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Daniel J. Carlat | 348 pages | 01 Oct 2016 | Lippincott Williams and Wilkins | 9781496327710 | English | Philadelphia, United States The Psychiatric Interview | SIMPLY PSYCH EDU

Want to Read saving…. Want to Read Currently Reading Read. Other editions. Enlarge cover. Error rating book. Refresh and try again. Open Preview See a Problem? Details if other :. Thanks for telling us about the problem. Return to Book Page. Helen Swick Perry Editor ,. Otto Allen Will Introduction. This is a book for all those working in the field of psychiatric disorder. It will be invaluable to medical students and doctors training in general practice, emergency and . At a time when the assessment of psychiatric patients is the responsibility of a range of clinicians, The Psychiatric Interview will also be of assistance to clinical psychologists, This is a book for all those working in the field of psychiatric disorder. At a time when the assessment of psychiatric patients is the responsibility of a range of clinicians, The Psychiatric Interview will also be of assistance to clinical psychologists, social workers and psychiatric nurses. It will also have a place as a reference book for police and security officers. Get A Copy. Paperback , pages. Published February 17th by W. Norton Company first published February More Details Original Title. Other Editions 2. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about The Psychiatric Interview , please sign up. Be the first to ask a question about The Psychiatric Interview. Lists with This Book. This book is not yet featured on Listopia. Community Reviews. Showing Average rating 4. Rating details. More filters. Sort order. Start your review of The Psychiatric Interview. Sep 18, Ian Felton rated it it was ok. This book will take you off-course. Jul 24, Dia rated it really liked it. Ah, if only I could have Harry Stack Sullivan on my shoulder, whispering in my ear as I interview clients Of course just reading this book won't cause one to instantly become an interviewer who's not a schmuck. It takes a lot of practice -- and careful observation and correction of what one is practicing. It takes basic maturity and probably some innate gifts, as well. In any case, whatever it takes, Sullivan shows that it is c Ah, if only I could have Harry Stack Sullivan on my shoulder, whispering in my ear as I interview clients In any case, whatever it takes, Sullivan shows that it is certainly possible to become so artful in one's interviews that the interview itself becomes therapeutic. He shows this with graceful humor and humility. Along the way, he makes interesting, unusual diagnostic comments, some of which one might first think are dated, but on further consideration turn out simply to be countercultural and probably true. Sullivan has much to say about anxiety, that of interviewer as well as interviewee, convincing me that anxiety is central to this and probably every other interpersonal act. This is the safest office set-up:. This is the safest way to position yourself:. Introduce yourself to the patient by informing them immediately who you are and what your role is. Then politely ask the patient for their preferred name and whether they feel comfortable talking to you in the current location. Remind the patient about the confidential nature of the information discussed and to let you know immediately if anything makes them feel uncomfortable. The opening question will vary depending on the setting and context. Jones, what is your understanding of the reason for being brought to the today? In addition, it gives you a sense of the patients thought process and verbal fluency. Allow the patient to speak for at least minutes before interrupting. Patients who ramble on or speak tangentially or circumstantially can be very difficult to interview. Try to give the patient at least minutes to talk uninterrupted before refocusing. K Physical and Neurological Examinations focused, if needed. Anxiety: Apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognized. Anxiety is primarily of intrapsychic origin, in contrast to fear which is the emotional response to a consciously recognized and usually external threat or danger. Anxiety and fear are accompanied by similar physiologic changes. Anxiety may be regarded as pathologic when it is present to such extent as to interfere with effectiveness in living, the achievement of desired realistic goals or satisfactions, or reasonable emotional comfort. Apathetic: Showing lack of interest, or indifference; lacking feeling. Association: Relationship between ideas or emotions by contiguity, by continuity, or by similarities. Autism autistic thinking : A form of thinking which attempts to gratify unfulfilled desires without due regard for reality. Objective facts are distorted, obscured, or excluded in varying degree. Blocking: Difficulty in recollection, or interruption of a train of thought or speech, due to emotional factors usually unconscious. Circumstantial: A characteristic of conversation that proceeds indirectly to its goal idea, with many tedious details and parenthetical and irrelevant additions. Clang Association: Associations that are governed by rhyming sounds, rather than meaning, e. A defensive substitute for hidden and still more unacceptable ideas and wishes. Anxiety results from failure to perform the compulsive act. The belief is maintained against logical argument and despite objective contradictory evidence. Common delusions include:. Delusions of Persecution: Ideas that one had been singled out for