The First Interview- Chapter 8

Front 1

Keep in mind when evaluating personal/social history

Back 1

- maintain skepticism re. validity
- some information subject to distortion (early childhood events, interpersonal disputes)
- use external checks on validity (informants, medical records)

Front 2

Childhood nuclear family

Back 2

- when/where were you born
- siblings/twins
- did pt feel wanted as a child
- closeness with parents
- disrupted family structure and why
- how parents related to each other
- adopted?

Front 3

Growing up

Back 3

- age of parents when pt was born
- deaths in the family
- hobbies, clubs, extracurricular interests
- sociability as a child

Front 4

Asking about abuse

Back 4

- sensitive topic; approach gradually ("What methods of discipline did your parents use?" "How well did you feel your parents provided for you?")
- how often abuse occurred
- who was the abuser (one parent? both?) and did someone try to shield the pt

Front 5

Childhood health

Back 5

- childhood medical history
- family response to illness (overprotection, rejection, "rewarding" with attention)
- pt's temperament and activity level as a child
- treatment for common childhood problems (bedwetting, stuttering, obesity, nightmares, etc.)
- concerns about masturbation
- when did puberty begin

Front 6

Education

Back 6

- parents' education
- pt repeating grades
- did pt ever miss school for a prolonged period of time? Why?
- highest grade completed/why dropped out
- at what age did pt become independent from parents

Front 7

Work history

Back 7

- current occupation and enjoyment thereof
- multiple jobs of brief duration? (often found with antisocial PD)
- unemployed? (often found with chronic schizophrenia)
- leisure activities

Front 8

Military history

Back 8

- has pt served in armed forces
- why joined/was drafted?
- rank
- disciplinary problems
- what type of discharge
- did you see combat
- enquire re. PTSD

Front 9

Legal history

Back 9

- may include lawsuits over insurance/disability
- can be a clue to personality disorders, bipolar, substance misuse
- pattern of illegal/criminal activity (may indicate antisocial PD)

Front 10

Religion

Back 10

- what religion
- different from childhood?
- religion may provide comfort, may reveal pt's values and ethics

Front 11

Current living situation

Back 11

- where does pt live and what is the neighborhood like
- live alone/with others? Quality of self-care?
- financial situation (ask: "has money been a problem for you?")
- homelessness

Front 12

Social network

Back 12

- to whom does pt feel close
- family network
- how often does pt see friends
- caregiver?
- social support network

Front 13

Marital status

Back 13

- "tell me about your spouse/partner"
- strong/weak points of relationship
- disputes/hot-topic issues
- how well do pt and spouse communicate
- children?

Front 14

Medical history

Back 14

- previous major illnesses/hospitalizations
- how well does pt comply with recommendations made by doctors/therapists ("Has it always been easy for you to follow recommendations?")
- ask re obvious physical problems

Front 15

Medications

Back 15

- history of present illness has already revealed current medications for emotional disorders
- any other medications (esp. important when pt presents with possible depression, psychosis, anxiety)
- self-medication

Front 16

Side effects/drug reactions

Back 16

- have there been side effects
1. what happened
2. how long after first dose
3. was treatment needed
- did pt try drug again/did it produce same result? (establish causation)

Front 17

Common side effects: antidepressants

Back 17

- drowsiness
- dry mouth
- dizziness
- nausea
- weight gain

Front 18

Common side effects: anxiolytics

Back 18

- drowsiness
- forgetfulness/confusion
- dizziness

Front 19

Common side effects: lithium

Back 19

- skin rash
- tremor
- thirst

Front 20

Common side effects: antipsychotics

Back 20

- low BP
- extrapyramidal effects

Front 21

Extrapyramidal side effects

Back 21

- may occur with antipsychotics
1. acute dystonia: sharp, cramping pain in the neck that may cause head to turn sideways
2. akathesia: profound restlessness
3. pseudoparkinsonism: Parkinsonian symptoms incl. tremors, decreased mobility of faces
4. tardive dyskinesia

