Download Psychiatric Interview and Communication Techniques and more Exams Psychology in PDF only on Docsity!
Psychology exam questions with answers
1. Psychiatric interview: the process by which psychiatric assessment is conduct-
ed -primary tasks
- building a therapeutic alliance between the PMHNP & client
- obtaining a database of psychiatric info about the client
- establishing a dx
- negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and warmth -most important goal of the interview process -the cooperative working relationship between the therapist and client
- begins during the initial or opening phase of the interview -fundamental component of successful therapy
- Without trust, adherence to treatment recommendations may be compromised
- interview may not elicit the information needed to formulate an appropriate dx & plan of care without rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive -Actively Defuse the Strangeness of the Clinical Situation -Give Your Patient the Opening Word -Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing material): -
-Normalization -Symptom Expectation
-Symptom Exaggeration -Reduction of Guilt -Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
- ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true for you?
2.Begin by describing another patient (or patients) who has engaged in the
behavior, showing your patient that she is not alone
- ex: I've talked to several patients who've said that their depression causes them to have strange experiences, like hearing voices or thinking that strangers are laughing at them. Has that been happening to you?
6. Symptom Expectation: communicate that a behavior is in some way normal or
expected -Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that you will not be offended by a positive response -high index of suspicion of some self-destructive activity -Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you had any thoughts that you'd be better off dead?" you might decide to use symptom expectation. "What kinds of ways to hurt yourself have you thought about?" *reserve this technique for situations in which it seems appropriate
11. three phases of the psychiatric interview: 1. Opening phase
2.Body of the Interview
3.Closing the Interview
12. Opening phase: -first 5-10 minutes
-establish rapport & therapeutic alliance -often most important phase
- establishes the foundation -begins with PMHNP asking "what brought you in to see me today?"
13. Body of the Interview: -30-40 minutes
-Chief Complaint Established
- additional Q's asked to elicit info r/t the complaint -ask about HPI, family hx, social/developmental hx, medical hx, psychiatric ROS -basis for dx and tx formulation
14. Closing the Interview: -5-10 minutes, final phase
Should include 2 components: discussion of your assessment using patient educa- tion techniques & negotiated agreement about tx or f/u plans -wrap-up statement and inquiry about missing info that may be of value -Patient education regarding working dx & recommended plan of tx
- education about meds if recommended -Homework may be assigned
- especially in CBT -Return visit agreed upon
15. Four Tasks of the Diagnostic Interview: 1. Build a therapeutic alliance
2.Obtain the psychiatric database
3.Interview for diagnosis
4.Negotiate a tx plan with your patient
16. Obtain the Psychiatric Database: Also known as the psychiatric history
-includes historical information relevant to the current clinical presentation
- history of present illness, psychiatric history, medical history, family psychiatric history, and aspects of the social and developmental history
17. Tricks for Improving Patient Recall: -Anchor Questions to Memorable Events
- major transitions (graduations and birthdays), holidays, accidents or illnesses, major purchases (a house or a car), seasonal events ("hurricane Katrina"), or public events (such as 9/11 or President Obama's election) -Tag Questions with Specific Examples
- similar to posing multiple-choice questions, specifically for areas in which your patient is having trouble with recall -Define Technical Terms
- patient's vague recall may be a lack of understanding of terms
18. How to Change Topics with Style: -Smooth Transition
- cue off something the patient just said to introduce a new topic -Referred Transition
- refer to something the patient said earlier in the interview to move to a new topic -Introduced Transition
- introduce the next topic or series of topics before actually launching into it
19. Techniques for the Reluctant Patient: -Open-Ended Questions and Com-
mands
- increase the flow of information -Continuation Techniques, keep the flow coming:
- Go on.
