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BOOK REVIEW
Year : 2014  |  Volume : 140  |  Issue : 6  |  Page : 796-797

The psychiatric interview: Evaluation and diagnosis


Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Web Publication3-Mar-2015

Correspondence Address:
Ajit Avasthi
Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Avasthi A, Malhotra N. The psychiatric interview: Evaluation and diagnosis. Indian J Med Res 2014;140:796-7

How to cite this URL:
Avasthi A, Malhotra N. The psychiatric interview: Evaluation and diagnosis. Indian J Med Res [serial online] 2014 [cited 2019 Sep 21];140:796-7. Available from: http://www.ijmr.org.in/text.asp?2014/140/6/796/152477

The psychiatric interview: Evaluation and diagnosis, A. Tasman, J. Kay, R. J. Ursano, editors (Wiley-Blackwell, UK) 2013. 194 pages. Price: ₤ 48.99

ISBN 978-1-119-97623-3

While interviewing skills are considered as a core competency for psychiatrists, there are no acceptable protocols or standard guidelines available to help the psychiatrists imbibe and practice these skills. The available psychiatric interviewing literature is by and large available in a textbook format, and in many cases the focus has been on a particular style of interviewing (e.g. psychodynamic interviewing). A guide for holistic assessment of patients in a true biopsychosocial perspective which does not focus on "interviewing" as an isolated technique is lacking till date. This book, therefore, is a welcome publication and holds promise to fill this gap.

The book is set out in eight chapters on various aspects of a psychiatric interview. The crux of the book is a thorough biopsychosocial assessment of the patients, using the seemingly simple yet difficult to develop interviewing skills, while keeping in mind important issues like cultural influence, special needs, therapist's own emotions and ethical boundaries. The book is written in a lucid manner which makes it appealing. The many interesting clinical vignettes bring out the authors' clinical expertise, tact, empathy, simplicity and commendable literary skills.

Chapter 1, 'Listening to the Patient' is the heart and soul of this book. The authors eloquently explain the crucial importance of listening to the patients even in the era of advanced biomedical knowledge. The authors introduce the tools and skills of effective diagnostic and therapeutic listening. They maintain an unbiased approach, and demonstrate how psychiatrists can imbibe the single most common skill of effective listening regardless of their theoretical stance, with the help of captivating case vignettes. The authors help the reader feel positive and even thrilled about finding opportunities to listen effectively, especially in complex and challenging clinical situations that are the most daunting and discouraging for the trainee psychiatrists.

In the second chapter, the authors discuss various aspects of physician-patient relationship. Historical and modern day understanding about functioning of this dyad has been discussed in brief. Authors have skilfully described the phases of development of the physician-patient relationship along with the factors affecting the progress of the relationship. Due stress has been laid on the sensitive issues of transference and counter transference, and termination of treatment.

In the third chapter, cultural context of clinical assessment has been discussed. The authors have briefly described the concept of culture, race, ethnicity and social class. The hindering and helping aspects of culture in causation, presentation, course and outcome of an illness have been brought out. Importance of language in a psychiatric interview has been rightly stressed upon and authors have precisely pointed out how simple shifts in language in case of bilingual patients can provide important information about psychopathology. Their clinical wisdom comes across in the strategies to elicit cultural information; practical suggestions on how to approach patients whose gender, social, religious, ethnic, or cultural backgrounds differ from that of the clinician; and acknowledgement of the possibility of demerits of the patient and therapist being from a similar cultural background. The parts on cultural formulation and cultural competence are exceptionally well written and the knowledge gathered from these can be of immense help in clinical situations.

Chapter four on the settings and techniques of psychiatric interview is enlightening. The authors give a summary of the evidence for brain dysfunction and the degree of response to biological and psychological treatments in different psychiatric disorders. Guidelines for both minimum and expanded database are included keeping in mind the different settings of psychiatric interview. It is highly rewarding to read the dimensions of interviewing techniques like directiveness, supportiveness, fact verses feeling orientation and feedback. Readers will be highly benefitted from the excerpts of dialogue and examples of actual questions in this chapter.

In the fifth chapter, authors have discussed the various aspects of psychiatric interviews in special populations. They have rightly covered important circumstances and populations namely inpatient units, medical ward, emergency department, mass causality /disaster situations, patients with psychosis, suicidal patients and children and adolescents. The part on medical wards is exceptionally well written with emphasis on the strategies and the importance of liaison with medical departments. Each segment illustrates the type of questions to be asked in that particular setting and ends with recommendations on how to proceed during the interview, which will prove to be very helpful. Though the chapter is quite elaborate, it would have been worthwhile to include the special aspects of interviewing and evaluating agitated/violent patients and elderly population.

The sixth chapter on formulation is brief but educative. The stress is on the benefits of a true biopsychosocial approach to bring together pertinent factors from entirety of person's life and experience for thorough understanding of the problems. Authors have used a wonderful case illustration, probably the best one in the book, to demonstrate the use of subtle cues in a patient's overt and covert behaviour and communication patterns in formulating the case. Authors encourage incorporation of cognitive styles, coping mechanisms and defences used by the patient during the interview in case formulation for understanding the deeper meaning of emotions and behaviour. Such a formulation can prove to be highly beneficial for effective management of patients.

Seventh chapter deals with clinical evaluation and treatment planning. Authors give a summary of the entire clinical assessment while highlighting the salient features for planning appropriate treatment. This chapter has been written to the point and the authors have rightly avoided unnecessary details.

The last chapter of the book deals with important issues of professional ethics and boundaries in a sensitive manner. Guidelines for psychiatrists on highly sensitive issues like torture, euthanasia, organ transplantation, sex selection, genetic counselling, ethnic discrimination have been provided, which will prove to be highly beneficial for trainee psychiatrists who generally find themselves at loss during such situations. While discussing boundary violations, authors have skilfully brought out important issues like maintaining neutrality, anonymity, confidentiality and avoiding dual relationships in an unbiased manner. While inappropriate touching of patients needs to be avoided in an interview setting, many clinical situations demand a thorough physical examination of the patient with a psychiatric illness. Without such an examination and assessment, the clinical evaluation may be incomplete and the clinician may miss important leads. In short, a true biopsychosocial approach to a patient is not complete without a complete physical examination.

Overall, the writing style is logical, clear, effective and well organized. The book maintains the spirit of a biopsychosocial approach to the patient. This book will prove to be highly beneficial not only for trainee psychiatrists, but also for other mental health professionals and practising psychiatrists.




 

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