Front 22

Review of systems

Back 22

- disturbance of appetite
- head injury
- history of unconsciousness, dizziness, fainting spells
- convulsions/seizures
- symptoms of PMDD

Front 23

Purpose of family history review

Back 23

1. brief biographical sketch of parents, siblings, SO, chlidren
2. learn about relationship between pt and relatives, current and past
3. learn whether mental disorders run in pt's family

Front 24

Family history

Back 24

- "tell me how you get along with..."
- identify ruptured relationships
- when asking about mental disorders, be explicit, also ask if any relatives considered odd/eccentric

Front 25

Personality

Back 25

Personality: all the mental, emotional, behavioral, and social aspects that make us individual

Personality traits: how individuals perceive, think about, and relate to the environment and themselves; persistent

Front 26

Evaluating personality

Back 26

- patient's self-assessment
- interviews with informants
- information about relationships, attitudes, behaviors with other people
- behaviors observed during initial interview
- standardized testing may be useful later, but probably not available for initial interview

Front 27

Patient's self-assessment

Back 27

"Describe yourself for me"
- what pt likes best about self
- self-evaluation of mood
- be alert for evidence of lifelong behavior patterns
- coping skills
- support system

Front 28

Relationships with others

Back 28

- may be useful when pt has trouble describing self ("What sorts of situations do people think you have trouble handling?")
- learn about pt's prejudices and regard for others ("How do you feel about your boss?" "Do you and your spouse always get along as well as you'd like?")
- evaluate all reports against behavior already known about

Front 29

Observed behaviors

Back 29

- may reveal character traits
- watch for indications of:
1. disinterest (yawn, gazes around room)
2. invasion of personal space (picking items up from desk)
3. asks for time out (e.g. to smoke)
4. questions credentials
5. criticizes clothing, hairstyle
6. expresses prejudice
7. confrontative
8. brags about qualities others might seek to conceal (e.g. sex life, aggression, substance use, trouble with law)

Front 30

Recognizing PD

Back 30

- dx only made when character traits so inflexible and poorly adaptive that they cause distress/impairment
- not an illness, but way of life; dx on basis of persistent behaviors suggesting interpersonal conflict, maladjustment, impulse control

Front 31

Antisocial PD

Back 31

- irresponsible, often criminal behavior
- begins ~age 15
- pathological childhood behavior: truancy, running away, lying, stealing
- as adults: defaulting on debts, fail to care for dependents
- characterized by lack of remorse

Front 32

Avoidant PD

Back 32

- hesitant to become involved with others/fear of criticism
- embarrassed to show emotion
- may have no close friends
- exaggerate risks of undertaking non-routine pursuits

Front 33

Borderline PD

Back 33

- impulsive
- recurrent threats of suicide
- affectively unstable
- unable to maintain stable interpersonal relationships

Front 34

Dependent PD

Back 34

- have problem starting projects, making independent decisions
- fear of abandonment
- easily hurt by criticism

Front 35

Histrionic PD

Back 35

- overly emotional and attention-seeking
- need constant reassurance about attractiveness
- may be self-centered

Front 36

Narcissistic PD

Back 36

- self-important
- preoccupied with envy, fantasies of success, ruminations about uniqueness of own problems
- sense of entitlement
- lack empathy

Front 37

Obsessive-compulsive PD

Back 37

- characterized by perfectionism, rigidity
- workaholic, but indecisive and preoccupied with detail
- "my way or the highway"
- trouble expressing affection

Front 38

Paranoid PD

Back 38

- expect to be threatened or humiliated
- quick to anger, slow to forgive
- few confidantes, doubt loyalty of others

Front 39

Schizoid PD

Back 39

- care little for social relationships
- restricted emotional range
- avoid close relationships

Front 40

Schizotypal PD

Back 40

- significant difficulty with interpersonal relationships
- uncomfortable in social situations; lack close friends
- suspiciousness, unusual perceptions, inappropriate affect
- considered eccentric by others