represents: Why are you so anxious?: Nontherapeutic communication technique: Asking for Explanations
22. therapeutic or nontherapeutic communication & communication tech- nique it
represents: Why don't you and John get married?: Nontherapeutic communication technique: Asking Personal Questions
23. therapeutic or nontherapeutic communication & communication tech- nique it
represents: What would you like to talk about today?: Therapeutic communication technique: Broad Openings
24. therapeutic or nontherapeutic communication & communication tech- nique it
represents: What do you think you should do about it?: Therapeutic communication technique: Reflecting
25. therapeutic or nontherapeutic communication: Older adults are always
confused.: Nontherapeutic
26. therapeutic or nontherapeutic communication & communication tech- nique it
represents: I don't see anyone else in the room.: Therapeutic communication technique: Presenting Reality
27. therapeutic or nontherapeutic communication & communication tech- nique it
represents: If I was you, I'd take a break from school.: Nontherapeutic communication technique: Giving Advice
28. therapeutic or nontherapeutic communication & communication tech- nique it
represents: I'm so sorry about your mastectomy; it must be terrible to lose a breast.: Therapeutic communication technique: Sympathy
29. therapeutic or nontherapeutic communication & communication tech- nique it
represents: Today we have talked about a plan for you to manage feelings of anger.: Therapeutic communication technique: Summarizing
30. therapeutic or nontherapeutic communication & communication tech- nique it
represents: You shouldn't even think about assisted suicide; it's not right.: Nontherapeutic communication technique: Disapproval
31. therapeutic or nontherapeutic communication & communication tech- nique it
represents: You seem upset about something.: Therapeutic communication technique: Making an Observation
32. therapeutic or nontherapeutic communication & communication tech- nique it
represents: No one here would intentionally lie to you.: Nontherapeutic communication technique: Defensive Responses
33. therapeutic or nontherapeutic communication & communication tech- nique it
represents: Don't worry, everything will be all right.: Nontherapeutic communication technique: False Reassurance
34. Translating emotions:: Sharing observations
Sharing empathy Sharing hope Sharing humor Sharing feelings
35. Non-verbal communication:: Active listening
Using touch Using silence
36. Information verification/dissemination:: Providing information
Clarifying Focusing Paraphrasing Validation Asking relevant questions
37. Psychiatric Interview versus the Medical Interview: most notable difference is
facilities, private practice, primary care, homeless shelters, or homecare
- may self-refer or be referred by another provider for support, guidance, and medication management, or court-ordered therapy
42. interview environment: -comfortable, clean space to put provider & client at
ease -a visible clock to monitor time -access to alarms or other safety measures -provider access to the door for safe exiting -removal of sharp objects such as scissors or letter openers -a noise-canceling device for privacy
43. Interview: Time Considerations: Be on time.
-Don't be late! -Schedule appointments thoughtfully to ensure promptness. Stay on time. -builds trust and communicates that respect for the client. Discuss follow-up visits in the closure phase of the interview -The timing of subsequent visits is informed by the client's unique circumstances, diagnosis and treatment, and medication regimens.
44. Therapeutic Communication: Verbal
-Active Listening: listening attentively to insure understanding -Broad Openings: allow clients to take initiative -Accepting: indicate you heard the client without judgment -Clarifying: make vague topics clear -Exploring: examine topics deeper -Focusing: putting attention into a single topic -Reflecting: direct the client's thoughts and feelings back to the client
-Restating: repeat the client's words in a different way to make more clear Nonverbal -Positive techniques
- relaxed movements
- open arm gestures
- smiles
- respect for personal space
- eye contact
- nods when clients talk can communicate agreement or understanding -negative body language
- finger-pointing
- crossed arms
- looking at a watch
45. Psychiatric Interview Long Form: adapted from the one used by Anthony
Erdmann, an attending psychiatrist at MGH. He takes notes on it while talking to patients and puts it in his chart Advantages -ensures a thorough data evaluation and saves time, because notes can be placed directly into the chart Disadvantages -patients may be alienated if you seem more interested in completing a form than in getting to know them
46. Psychiatric Interview Short Form: can be used for rough notes
-when you are going to dictate the evaluation or write it up in a longer version
Advantages -increase patients' understanding of their diagnosis -sense that they are collaborating in their tx Disadvantages -may present more info than some patients can handle -Info may be misinterpreted
50. Active Listening: involves preparing to be fully attentive to the interaction
-note verbal and non-verbal cues
- including what is said and how it is said -indicate attentiveness through their feedback and body language
51. Observation: may include client presentation, grooming, and facial expressions
-Observation skills are also used to collect objective data
52. Advanced communication skills: critical listening
critical questioning critical thinking
53. Much of the information collected during the interview is obtained through
& : active listening & observation
54. Delusional clients require:: patience and understanding during the psychiatric
interview -Avoid disagreeing with them or denying the reality of their delusions
55. Client Considerations: mute or catatonic clients: use of observation tech-
niques will help in formulating a potential diagnosis.
56. pitfalls that can subvert the therapeutic alliance: -rushing the interview
-giving advice -transference and countertransference
57. pitfalls: transference and countertransference: two phenomena that can im- pact
the therapeutic alliance -Transference: a client's displacement or projection of feelings or wishes towards important individuals in the client's past, such as parents, onto the therapist
- not always (-), provides opportunity to bring repressed feelings to the surface, If client is reminded of someone for whom they have fond memories, may allow for a (+) experience during the initial interview. If the feelings are (-) the client may appear angry or make provocative statements -Countertransference: a therapist's conscious or unconscious reactions to a client based on the therapist's psychological needs or conflicts.
