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Applied the cloze technique to patient speech samples that were obtained from tape-recorded initial intake interviews in a psychiatric outpatient clinic. The findings indicated that cloze samples taken from the end of the interview were less predictable than those obtained from the beginning. Correlation with cloze change scores in discussed.
Demographic and treatment variables were, for a second time, found associated with number of treatment interviews completed by lower socioeconomic patients of a barrio area neighborhood mental health service. Of the eight variables that originally differentiated patients with respect to number of interviews, six remained significant on cross-validation. The longer staying patients were characterized by: young adult age range; disrupted marital status; self-referral; using psychotropic medication; major and secondary problems of anxiety and depression.
The clinical Alcoholism Interview Schedule (CAIS) is being developed as a standardized instrument for initial assessment of alcoholic patients and as a research tool. Fifty questions cover key areas of clinical concern, and accompanying guidelines describe the method of administration. An initial study of inter-rater reliability has been conducted with five raters independently rating taped interviews with each of ten patients. Agreement was assessed both by percentage agreement and by weighted Kappa. Detailed results, which are presented, in general show a fairly satisfactory level of reliability except for certain identified items which include the Jellinek classification of type of alcoholism.
In two apparently disoriented patients, the emergency physician's use of amobarbital quickly eliminated diagnoses of an organic etiology. Although thousands of amobarbital interviews have had no complications, the use of amobarbital should follow a thorough evaluation. The amobarbital interview is a safe and simple technique to discriminate functional from organic illness, thus avoiding unnecessary medical and surgical treatment, neglected illness, and inappropriate disposition.
A standardized, semi-structured interview for examining and recording the mental state in elderly subjects is described. It allows the classification of patients by symptom profile and can demonstrate changes in that profile over time. It is believed that good reliability is demonstrated between psychiatric raters both for psychiatric diagnosis made on the basis of the schedule findings and for individual items. The Geriatric Mental State Schedule (GMS) consists mainly of items from the eighth edition of the PSE (Wing et al. 1967), together with additional items from the PSS (Spitzer et al. 1964), and extra sections dealing with disorientation and other cognitive abnormalities. Modifications have been introduced to facilitate interviewing elderly subjects.
An interview assessment of marriage relationships is described. It is shown to have good inter-rater reliability, high consistency across the accounts of both marriage partners and to be resistant to methodologic bias. A four-year follow-up study demonstrated high predictive validity to later marriage breakdown. The marriage measure also showed a strong association with behavioural deviance in the children. The intercorrelations between individual measures of various aspects of the marriage and the summary are given. A shortened version of the interview is described and preliminary findings are given on its validity.
A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patient's instrumental objective of participating in the treatment planning. The sharpest divergence between the clinician's and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of setting, and the implication for the delivery of services.
Small groups of medical students are introduced to the subject of family therapy using a technique involving the simulation of family interviews. The students are called upon to enact a situation in which family members visit their general practitioner with a problem relating to one of the children, and the diffusion of this problem within the family is traced during the course of the simulation. Discussion is focused on the feelings evoked by the simulation, the psychodynamics of the simulated family and the quality of the relationship between the general practitioner and the family as it arises out of the interview. An effort is made to help the students to get in touch with some of their feelings towards disturbed families and to mobilize these feelings towards the effective management of the family's problems. By role playing the general practitioner, students can prepare themselves for their future professional roles in a situation which allows for feedback from colleagues and experimentation. At the same time, when family members are role-played, the process of identification and empathy with patients is enhanced. The technique is potentially stressful because of the unusual demands that it makes upon the students in terms of personal involvement, but the experience derived from successive groups of students over a 2 year period has been consistently rewarding, and most students have expressed an enthusiastic interest in the exercise.
The relative specificity of the structure of psychological traits has presented the clinical psychologist with a very difficult problem; it means that generalized test procedures are of limited use. This paper suggests: (1) that the interview presents one way of beginning to solve this problem, and (2) that the findings of psychological research may provide the means of arriving at a distinctive style of valid interviewing for assessment purposes. This style has two main features: (1) it facilitates self-exploration and self-disclosure and (2) it maximizes the accuracy of the information obtained. An outline of some of the research findings is presented; some of the methodological problems are discussed; and a brief example is given.
A new method of evaluating the time course of an antidepressive drug effect is described. It has the advantage that the rater is "blind" as to the duration of the treatment (time-blind analysis). TV-stored tapes of interviews recorded during the drug trial were presented in a randomized sequence to raters who ranked each patient's tapes in terms of the degree of depression shown during the interview. Patients treated with Amitriptyline showed a continuous amelioration of depression throughout the drug trial while those treated with Mianserin showed an amelioration of depression that was not constant in time.
In a sample of 89 patients referred from a psychiatric service emergency room, the author investigated variables related to completion and noncompletion of the physician's recommendation. The completers (58%) tended to be older and more educated, to be diagnosed as depressed, and to demonstrate congruence in terms of their request and their perception of the physician's goal. Implications for referral include ensuring that the interview with the patient includes a communication, empathy, and mutual influence. Using the negotiated approach and criteria derived during the clinical interview, certain patients can be identified as being "at risk" for noncompletion and as requiring special efforts.
