When Your Loved One Has a Mental Illness

The psychiatric interview is the main tool in psychiatry. First and foremost it helps one to understand the problems the patient may have. It also helps to identify the signs and symptoms, to enable the clinician make appropriate diagnosis.

Equally very importantly, it helps in initiating treatment and predicting the outcome. The interview therefore, helps to seek clarification of the problems in the patient as he is given an opportunity to express himself, as well as the family members.

It is also not a judgmental or critical assessment. There are many reasons why patients and relatives seek mental health services. It may be voluntary, or because of pressure from parents or co-workers, it may also be as a result of order from the police or court.

The clinician therefore must be trained on what to ask, how to ask and when to ask, and also to know how to interpret the response and reaction of the patient. This is because; the complaints from the patients and relatives may seem bizarre and confusing.

SETTING OF THE PSYCHIATRIC INTERVIEW

•    Observation Of Behaviour:

The interview starts from the moment the patient walks into the consulting room. The physical appearance and the gait should be noted. Normal greeting and introduction should be done. Reason for referral should be made known to the patient.

While doing this, the clinician would focus on verbal and non-verbal communication. For example, the facial expression, reluctance to talk by the patient, constant checking around the room, are all important, for both clinical as well as medico-legal use.

In case of language barrier, an interpreter will be essential who shares the same cultural background with the patient because many psychiatric symptoms vary from culture to culture in presentation.

Argument with the patient should be avoided, and at all times, the clinician should make sure he understands what the patient says or feels. One way of clarifying what the patient says is to summarize a number of times during the interviews.

For young clinician emotional outburst by the patient like weeping may make the clinician feel awkward and confused as to what to do, but all the same, the patient should be offered the opportunity to unburden these feelings which may have a calming effect.

Sensitive topics, are generally handled carefully, as it is best to introduce them gradually e.g. many people have difficulties talking about their sexual life.

So statements like “I know it’s difficult talking about sexual experiences, but it is very important to our care,” this may then encourage the patient to start the discussion.

Sometimes, the patient may not respond to the questions posed to him. This may be as a result of the patient trying to sort out his thoughts, or he may just not wish to respond to that particular question.

This should be kept in mind for further discussion later in the interview or some other day.

•    Active Observation and Awareness of Behaviour:

Non-verbal communication such as facial expression, resistance during the interview as well as absence of eye contact and suspicious expressions from the patient are all important cues.

The patient may need to be prompted to cooperate to answer questions from the interviewer by establishing rapport and shared feelings of mutual respect and understanding.

Another significant attitude encountered by a novice is when a patient talks about suicidal feelings. The important point is when and how to ask such questions when a patient describes feelings of hopelessness and worthlessness.

The appropriate way to ask is “when you feel so low, do you sometimes feel that life is not worth living?”

Sometimes the patient may show resistance and this is to be kept in mind for further discussion. It is best to introduce sensitive topics gradually, carefully and tactfully.

In Summary there are Three Phases of the Interview

•    The initial Phase:

From the moment the patient walks in through the door, observation is made about his appearance, and gait. The clinician should greet the patient and introduce himself. The patient should be addressed properly and correctly in keeping with traditional norms, age and social status. Questions should be open-ended and simple as questions that begin with “why” are usually difficult to answer and create resistance, hence should be avoided

•    The Middle Phase:

This part focuses on the background of the patient, his early childhood life, family life, educational and vocational life as well as interpersonal relationship. The influences, attitude and behaviours of the patient is also considered here.

•    Closing Phase:

Patients are usually given the opportunity to ask questions or clarify issues or points that were not covered during the interview.

The Psychiatric Assessment

•    Identifying Data:

The name, age, sex and marital status of the patient need to be clearly written.

•    The Referral System:

The source of referral is equally noted, whether by a member of the family, health worker or self-accord, indicating the main reason for referral.

•    Chief Complaint:

This is a brief statement of why the patient seeks help. If the patient is uncooperative, then the family’s story should be taken, as sometimes the patient may not see himself as needing help, or may be unable to speak.

•    History Of Present Illness:

Records of the complaints are noted and explored in detail and in chronological order. This usually entails beginning from the time when the patient started feeling discomfort and its consequences on his family life and his career or occupation.

Other symptoms associated with the chief complaints are also documented. These are usually psychosocial stress factors being experienced by the patient, as well as physical illness. These two should be noted.

•    Past Psychiatric And Medical Illnesses:

If there are previous physical and emotional illnesses of the patient in the past, they should be documented as well as the type of investigation and their results. Also included are the treatment received and outcome of investigation done.

•    Family History:

We would want to know whether it is nuclear family or a polygamous one. It is important to note the name, age, sex, marital status and occupation of each member of the family. It is useful to find out if there is any family member who has a mental illness or medical illness that is currently being treated or previously treated.

•    Personal History:

A comprehensive picture of the patient is taken note of and factors in the past which should be explored, these include, medical, surgical, and psycho social difficulties.

- Pregnancy and early development

- Childhood to puberty

- Adolescence to 19 years.

•    Occupational History:

The areas involved are the age and the works history that the patient has been engaged in previously, job satisfaction; growth and development or deterioration in each of the jobs are also considered.

•    Marital History:

Enquiries about the age when the patient got married and whether the marriage was a personal decision or arranged by the family, should be made. The health and personality of the spouse plays an important role in the relationship.

•    Sexual History:

Information about the sexual life is an important history, but care should be taken when eliciting the history, so as not to embarrass the patient. If there are indications there is a sexual problem, then a detailed sexual history is necessary.

The view of the patient, his attitude towards sex and his sexual experiences in the past also need to be taken.

MENTAL STATE EXAMINATION:

Quite a great deal of the mental status examination is obtained during the interview about the present illness as well as the following, using these guidelines.

•    General Appearance:

The gait, physical characteristics, facial expression, posture are taken note of. Also the state of awareness, drowsiness, or coma should also be noted.

•    Speech-

Take note of the volume, rate and clarity of the speech.

•    Mood

This refers to the expression of emotion of the patient. The mood could be described as irritable, excited or elevated. It could also be depressed or inappropriate.

•    Thoughts:

The thought components...