persecution. Delusions of Reference: Incorrect assumption that certain casual or unrelated remarks or the behavior of others applies to oneself. Depersonalization: Feelings of unreality or strangeness concerning either the environment or the self. Depression: Psychiatrically, a morbid sadness, dejection or melancholy; to be differentiated from grief which is realistic and proportionate to what has been lost. A depression may vary in depth from neurosis to . See post on grief vs depression. Dissociation: A psychological separation or splitting off; an intrapsychic defensive process which operates automatically and unconsciously. Through its operation, emotional significance and affect are separated and detached from an idea, situation, or object. Dissociation may, unconsciously, defer or postpone experiencing the emotional impact, as for example, in selective amnesia. Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. Flattened Affect: Displaying an abnormally small range of emotional expression. Flight of Ideas: Verbal skipping from one idea to another before the last one has been concluded; the ideas appear to be continuous, but are fragmentary and determined by chance associations. Hallucination: A false sensory perception in the absence of an actual external stimulus; may be of emotional or external chemical , alcohol, etc. Illusion: The misinterpretation of a real, external sensory experience. Inappropriate: Emotional expressions that are not in accord with the Affect situation, or what is being said, e. More superficially, recognition by the patient that he is mentally ill. Loss of Goal: Failure to follow a chain of thought through to a logical conclusion usually elicited by asking a question which the patient starts to answer, but then seems to wander off the subject. Neologism: In psychiatry, a new word or condensed combination of several words coined by a patient to express a highly complex meaning related to his conflicts; not readily understood by others; common in schizophrenia. Obsession: Persistent, unwanted idea or impulse that cannot be eliminated by logic or reasoning. Orientation: Awareness of oneself in relation to time, place and person. Perseveration stereotype : Persistent, mechanical repetition of an activity, common in schizophrenia. Phobia: An obsessive, persistent, unrealistic fear of an external object or situation such as heights, open spaces, dirt, and animals. The fear is believed to arise through a process of displacing an internal unconscious conflict to an external object symbolically related to the conflict. Sensorium: Roughly approximates consciousness. Includes the special sensory perceptive powers and their central correlation and integration in the brain. A clear sensorium conveys the presence of a reasonably accurate memory together with a correct orientation for time, place, and person. General Appearance, Behavior and Attitude : Provide a description of the patient such that another provider could identify the patient after reading it. The following should be noted:. Posture: This should include such things as the way he sits or lies during the interview, restlessness, tension and bizarre or unusual positions. Psychomotor Activity : Describe in detail the motor activity which you observe in the patient. Is this activity increased or reduced? Are his actions spontaneous? Does he initiate activity? Take note of the appropriateness of his motor activity, and of such things as compulsive rituals, fumbling at the bed clothes, assaultness, negativism, attempts to escape and so on. Is he restless, agitated, slowed, pacing, immobile, tremulous, etc.? Are there tics present? Pressured speech is noted when patients talk continuously without allowing the examiner to interject and is a common symptom of bipolar mania and psychosis. Prosody refers to the tune and rhythm of speech and how these features contribute to meaning. The spontaneity of speech refers to an individuals ability to speak without being prompted. This involves feelings at the time of the examination and a few hours preceding it. Best way to assess is to ask the patient directly. Affect: is the objective assessment of the emotional expression of the patient. Characteristics of affect include:. Quality : Is the patient composed, complacent? Is he irritable, angry, happy, elated or exalted? Is he boastful, self-satisfied or expansive? Is he suspicious, distant or aloof? On the other hand, is he indifferent, apathetic, dissociated, perplexed, fearful, anxious or tense? Range : Does the patient exhibit a full range of emotion objectively in response to the interview? Is the range constricted, blunted, or completely absent? Appropriateness to content and situation : Is the affect compatible and appropriate to the ideas expressed. In other words, if the patient is discussing a depressing subject are they laughing and giggling or sad? Normal thought process is logical and goal directed. A formal thought disorder may be characterized by circumstantiality or tangentiality, blocking, neologisms, clang associations, flight of ideas, loose associations. Thought Content : This refers to what the patient is thinking with less emphasis on the form or process. Perceptions: Perceptions include hallucinations, illusions, and somatic complaints. The Psychiatric Interview - PsychDB

