The Psychiatric Interview

1. Overview & Purpose of the Interview

Definition

• The psychiatric interview is a structured, goal-oriented conversation that is both the principal diagnostic instrument and the first therapeutic act. There is no blood test or scan that replaces it — "after speaking to and examining the patient in detail we form a diagnosis" (Gajdos).
• "Blick" (at-a-glance) diagnosis is dangerous in psychiatry. What we see is context-dependent: "What we see is not always there and vice versa." Detail matters precisely because the symptoms are subjective and norm-relative.

What is a psychiatric symptom? (PSY - 2.3)

A psychiatric symptom is not only what the patient complains of. It can take any of the following forms — and frequently a combination:

• A subjective experience or a change in experiences — above all, suffering (e.g. low mood, anxiety, a delusional conviction).
• A somatic symptom or a disorder/dysfunction of a bodily function (e.g. palpitations of panic, psychomotor retardation, insomnia).
• Behaviour that is too frequent, inadequate, or absent — excessive behaviour, a lack of normal reactions, or behaviour inappropriate to context.

Examiner pounce: "Give me an example of a symptom that is purely behavioural." → e.g. catatonic negativism (absent reaction) or compulsive checking (excessive behaviour) — the patient may not "complain" of it at all.

The two technical goals of the interview

Every psychiatric interview pursues two aims simultaneously (Gajdos / Kaplan & Sadock):

1. Recognition of the psychological determinants of behaviour (the insight-oriented goal).
2. Symptom classification for diagnosis (the symptom-oriented goal).

An interview can be weighted insight-oriented or symptom-oriented depending on the patient and the clinical question.

What influences the interview?

• The patient's personality and character style.
• The emotional context.
• The place of the interview — "a clinical ward or the edge of a skyscraper?" The same words mean different things in a crisis.
• Technical factors — telephone interruptions, an interpreter, even the interviewer's "uh-huhs".
• The process of the interview — unconscious mistakes and non-verbal signs on both sides.
• The frame is the biopsychosocial (+ spiritual) model — never purely biomedical.

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