Wednesday, April 15, 2009

Preparing for a psychiatry interview

There are many reasons to see a psychiatrist. There are different types of psychiatric interviews, depending on the situation and on the individuals involved.

A psychiatric interview is a chance to describe your history, examine your problems, review your symptoms in detail, and hopefully to make a plan for things to change.

You may feel reserved about sharing your personal history in detail until you have built up a greater trust in the therapeutic relationship. I think it is important to feel comfortable with your psychiatrist, and to know that you don't have to talk about certain things, or to answer certain questions, unless it is your wish to do so.

There are some elements of a psychiatric history which you can organize or prepare in advance, if you wish, and if these things are relevant to you:

1) charts or chronologies of specific symptoms
-if you have had a history of mood symptoms, it can be informative to prepare a chart showing how your symptoms have changed over time.
-your chart might start literally at your birth, continuing up to the present, with a graph showing how your mood has changed (e.g. showing when your mood has felt good, felt anxious, felt depressed, felt manic, etc.)
-a closer examination of the past few months, or past few years, could allow you to show mood changes in more detail
-underneath the graph of your symptom, you might include significant life events (e.g. losses, changes or problems in school, work, relationships, family, finances, etc.). This allows an examination of the relationship between life events and symptoms
-in another row underneath the graph of your symptoms, you might include any treatments you have attempted (e.g. starting, changing, or stopping any counseling, medications, or self-help)
-these charts could illustrate the long-term pattern of your mood, and illustrate what things might have helped or hindered your problems over the years
-if you have had medication treatments, it can be especially useful to see how your symptoms have changed in association with starting or stopping the medication

Here is an on-line example of a so-called "restrospective life chart": I find this particular chart cumbersome and cluttered--I invite you to make your own simple, personalized version of such a chart, with areas on the chart pertinent to your own specific symptoms or treatments.

There are various monthly mood symptom charts you can find on-line. I have included my own version of a monthly mood chart, which you could adapt according to your own symptoms. You can right-click on the chart above, select "copy image", then open your word processor and paste the image onto a new empty word processing file. To use my chart, you could circle the number most representative of how your symptom is on a given day; or make an oval over several numbers at once to show symptoms that have fluctuated during the same day; or you could gradually trace a line showing symptom changes, without circling the numbers, etc. I made my chart in a few minutes using Excel--you could make your own, with different categories relevant to your situation.

2) sometimes writing a narrative essay about your life can be a useful exercise to prepare for a psychiatric interview; however, you may wish to speak out this narrative during therapy sessions, rather than write it down in advance. You may find that you can do both: in the course of therapy, you may find elements of your written narrative to expand upon or emphasize more strongly, other new elements to write about for the first time, and other elements you may wish to retire from the foreground.

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