Want to Read Currently Reading Read. Other editions. Enlarge cover. Error rating book. Refresh and try again. Open Preview See a Problem? Details if other :. Thanks for telling us about the problem. Return to Book Page. Helen Swick Perry Editor ,. Otto Allen Will Introduction. This is a book for all those working in the field of psychiatric disorder. It will be invaluable to medical students and doctors training in general practice, and psychiatry. At a time when the assessment of psychiatric patients is the responsibility of a range of clinicians, The Psychiatric Interview will also be of assistance to clinical psychologists, This is a book for all those working in the field of psychiatric disorder. At a time when the assessment of psychiatric patients is the responsibility of a range of clinicians, The Psychiatric Interview will also be of assistance to clinical psychologists, social workers and psychiatric nurses. It will also have a place as a reference book for police and security officers. Get A Copy. Paperback , pages. Published February 17th by W. Norton Company first published February More Details Original Title. Other Editions 2. Friend Reviews. To see what your friends thought of this book, please sign up. To ask other readers questions about The Psychiatric Interview , please sign up. Be the first to ask a question about The Psychiatric Interview. Lists with This Book. This book is not yet featured on Listopia. Community Reviews. Showing Average rating 4. Rating details. More filters. Sort order. Start your review of The Psychiatric Interview. Sep 18, Ian Felton rated it it was ok. This book will take you off-course. Jul 24, Dia rated it really liked it. Ah, if only I could have Harry Stack Sullivan on my shoulder, whispering in my ear as I interview clients Of course just reading this book won't cause one to instantly become an interviewer who's not a schmuck. It takes a lot of practice -- and careful observation and correction of what one is practicing. It takes basic maturity and probably some innate gifts, as well. In any case, whatever it takes, Sullivan shows that it is c Ah, if only I could have Harry Stack Sullivan on my shoulder, whispering in my ear as I interview clients In any case, whatever it takes, Sullivan shows that it is certainly possible to become so artful in one's interviews that the interview itself becomes therapeutic. He shows this with graceful humor and humility. Along the way, he makes interesting, unusual diagnostic comments, some of which one might first think are dated, but on further consideration turn out simply to be countercultural and probably true. Sullivan has much to say about anxiety, that of interviewer as well as interviewee, convincing me that anxiety is central to this and probably every other interpersonal act. In the interview, the trick is to allow the interviewee to protect herself enough that she will feel safe enough to speak openly, but not so much that she is out of touch with her actual truths and needs. The psychiatric interview refers to the set of tools that a mental health worker most times a or a psychologist but at times social workers or nurses uses to complete a . 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. As such, one the interview's goals is to collect data that is both valid and reliable. Validity refers to how the data compares to an ideal absolute truth that the interviewer needs to access and uncover. Challenges that might affect the interview validity include can be categorized as patient related factors and interviewer related factors. Patient's related factors include:. Reliability refers to how datasets collected by different interviewers or the same interview at different times compare with one another. Ideal reliability is when a dataset will be stable irrespective of changes in specifics of the data collection. Different interview techniques have been shown to result in variations in the validity and reliability of the collected data. Open-ended question "Tell me about your sleep. From Wikipedia, the free encyclopedia. Psychiatric interview Purpose psychiatric assessment The psychiatric interview refers to the set of tools that a mental health worker most times a psychiatrist or a psychologist but at times social workers or nurses uses to complete a psychiatric assessment. The goals of the psychiatric interview are: Build rapport. Collect data about the patient's current difficulties, past and , as well as relevant developmental, interpersonal and social history. Diagnose the mental health issue s. Understand the patient's personality structure, use of defense mechanisms and coping strategies. Improve the patient's insight. Create a foundation for a therapeutic alliance. Psychiatric interview - Wikipedia

The opening question will vary depending on the setting and context. Jones, what is your understanding of the reason for being brought to the hospital today? In addition, it gives you a sense of the patients thought process and verbal fluency. Allow the patient to speak for at least minutes before interrupting. Patients who ramble on or speak tangentially or circumstantially can be very difficult to interview. Try to give the patient at least minutes to talk uninterrupted before refocusing. K Physical and Neurological Examinations focused, if needed. Anxiety: Apprehension, tension or uneasiness which stems from the anticipation of danger, the source of which is largely unknown or unrecognized. Anxiety is primarily of intrapsychic origin, in contrast to fear which is the emotional response to a consciously recognized and usually external threat or danger. Anxiety and fear are accompanied by similar physiologic changes. Anxiety may be regarded as pathologic when it is present to such extent as to interfere with effectiveness in living, the achievement of desired realistic goals or satisfactions, or