- can be positive or negative
58. HPI: history of the present illness
-concise, clear, and chronological description of the chief complaint which prompted the client's visit
- details what the client believes to be causing the present symptoms -guided by the mnemonic "OLDCARTS" -gather information about the timeframe of symptom onset or exacerbation, triggers or stressful life events, and recent treatment and treatment changes -nature of the symptoms, when they emerged, and how they have progressed
- psychiatric
- health maintenance -major medical illness or surgery may precipitate a psychiatric disturbance -name and dosing schedule for all currently meds to avoid risk of adverse interac- tions with new psychiatric prescriptions
61. Family Hx: Document info about the client's parents, grandparents, siblings,
children, and grandchildren -regarding age, health, & cause of death. -Include whether they have conditions such as hypertension, coronary artery dis- ease, stroke, diabetes, or cancer. -Many psychiatric disorders have a genetic component
- info about family psych hx including tx that was successful/unsuccessful may help form dx/tx plan, can help ID those available for support, ID stresses/contributing factors to clients condition
62. Personal and Social Hx: Personal Hx:
-personality and interests, sources of support, coping style, strengths, and concerns -sexual orientation and gender identification, occupation and education, relation- ships, safety, spirituality, and support systems -older adults/clients with diabilities: level of function and activities of daily living Social Hx: -tobacco, illicit drug, and alcohol use -sexuality & risk-taking sexual practices -Five Ps+
- Partners (gender & # of partners)
- Practices (oral, vaginal, anal)
- Protection from STIs
- Past hx of STIs
- Pregnancy plans
- +Plus (assess for trauma, violence, sexual health concerns & provide support for sexual orientation and gender identity)
63. ROS: review of systems used to obtain additional info about client's CC & HPI &
to uncover any additional symptoms r/t potential problems in systems unrelated to the CC -follow a head-to-toe approach with yes or no questions
- follow up when there is a response that indicates an abnormality with open- ended questions -subjective
- constitutional
- skin
- head
- eyes
- ears
- nose/sinuses
- allergies
- mouth/throat
- neck
- breast
- respiratory/cardiac
- gastrointestinal
- urinary
"Where did the problem start; does it move anywhere?" "How long does the problem last or is it constant?" "Can you describe what the problem feels like?" "Does anything make it worse?": -Onset: "When did this start?" -Location: "Where did the problem start; does it move anywhere?" -Duration: "How long does the problem last or is it constant?" -Characteristics: "Can you describe what the problem feels like?" -Aggravating Factors: "Does anything make it worse?" -Relieving Factors: "Does anything make it better?" -Treatments: "Have you taken any medications or nonpharmaceutical treatments for this problem?" -everity of the Symptoms: "How bothersome is this problem?"
66. The psychiatric history: -describes previous episodes of mental health symp-
toms
- whether treated or not -should detail the initial onset of symptoms and progress chronologically to the current episode
- characteristics and progression should be described in detail -distinguish chronic disorders from isolated episodes -gather info on prior treatments -note which drug(s) prescribed, dosage & length of tx, & client's response to tx -which meds therapeutic & if adverse effects -if client received psychotherapy, note which modality was used, frequency, length of therapy, any benefits -hospitalizations -suicide attempts, ideations, episodes of self-harm -any emotions revealed through the inquiry
67. Medical diagnoses may present with psychiatric symptoms: hyperthy- roidism:
anxiety, panic attacks, and mood swings
68. Medical diagnoses may present with psychiatric symptoms: hypothy- roidism:
depression, difficulty sleeping, and loss of appetite
69. Medical diagnoses may present with psychiatric symptoms: diabetes: -
mood disturbances
70. Medical diagnoses may present with psychiatric symptoms: chronic pain-
: depression, anxiety, poor sleep
71. Medical diagnoses may present with psychiatric symptoms: serious or terminal
illnesses such as cancer or chronic autoimmune disorders: anxiety and depression
72. Focused Questions for The Psychiatric Assessment: The Psychiatric His- tory: -
Have you ever been hospitalized for any mental health issues? -Have you ever had counseling or psychotherapy? -Have you ever taken medications for your mental health in the past? -Are you currently on any medications for mental health or sleep?
73. Focused Questions for The Psychiatric Assessment: Family Psychiatric History: -
Has any relative of yours ever been hospitalized for a mental health issue? -Has any blood relative of yours ever been diagnosed with a mental health issue? -Has any blood relative of yours had a history of seizures or dementia/Alzheimer's?
74. Focused Questions for The Psychiatric Assessment: Social and Develop- mental
History: -Tell me a little bit about your childhood and how you grew up. -How was your experience in school when you were younger? Did you enjoy school? -How do you support yourself with your finances? -Do you have a good support system? Are you currently in a relationship? Where do you live? Who do you live with? -What do you do in your free time? What activities do you enjoy?
75. Focused Questions for The Psychiatric Assessment: Medical Histo-
ry/Screening for General Medical Conditions: -Do you have a primary care provider?