Immediately following receipt of their 1-year follow-up mailed questionnaire, 55 former patients from an addiction treatment program were interviewed personally, and a urine sample was collected. Results indicate a high degree of correspondence of self-reported drug use with the urinalysis reports, and moderately high correspondence between the information on employment, school attendance, legal status,and length of heroin run given in the mailed questionnaire with that provided in the personal interview.
In observing more than 300 clinical interviews, we have seen a high frequency of physician-engendered defects. Most of the defective examples can be classified as one or a combination of five syndromes: the therapeutic lack; inattention to primary data (symptoms); a high control style; an incomplete data base usually omitting patient-centered data and active problems other than the present illness; and a thoughtless interview in which the physician fails to formulate needed working hypotheses. Proper diagnosis of these defects allows for better prescription of educational correction.
Transference phenomena can be used effectively in pursuing diagnostic and therapeutic aims in initial interviews. Theorectical and clinical aspects of transference phenomena are discussed with special reference to preformed transference expectations, the dynamic and genetic aspects of transference, the differentiation of transference phenomena from transference and the transference neurosis, and their relevance to other analytic data. A case is presented, and two transference phenomena is the initial interviews are traced through later stages of the analysis; their origins and multiple determinants are demonstrated.
To improve observer uniformity and objectivity in the psychiatric appraisal of parents of psychotic children, structured psychiatric interviews were administered to 64 parents of psychotic children, including 28 husband--wife pairs and 8 single parents. Judgments were recorded on the Spitzer--Endicott Psychiatric Status Schedule and the past section of their Current and Past Psychopathology Scales. There were no significant differences between fathers and mothers of organic and nonorganic children (children with and without evidence of neurological dysfunction). As a whole, the 56 parents in the 28 participating husband-wife pairs fell between a contrast group of 55 adult subjects attending a psychiatric clinic and another contrast group of 130 subjects living in the community in upper Manhattan in their trends to pathological symptoms as judged by the Psychiatric Status Schedule. Similarly, in the past section of the Current and Past Psychopathology Scales the parents showed a trend to more psychopathology than a community sample of 36 nonpatient adults. Finally, computer diagnoses based on the Psychiatric Status Schedule showed more schizophrenia in the parents of the psychotic children than in a sample of 130 nonpatient adults in the community. The data thus tend to support findings based on the unstructured interview of elevated schizophrenia rates in parents of psychotic children.
BACKGROUND: The endpoint Time to Subsequent Therapy (TTST) is an intermediate endpoint used in research and regulatory assessments. TTST denotes initiation of subsequent therapy and is a clearly definable, clinically relevant event for healthcare professionals. However, it has not been systematically established to which extent TTST is subjectively meaningful to patients. The objective of this study was to define TTST as a patient-relevant intermediate endpoint. METHODS: The study examined five oncological indications (breast cancer, prostate cancer, melanoma, multiple myeloma, and non-small cell lung cancer) using a systematic literature review, analysis of case report forms used in international randomized controlled trials, review of German Federal Joint Committee (G-BA) documents, semi-structured interviews and a two-stage Delphi survey with healthcare professionals, patients, and relatives. RESULTS: A total of 35 individuals participated in qualitative interviews. Most of them rated TTST as particularly significant. The Delphi Survey included 264 interviewees in round one, and 117 in round two. Patient-relevance of TTST was confirmed by 81% of respondents (95% confidence interval 76%, 85%). Nine treatment scenarios that justify TTST were identified. To capture patient-relevance, prospective collection of reasons for and consequences of therapy change are required. A checklist with standardized response formats plus free-text fields was developed: a comprehensive master checklist for flexible, complete documentation and a short version focused on therapy change-specific items. CONCLUSIONS: TTST is an intermediate endpoint whose systematic documentation of characteristics demonstrating patient-relevance can be standardized in research and clinical practice using the developed checklists.
This paper describes a structured course for teaching interviewing which focuses on the interaction between the patient and the practitioner. Three main areas of learning were selected because of their universal application: relationship, communication, and feelings. Theoretical material is related to positive and negative interactions with patients, and these are described behaviorally in a checklist form. The development of good interviewing techniques consists of increasing the positive interactions and learning to use them as diagnostic and therapeutic tools. Different methods are utilized to help students apply these skills in clinical situations. Although this course was developed for a specific group of pediatric practitioners, it can be utilized by all types of health care professionals.
The medical importance of the patient-physician relationship is widely acknowledged, but research on its effects has been hampered by the lack of a method to quantify its clinically relevant features. In this study a new method of coding verbal interaction was applied to 52 interviews with adults in a general medical screening clinic. "Average interaction profiles" for patients and for physicians in the medical history, physical examination, and conclusion segments of the interviews provided detailed descriptions of the relationship that appear to be accurate and coincide with descriptions derived from clinical experience, textbooks, and other studies. The profiles yield quantitative indexes of such crucial aspects of the relationship as the manner in which patients give a history and physicians trasmit information to patients.