reasonable emotional comfort. Apathetic: Showing lack of interest, or indifference; lacking feeling. Association: Relationship between ideas or emotions by contiguity, by continuity, or by similarities. Autism autistic thinking : A form of thinking which attempts to gratify unfulfilled desires without due regard for reality. Objective facts are distorted, obscured, or excluded in varying degree. Blocking: Difficulty in recollection, or interruption of a train of thought or speech, due to emotional factors usually unconscious. Circumstantial: A characteristic of conversation that proceeds indirectly to its goal idea, with many tedious details and parenthetical and irrelevant additions. Clang Association: Associations that are governed by rhyming sounds, rather than meaning, e. A defensive substitute for hidden and still more unacceptable ideas and wishes. Anxiety results from failure to perform the compulsive act. The belief is maintained against logical argument and despite objective contradictory evidence. Common delusions include:. Delusions of Persecution: Ideas that one had been singled out for persecution. Delusions of Reference: Incorrect assumption that certain casual or unrelated remarks or the behavior of others applies to oneself. Depersonalization: Feelings of unreality or strangeness concerning either the environment or the self. Depression: Psychiatrically, a morbid sadness, dejection or melancholy; to be differentiated from grief which is realistic and proportionate to what has been lost. A depression may vary in depth from neurosis to psychosis. See post on grief vs depression. Dissociation: A psychological separation or splitting off; an intrapsychic defensive process which operates automatically and unconsciously. Through its operation, emotional significance and affect are separated and detached from an idea, situation, or object. Dissociation may, unconsciously, defer or postpone experiencing the emotional impact, as for example, in selective amnesia. Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. Flattened Affect: Displaying an abnormally small range of emotional expression. Flight of Ideas: Verbal skipping from one idea to another before the last one has been concluded; the ideas appear to be continuous, but are fragmentary and determined by chance associations. Hallucination: A false sensory perception in the absence of an actual external stimulus; may be of emotional or external chemical drugs, alcohol, etc. Illusion: The misinterpretation of a real, external sensory experience. Inappropriate: Emotional expressions that are not in accord with the Affect situation, or what is being said, e. More superficially, recognition by the patient that he is mentally ill. Loss of Goal: Failure to follow a chain of thought through to a logical conclusion usually elicited by asking a question which the patient starts to answer, but then seems to wander off the subject. Neologism: In psychiatry, a new word or condensed combination of several words coined by a patient to express a highly complex meaning related to his conflicts; not readily understood by others; common in schizophrenia. Obsession: Persistent, unwanted idea or impulse that cannot be eliminated by logic or reasoning. Orientation: Awareness of oneself in relation to time, place and person. Perseveration stereotype : Persistent, mechanical repetition of an activity, common in schizophrenia. Phobia: An obsessive, persistent, unrealistic fear of an external object or situation such as heights, open spaces, dirt, and animals. The fear is believed to arise through a process of displacing an internal unconscious conflict to an external object symbolically related to the conflict. Sensorium: Roughly approximates consciousness. Includes the special sensory perceptive powers and their central correlation and integration in the brain. A clear sensorium conveys the presence of a reasonably accurate memory together with a correct orientation for time, place, and person. General Appearance, Behavior and Attitude : Provide a description of the patient such that another provider could identify the patient after reading it. The following should be noted:. Posture: This should include such things as the way he sits or lies during the interview, restlessness, tension and bizarre or unusual positions. Psychomotor Activity : Describe in detail the motor activity which you observe in the patient. Is this activity increased or reduced? Are his actions spontaneous? Does he initiate activity? Take note of the appropriateness of his motor activity, and of such things as compulsive rituals, fumbling at the bed clothes, assaultness, negativism, attempts to escape and so on. Is he restless, agitated, slowed, pacing, immobile, tremulous, etc.? Are there tics present? Pressured speech is noted when patients talk continuously without allowing the examiner to interject and is a common symptom of bipolar mania and psychosis. Prosody refers to the tune and rhythm of speech and how these features contribute to meaning. The spontaneity of speech refers to an individuals ability to speak without being prompted. This involves feelings at the time of the examination and a few hours preceding it. Best way to assess is to ask the patient directly. Affect: is the objective assessment of the emotional expression of the patient. Characteristics of affect include:. Quality : Is the patient composed, complacent? Is he irritable, angry, happy, elated or exalted? Is he boastful, self-satisfied or expansive? Is he suspicious, distant or aloof? On the other hand, is he