview may follow.[4] These formats use different approaches but aim to gather the same information.[4]

  • Fully structured psychiatric interview: This interview follows a set of specific questions, asked in a specific order.[4] The questions are designed to elicit information that conforms to diagnostic criteria specified in the DSM-5.[4] Structured interviews are developed to be more reliable, and can be performed by less experienced interviewers.[4] Structured interviews rely heavily on binary yes or no answers and depend on the patient having some degree of insight into their condition prior to the start of the interview.[4] This structure of interview attempts to elicit objective data from the patient's subjective experience.[4]
  • Conversational, semi-structured interview: This interview uses a conversational format in order to gather information on a predetermined list of topics.[4] Questions can be asked and answered in any order to gather this information.[4] Question format is up to the interviewer to decide as the conversation progresses.[4] If the patient responds with yes or no answers, the interviewer must seek further clarification.[4] This style of interview requires an experienced interviewer.[4] This structure of interview attempts to elicit the patient's full, subjective narrative of their condition.[4]

Components of the interview

The psychiatric interview can be an experience that causes the patient shame, so it is important to start the interview by creating a space of psychological safety.[4] The interviewer elicits the patient's chief complaint, or the reason the patient appeared for psychiatric evaluation, as well as symptoms the patient is currently experiencing and possible precipitating factors.[3] The interviewer asks about pertinent medical history, including past medical diagnoses, family history of medical conditions, current medications, and allergies.[3] The interviewer asks about psychiatric history, including psychiatric diagnoses, past psychiatric medication trials, current psychiatric medications, past suicide attempts, past in-patient psychiatric hospitalizations, out-patient psychiatric provider, and family history of psychiatric conditions.[3][5] The interviewer will ask about social history, including drug use, alcohol use, occupation, family and social support, living situation, trauma history, and stressors.[3] Mental status exam or mini-mental status exam is completed.[3] Based on the information that is gathered, other indicated testing, such as an IQ test, Minnesota Multiphasic Personality Inventory, or Rorschach test, may also be administered during the interview.[5] In a fully structured psychiatric interview, information is gathered in a predetermined order, whereas a conversational interview, information can be gathered in any order, as the patient may become more comfortable sharing information or remember more information as the interview progresses.[4] Information is gathered through the observation of patient behavior, as well as through the information shared by the patient.[3] The gathered information is used to complete a psychiatric assessment in order to determine a diagnosis, differential diagnoses, and treatment plan.[3] Diagnosis is made primarily based on the DSM-5-TR and ICD criteria.[5][6]

Considerations

Several considerations must be made depending on the presentation of the patient.

  • Homicidal ideation: If a patient is expresses thoughts of harming others, the interviewer should take precautions for their own safety.[5] Possible in-patient hospitalization should be considered.[3] The provider must inquire about homicidal ideation, even if it is uncomfortable for the patient.[3] Per Tarasoff v. Regents of the University of California, if a patient makes credible threats of harm to others during an encounter with a provider, the subject of the threats must be informed.[5]
  • Suicidal ideation: Suicidality must be evaluated in all patients. It is especially important to evaluate in depressed patients, who have a high risk of suicidal thoughts and behaviors.[3][5] Other conditions that increase risk for suicidal thoughts and attempts include bipolar disorder, schizophrenia, panic disorder, substance use disorders, and neurocognitive disorders.[3] Other risk factors for suicide include male sex, white or Native American race, and older age.[3] During the interview, it is important to discern between active and passive suicidal ideation and whether the patient has access to means to complete their plan.[5] Patients who are actively suicidal should be hospitalized.[5]
  • Agitated patients: If a patient is experiencing agitation, the interviewer should take precautions for their own safety to avoid injury.[5] It is important for the provider to consider hospitalization, sedating medications, and restraints for the safety of the patient, their family and friends, and medical staff.[3] Etiology of the agitation should be determined.[3]
  • Delusional patients: If a patient is delusional, it is important that the interviewer does not validate the delusion.[5]

Challenges

Validity refers to how the data compares to an ideal absolute truth that the interviewer needs to access and uncover.[4] Challenges that might affect the interview validity include can be categorized as patient related factors and interviewer related factors.[4]

Patient's related factors include:

