Clinical Interviewing and Psychiatric Assessment
Core concepts
The interview is the primary diagnostic instrument. Candidates must demonstrate a structured but flexible approach: establishing rapport and consent, clarifying the presenting complaint, then systematically covering history of present illness, past psychiatric and medical history, medication and substance history, family history, developmental and social history, and premorbid personality. The mental state examination (MSE) is a separate, cross-sectional description - appearance, behaviour, speech, mood and affect, thought form and content, perception, cognition, insight and judgement - and must not be confused with the longitudinal history.
Traps in questions
- Conflating mood (patient's sustained subjective state) with affect (observed, fluctuating expression).
- Recording interpretation rather than observation: "patient was paranoid" instead of "patient stated staff were poisoning his food".
- Missing collateral history, which is often decisive in psychosis, dementia and personality disorder.
- Overlooking physical causes: always ask about thyroid disease, epilepsy, steroids, and recent infections.
- Ignoring the patient's own explanatory model and cultural context.
Rule of thumb
Use the SIGECAPS screen for depression and the DIGFAST mnemonic for mania only as prompts, not diagnoses. For any first-episode presentation, complete a physical and cognitive screen before concluding a primary psychiatric disorder.
Worked example
A candidate is asked how to assess insight. A strong answer describes dimensions: awareness of illness, awareness of symptoms, attribution, awareness of need for treatment, and awareness of consequences - and notes that insight is fluctuating, not binary.