in this video we'll be covering how to do a psychiatric interview this is a key skill for any clinician who will be evaluating patients with any sort of mental health concern it's similar to the history and physical performed when seeing a patient in any medical setting but includes a greater focus on psychological and social aspects of health there are many elements of the psychiatric interview to remember so let's use the mnemonic champion psyche vowel to list them all out this is an acronym that stands for chief complaint how can we help additional information medical history psychiatric history ideation orientation navigation social support prescriptions substances youth and development collateral housing employment victimization ancestry and legal issues let's go over each of these elements in some more detail to start the interview you'll want to introduce yourself then ask about the patient's chief complaint or their primary reason for coming to medical attention try to keep the conversation open-ended at first by asking questions that can't be answered with a simple yes or no like asking tell me about what's been going on rather than are you depressed after framing the nature of the problem ask the patient how they think that you can be of help after all the patient came to your attention for a specific reason and it can be helpful to make their desires known from the beginning of the interview by doing this you can focus the rest of the interview on gathering the information necessary to determine whether the request is appropriate or not once you have a sense of the patient's concerns gather some additional information on the problem by taking a history of present illness or hbi this will help to fill in the gaps of the patient's chief complaint including when it began how long it's been going on what it feels like if anything makes it better or worse and how distressing or disabling it is while a psychiatric interview is mostly focused on mental health make sure to inquire about physical health as well by taking a past medical history this will help you to screen for current threats to health as well as determine which psychiatric treatments would be appropriate given any of their comorbid conditions next asking about a patient's past psychiatric history including hospitalizations therapy medications in history of suicide attempts or self-harm can help clue you into the nature and severity of their problem consider doing a psychiatric review of systems where you ask screening questions about some of the most common disorders such as depression bipolar disorder anxiety and schizophrenia to help rule these diagnoses out the next three elements are all words that end in asian which should help to clue you in when using the mnemonic the first asian is ideation there are two types of ideation that you will be asked about in psychiatry suicidal ideation and homicidal ideation because nearly all psychiatric conditions increase the risk of suicide screening for suicidal ideation should be done for every single patient presenting with a mental health concern in contrast assessment of homicidal ideation can only be done in cases where it's relevant the next station is orientation a patient's current level of orientation can be assessed by asking about person place time and situation this is particularly important for any patients who appear confused or have had recent changes in cognition the final asian is often overlooked but asking about the patient's ability to engage in safe navigation of their environment can be crucial at times for coming up with the plan especially in emergency settings when the patient's disposition is in question for example when working with a patient who would like to return home but was brought in by an ambulance ask yourself how would they get there do they have a family member willing to pick them up if not would they be able to take a cab or a bus these sorts of questions will help to make sure that your plans don't get derailed friends and family play a key role in mental health so knowing your patient's social support can often directly impact management for example you should be much more hesitant to discharge a suicidal patient who is socially isolated and lives alone compared to someone who will return home to a supportive family who will volunteer to keep a close eye on them over the next few days so that's the word champions next we'll move on to the word psych the p stands for prescriptions as it's crucial to know the names dosages schedules and indications for all medications that a patient is taking remember to ask about over-the-counter drugs and supplements as well for patients you'll be treating asking about past psychiatric medication trials can help to direct future treatment options try to outline exactly when each of these trials occurred as well as the outcome such as whether the drug was stopped due to side effects or because it was ineffective asking about allergic reactions is crucial as well especially in acute situations where emergency medications may be needed next the s is for substances it goes without saying that mental health and substance use are intricately linked for this reason you should ask patients if they drink alcohol smoke cigarettes or use any recreational drugs in cases where substance use appears to play a large role in the patient's case consider taking a full substance history including specific substances used age of first use amount and frequency of use time of last use any positive or negative effects of use in any history of treatment efforts the why of psych stands for youth and development assessing developmental history can provide important diagnostic clues especially when working with children and adolescents developmental history should begin with an assessment of prenatal development and then continue on to assess developmental milestones such as speech and motor abilities next the c stands for collateral you always want to try your best to identify someone from whom you can obtain an outside perspective typically from people who know the patient best such as family members roommates friends or other healthcare providers collateral contacts can be crucial in determining the diagnosis and making a treatment plan so don't neglect this step from here we're going to shift our attention to a few of the highest yield social determinants of mental health starting with housing it's important not to assume that your patients all have homes to go to many of your patients won't live in traditional houses but rather in group homes nursing facilities rehab programs or even out on the street this can be important not only diagnostically but also in terms of intervention such as providing referrals to shelters and other resources as appropriate next knowing about a patient's employment status and financial situation can both help to provide insights into the patient's functional status and overall level of support because financial topics can be sensitive avoid asking specifically how much money the patient makes instead focus on how they support themselves on a day-to-day basis while it's a sensitive topic inquiring about abuse neglect and exposure to domestic violence may give your patients a rare opportunity to speak with someone about their experience and potentially even take steps to remove themselves from a dangerous situation while screening for abuse is important for all patients it's particularly crucial when working with dependents or people who rely on others for their safety and survival such as children the elderly and the disabled next the a stands for ancestry which is a reminder to screen for family history of mental disorders nearly all psychiatric syndromes are heritable to a certain degree and knowing how mental disorders have affected other people in the patient's family can inform current diagnosis and treatment decisions finally knowing about your patients past and present intersections with the legal system may reveal important information for example a past arrest for driving under the influence of alcohol may suggest a substance use disorder impulsivity due to mania or reckless disregard for the rights of others related to antisocial personality disorder and that's it if you've addressed all these elements then you have done a complete and thorough psychiatric interview in actual clinical settings you may spend more or less time on certain elements as the situation calls for but you should know at least a little bit about each of these areas by the end of your time with the patient i recommend running through the champion psyche bell mnemonic in your mind before finishing up the clinical encounter to make sure that you're not forgetting any major parts of the history this will help to prevent you from needing to go back and get additional information later thanks so much for watching the video i'd love to hear your experience with this acronym so please comment below to tell me how it went once you use it for a fuller discussion of the psychiatric interview as well as all things related to psychiatry check out my book memorable psychiatry on amazon until next time bye for now