The psychiatric interview
- Technique
A structured conversation that gathers the psychiatric history, checks safety and builds the trust needed for treatment.
What it is
The psychiatric interview adds to the general clinical interview the parts that mental health needs: past psychiatric episodes and treatments, substance use, development, social life and, always, risk to self and others. It uses open questions so the person tells the story in their own words, with enough time, and it is completed with information from relatives, carers or previous records when the person cannot give a reliable history. It ends with a summary and a plan agreed with the person.
Key facts
- Identification and source: who is giving the information, how reliable it is and who referred the person.
- Reason for consultation in the person's own words, and how the problem affects work, study, family and relationships.
- Present illness: onset, course, triggers, previous similar episodes and what has been tried.
- Past psychiatric history: diagnoses, treatments, adherence, hospital stays, self-harm and suicide attempts.
- Substance use: tobacco, alcohol, cannabis and other drugs, pattern, consequences and last use.
- Medical history and current medicines, family history (including psychiatric disorders), childhood family atmosphere and development, schooling, work, relationships, legal history and supports.
How it is done
- Prepare: choose a private room with adequate exits and allow enough time.
- Introduce yourself with your name and role, explain the purpose of the interview and ask how the person prefers to be addressed.
- Use open-ended questions so the person tells the story in their own words.
- Explore the present illness, then past psychiatric history: previous treatments, hospital stays and adherence.
- Ask about tobacco, alcohol and drug use, medical history and medicines, family history, childhood family atmosphere and legal history.
- Ask directly about suicidal thoughts, plans and intent, and about intent to harm others.
- If the person cannot give a reliable history, seek information from family, carers or other collateral sources.
- Ask about attitudes toward psychiatric treatment and agree the next steps with the person as an active partner.
Difficult interview situations and what helps
| Situation | What helps |
|---|---|
| Suspicious or guarded patient | Give plenty of space; do not argue or become defensive; agree where you honestly can or agree to disagree. |
| Very talkative or pressured speech | Use short, simple sentences and repeat the key message; note the speed and flow of speech for the mental status exam. |
| Mute or very slowed patient | Allow time, ask simple questions, observe behaviour and look for a medical cause. |
| Intoxicated patient | Look first for medical problems and the substance involved; rely on collateral sources until the person can give a reliable history. |
| Angry patient | Keep at least two arm’s lengths away, stand at an angle, listen and repeat back what you hear, and set clear limits calmly. |
| Patient brought against their will | Tell them your name and role, ask what they want and offer real choices, so that they become an active partner in the evaluation. |
Clinical notes
- Psychiatric symptoms at an unexpected age (such as new psychosis in an older adult), abnormal vital signs, or confusion that is sudden or fluctuating point first to a medical cause.
- Information from family, carers or records is recorded with its source; it carries more weight when the person cannot give a reliable history.
- Ask about the person’s attitudes toward psychiatric treatment, including medicines and psychotherapy; they shape the plan.
Test yourself
Think of the answer, then tap the question to see it.
Does asking a patient directly about suicidal thoughts increase their risk?
No. Studies show that asking about suicide does not increase suicidal thoughts or behaviour; it is a standard part of every psychiatric interview.
What should be done when a patient cannot give a reliable history?
Rely more on collateral sources such as relatives, carers and previous records, and note the source of each piece of information.
What may body language reveal during the interview?
Attitudes and feelings that the person denies, such as anxiety shown as restlessness.
Which past psychiatric data does the history record?
Previous diagnoses and treatments, hospital stays, suicide attempts and adherence to past treatment.
Elsewhere in DurgiPedia
- The medical interview: rapport, open questions and listening
- The clinical history: its parts and their order
- The limits of confidentiality: duty to warn and legal disclosure
- Informed consent: elements and how to obtain it
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Initial Psychiatric Assessment (MSD Manual Professional Edition, 2024); Medical Assessment of the Patient With Psychiatric Symptoms (MSD Manual Professional Edition, 2024); 5 Action Steps to Help Someone Having Thoughts of Suicide (National Institute of Mental Health (NIMH), 2024); Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup (Western Journal of Emergency Medicine, PubMed Central, 2012).
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Representative model, for educational purposes only.