indifferent, apathetic, dissociated, perplexed, fearful, anxious or tense? Range : Does the patient exhibit a full range of emotion objectively in response to the interview? Is the range constricted, blunted, or completely absent? Appropriateness to content and situation : Is the affect compatible and appropriate to the ideas expressed. In other words, if the patient is discussing a depressing subject are they laughing and giggling or sad? Normal thought process is logical and goal directed. A formal thought disorder may be characterized by circumstantiality or tangentiality, blocking, neologisms, clang associations, flight of ideas, loose associations. Thought Content : This refers to what the patient is thinking with less emphasis on the form or process. Perceptions: Perceptions include hallucinations, illusions, and somatic complaints. Illusions : Have you ever found yourself misinterpreting shadows or noises? Did you ever feel you were being touched? Did you ever see a ghost? Hallucinations : assess all sensory modalities Auditory, visual, gustatory, olfactory, somatic. Is the patient able to focus during the interview or is the patient inattentive requiring frequent refocusing? Diagnose the mental health issue s. Understand the patient's personality structure, use of defense mechanisms and coping strategies. Improve the patient's insight. Create a foundation for a therapeutic alliance. Foster healing. Patient's related factors include: Shame: the patient might feel ashamed to discuss some of his difficulties. 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. Lack of awareness: patient might have distorted recollection of past events with significant emotional valence. Cognitive deficits: the patient might have a memory deficit that might impair his ability to correctly recall past events. Secondary gain : the patient decided to misrepresent fact in order to gain a certain benefit e. Interviewer related factors include: Powerful feelings of like or dislike that might affect the interviewer objectivity. Lack of experience: the interviewer lack the skills and knowledge necessary to explore a specific area of . Diagnostic bias : the interviewer is invested in a specific psychiatric diagnosis e. 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The Psychiatric Interview by Harry Stack Sullivan

See the pages above. Ask the pertinent social history upfront: this allows you to frame the interview and understand your patient's social situation. In patients with a history of multiple manic and depressive episodes, it can often be overwhelming and not practical to ask about the course of each specific episode. It is useful to obtain in broad strokes the following details instead:. Various medical conditions can relate to psychiatric symptoms, and can also have medication interactions. In brief, you should always ask:. While obtaining your social history, this is a good time to touch on any possible history of trauma. This is a good time to screen for things like borderline personality disorder :. 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. Now that you have finished gathering information, the next steps will be to establish a diagnosis and to formulate the patient. Last edited 3 weeks ago. Table of Contents The Psychiatric Interview. History of Presenting Illness. Diagnosis and Biopsychosocial Formulation. Recommended Reading. Ask neutral questions early. Be careful of using leading questions and piggybacking multiple symptoms along. Occam's Razor should be in the back of your mind. It is always a good idea to have balance of open-ended and close-end questions. This allows you to have some balanced of control over the interview. Ask: why here, and why now? Start with close ended questions, do not ask leading questions. Make them direct! Allow your patients to tell you the story. Doctors have a bad habit of interrupting patients. You should focus on their symptoms for the past month and up to 1 year if necessary. Always Establish the Chronology of Events Timing is everything. When there is concomitant substance use in the context of mood symptoms, ask specifically: did the mood symptoms appear before , or after the substance use started? Substance use can masquerade as a depression or anxiety disorder substance-induced mood disorder or substance-induced anxiety disorder. Sleep is more than just good or bad, you need to ask specific questions about the nature of the sleep:. Are you told you snore at night? ADHD screen may be applicable here. Now may be a good time to ask about eating disorders always ask, because patients do not volunteer eating disorder information! Sleep changes difficulty falling or staying asleep, or restless, unsatisfying sleep? Sexual indiscretion when you normally wouldn't? Having sexual relations with strangers? Anxiety results from failure to perform the compulsive act. The belief is maintained against logical argument and despite objective contradictory evidence. Common delusions include:. Delusions of Persecution: Ideas that one had been singled out for persecution. Delusions of Reference: Incorrect assumption that certain casual or unrelated remarks or the behavior of others applies to oneself. Depersonalization: Feelings of unreality or strangeness concerning either the environment or the self. Depression: Psychiatrically, a morbid sadness, dejection or melancholy; to be differentiated from grief which is realistic and proportionate to what has been lost. A depression may vary in depth from neurosis to psychosis. See post on grief vs depression. Dissociation: A psychological separation or splitting