The Psychiatric Interview
#Notes on the Craft
Martin Greenwald on history taking in psychiatry
Why does it seem absurd to think of spotting psychosis in a patient as a talent?
Early in my training I was surprised by how often my non-psychiatrist medical colleagues failed to realize that their patients were psychotic. This was most common when we consulted on medically hospitalized patients, where consultations for delirium, anxiety, and depression would not infrequently reveal someone suffering somewhere on the psychotic spectrum. Incidentally, my recent experience is the opposite, and I see far more false positives—patients being diagnosed as psychotic when they are not—especially among those who are younger, suggestible, and spend large amounts of time online.
Whether under- or over-diagnosis, this points to the difficulties in recognizing certain kinds of psychosis, especially for those who either do not encounter it often, do not take sufficient time in an interview, or do not have a knack for spotting it. I have also noticed some common interview techniques which reliably cause people to fail to recognize psychosis, two of which I will note briefly here. As a caveat, I should stress that psychiatrists are not exempt from my criticisms and are in some ways the worst offenders.
He delivers on the promise.