  • Shame: the patient might feel ashamed to discuss some of their difficulties.[4]
  • Fear of being judged: while not ashamed the patient might be reluctant to discuss some of the issues that she thinks that she can be judged for.[3]
  • Lack of awareness: patient might have distorted recollection of past events with significant emotional valence.
  • Lack of insight: patient may not be cognizant of their condition or symptoms.[3]
  • Cognitive deficits: the patient might have a memory deficit that might impair his ability to correctly recall past events.[3]
  • Secondary gain/malingering: the patient decided to misrepresent fact in order to gain a certain benefit (e.g. disability benefits) or avoid a certain penalty (e.g. insanity defense).
  • Transference: Powerful feelings of like or dislike based on past experiences which the patient may unconsciously have towards the interviewer.[7]
  • Education: patient's understanding of interview questions may be affected by their education level.[3]
  • Language: patient's proficiency in the language the interview is conducted in may affect their ability to respond to questions fully.[3]

Interviewer related factors include:

  • Countertransference: Powerful feelings of like or dislike based on past experiences that unconsciously might affect the interviewer's objectivity.[3][7]
  • Lack of experience: the interviewer lack the skills and knowledge necessary to explore a specific area of pathology.[2]
  • Medical jargon: use of complex medical terms by the interviewer may cause the patient confusion and result in an incomplete data collection.[3]
  • Diagnostic bias: the interviewer is invested in a specific psychiatric diagnosis (e.g. same patient might be diagnosed with schizophrenia by a schizophrenia researcher or bipolar disorder with psychotic features by a bipolar disorder researcher).[4]

Reliability refers to how datasets collected by different interviewers or the same interview at different times compare with one another.[4] Ideal reliability is when a dataset will be stable irrespective of changes in specifics of the data collection.[4]

Validity and reliability of the interview can be improved by helping the patient communicate their history and symptoms clearly.[3] This can be done through empathetic listening and establishing a strong therapeutic alliance.[3] Different interview techniques have been shown to result in variations in the validity and reliability of the collected data.[4] Open-ended question ("Tell me about your sleep.") have been shown to have better validity but less reliability than closed-ended questions("Do you have sleeping difficulties?")[4]

References

  1. ^ a b c d Savander, Enikö Èva; Hintikka, Jukka; Wuolio, Mariel; Peräkylä, Anssi (2021-05-10). "The Patients' Practises Disclosing Subjective Experiences in the Psychiatric Intake Interview". Frontiers in Psychiatry. 12 605760. doi:10.3389/fpsyt.2021.605760. ISSN 1664-0640. PMC 8141629. PMID 34040547.
  2. ^ a b c d e f The Psychiatric Interview. Springer Publishing Company. 2023-08-20. ISBN 978-0-8261-6263-2.
  3. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab "The Psychiatric Interview", Massachusetts General Hospital Handbook of General Hospital Psychiatry, W.B. Saunders, pp. 25–38, 541–554, 2010-01-01, retrieved 2026-03-11
  4. ^ a b c d e f g h i j k l m n o p q r s t u v w x Nordgaard, Julie; Sass, Louis A.; Parnas, Josef (2013). "The psychiatric interview: validity, structure, and subjectivity". European Archives of Psychiatry and Clinical Neuroscience. 263 (4): 353–364. doi:10.1007/s00406-012-0366-z. ISSN 0940-1334. PMC 3668119. PMID 23001456.
  5. ^ a b c d e f g h i j Ganti, Latha; Blitzen, Sean; Kaufman, Matthew (2016). First Aid for the Psychiatry Clerkship (4th ed.). New York: McGraw Hill. pp. 12–19. ISBN 978-0-07-184175-7.
  6. ^ Faiad, Y.; Khoury, B.; Daouk, S.; Maj, M.; Keeley, J.; Gureje, O.; Reed, G. (December 2012). "Frequency of use of the International Classification of Diseases ICD-10 diagnostic categories for mental and behavioural disorders across world regions". Epidemiology and Psychiatric Sciences. 27 (6): 568–576. doi:10.1017/S2045796017000683. ISSN 2045-7960. PMC 6999009. PMID 29117869.
  7. ^ a b Prasko, Jan; Ociskova, Marie; Vanek, Jakub; Burkauskas, Julius; Slepecky, Milos; Bite, Ieva; Krone, Ilona; Sollar, Tomas; Juskiene, Alicja (2022). "Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application". Psychology Research and Behavior Management. 15: 2129–2155. doi:10.2147/PRBM.S369294. ISSN 1179-1578. PMC 9384966. PMID 35990755.