off; an intrapsychic defensive process which operates automatically and unconsciously. Through its operation, emotional significance and affect are separated and detached from an idea, situation, or object. Dissociation may, unconsciously, defer or postpone experiencing the emotional impact, as for example, in selective amnesia. Euphoria: An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. Flattened Affect: Displaying an abnormally small range of emotional expression. Flight of Ideas: Verbal skipping from one idea to another before the last one has been concluded; the ideas appear to be continuous, but are fragmentary and determined by chance associations. Hallucination: A false sensory perception in the absence of an actual external stimulus; may be of emotional or external chemical drugs, alcohol, etc. Illusion: The misinterpretation of a real, external sensory experience. Inappropriate: Emotional expressions that are not in accord with the Affect situation, or what is being said, e. More superficially, recognition by the patient that he is mentally ill. Loss of Goal: Failure to follow a chain of thought through to a logical conclusion usually elicited by asking a question which the patient starts to answer, but then seems to wander off the subject. Neologism: In psychiatry, a new word or condensed combination of several words coined by a patient to express a highly complex meaning related to his conflicts; not readily understood by others; common in schizophrenia. Obsession: Persistent, unwanted idea or impulse that cannot be eliminated by logic or reasoning. Orientation: Awareness of oneself in relation to time, place and person. Perseveration stereotype : Persistent, mechanical repetition of an activity, common in schizophrenia. Phobia: An obsessive, persistent, unrealistic fear of an external object or situation such as heights, open spaces, dirt, and animals. The fear is believed to arise through a process of displacing an internal unconscious conflict to an external object symbolically related to the conflict. Sensorium: Roughly approximates consciousness. Includes the special sensory perceptive powers and their central correlation and integration in the brain. A clear sensorium conveys the presence of a reasonably accurate memory together with a correct orientation for time, place, and person. General Appearance, Behavior and Attitude : Provide a description of the patient such that another provider could identify the patient after reading it. The following should be noted:. Posture: This should include such things as the way he sits or lies during the interview, restlessness, tension and bizarre or unusual positions. Psychomotor Activity : Describe in detail the motor activity which you observe in the patient. Is this activity increased or reduced? Are his actions spontaneous? Does he initiate activity? Take note of the appropriateness of his motor activity, and of such things as compulsive rituals, fumbling at the bed clothes, assaultness, negativism, attempts to escape and so on. Is he restless, agitated, slowed, pacing, immobile, tremulous, etc.? Are there tics present? Pressured speech is noted when patients talk continuously without allowing the examiner to interject and is a common symptom of bipolar mania and psychosis. Prosody refers to the tune and rhythm of speech and how these features contribute to meaning. The spontaneity of speech refers to an individuals ability to speak without being prompted. This involves feelings at the time of the examination and a few hours preceding it. Best way to assess is to ask the patient directly. Affect: is the objective assessment of the emotional expression of the patient. Characteristics of affect include:. Quality : Is the patient composed, complacent? Is he irritable, angry, happy, elated or exalted? Is he boastful, self-satisfied or expansive? Is he suspicious, distant or aloof? On the other hand, is he indifferent, apathetic, dissociated, perplexed, fearful, anxious or tense? Range : Does the patient exhibit a full range of emotion objectively in response to the interview? Is the range constricted, blunted, or completely absent? Appropriateness to content and situation : Is the affect compatible and appropriate to the ideas expressed. In other words, if the patient is discussing a depressing subject are they laughing and giggling or sad? 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. Lack of awareness: patient might have distorted recollection of past events with significant emotional valence. Cognitive deficits: the patient might have a memory deficit that might impair his ability to correctly recall past events. Secondary gain : the patient decided to misrepresent fact in order to gain a certain benefit e. Interviewer related factors include: Powerful feelings of like or dislike that might affect the interviewer objectivity. Lack of experience: the interviewer lack the skills and knowledge necessary to explore a specific area of pathology. Diagnostic bias : the interviewer is invested in a specific psychiatric diagnosis e. Gynaecology Maternal—fetal medicine Obstetrics Reproductive endocrinology and infertility Urogynecology. Biological psychiatry Child and adolescent psychiatry Cognitive neuropsychiatry Cross-cultural psychiatry Developmental disability Descriptive psychiatry Eating disorder Emergency psychiatry Forensic psychiatry Geriatric psychiatry Immuno- psychiatry Liaison psychiatry Military psychiatry Narcology Neuropsychiatry Palliative medicine Pain medicine Psychotherapy Sleep medicine. 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