What are the components and challenges to assessing psychiatric history in the interview?

Question

What will be an ideal response?

Answer 1

This interview is complicated. For example, the clinician must address the following components. One, is there a history of an independent DSM-5 diagnosed psychiatric disorder? Two, regardless of history, is the client demonstrating any current symptoms that may reflect a psychiatric disorder? Three, what is the history of the client’s psychiatric symptom experiences in conjunction with substance intoxication, withdrawal, or prolonged abstinence? Four, are there any instances of distressful emotional experiences that may resemble diagnosable disorders but fail to adhere to any nosology?

The challenges are two-fold. One, there is tremendous overlap between substance use and psychiatric symptoms. For example, experiences of anxiety, depressed mood, or paranoia are symptoms of numerous psychiatric disorders but also occur in various instances of substance intoxication or withdrawal. Considering that many clients enter treatment or an ER setting while still actively using or in the early withdrawal phase, it can become very difficult to tease out the temporal and causal relationship (if any) between substance use and psychiatric symptoms. Two, you are asking about psychiatric symptoms and history with an individual who (due to substance use past and present) is not the best equipped to provide a lucid and organized recollection of all symptoms and experiences.