Contents
A. Clinical Psychiatry 临床精神医学
- Examination and Diagnosis of the Psychiartric Patient
精神科患者的检查与诊断
- The Adult Patient
成年患者- Children and Adolescents
儿童与青少年- Geriatric Patients
老年患者- Neurodevelopmental Disorder and Other Childhood Disorders
- Intellectual Disability
智力障碍- Communication Disorder
沟通障碍- Attention-Deficit / Hyperactivity Disorder
注意缺陷/多动障碍（ADHD）- Specific Learning Disorder
特定学习障碍- Motor Disorders
运动障碍- Feeding and Eating Disorders of Infancy or Early Childhood
婴儿期或儿童早期的喂养与进食障碍- Trauma- and Stressor-Related Disorders in Children
儿童期创伤及应激相关障碍- Depressive Disorders and Suicide in Children and Adolescents
儿童与青少年抑郁障碍及自杀- Early-Onset Bipolar Disorder
早发性双相障碍- Disruptive Mood Dysregulation Disorder
破坏性心境失调障碍（DMDD）- Disruptive Behaviors of Childhood
儿童期破坏性行为- Anxiety Disorders of Infancy, Childhood, and Adolescence: Separation Anxiety Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder (Social Phobia)
婴儿期、儿童期与青少年期的焦虑障碍：分离焦虑障碍、广泛性焦虑障碍和社交焦虑障碍（社交恐惧症）- Selective Mutism
选择性缄默症- Obsessive-Compulsive Disorder in Childhood and Adolescence
儿童与青少年强迫症- Early-Onset Schizophrenia
早发性精神分裂症- Adolescent Substance Use Disorders
青少年物质使用障碍- Neurocognitive Disorders
- Delirium
谵妄- Dementia (Major Neurocognitive Disorder)
痴呆（重度神经认知障碍）- Major or Minor Neurocognitive Disorder due to Another Medical Condition (Amnestic Disorders)
由于其他躯体疾病所致的重度或轻度神经认知障碍（遗忘障碍）- Neurocognitive and Other Psychiatric Disorders due to a General Medical Condition
由于一般医学状况所致的神经认知障碍及其他精神障碍- Mild Cognitive Impairment
轻度认知损害- Substance Use and Addictive Disorders
物质使用障碍及成瘾障碍
- General Features of the Substance-Related Disorders
物质相关障碍的一般特征- Alcohol-Related Disorders
酒精相关障碍- Cannabis-Related Disorders
大麻相关障碍- Opioid-Related Disorders
阿片类相关障碍- Sedative-, Hypnotic-, or Anxiolytic-Related Disorders
镇静剂、催眠剂或抗焦虑药相关障碍- Stimulant-Related Disorders
兴奋剂相关障碍- Tobacco-Related Disorders
烟草相关障碍- Caffeine-Related Disorders
咖啡因相关障碍- Hallucinogen-Related Disorders
致幻剂相关障碍- Inhalant-Related Disorders
吸入剂相关障碍- Anabolic-Androgenic Steroid Use
合成代谢雄激素类固醇使用- Gambling Disorder
赌博障碍- Other Disorders Related to the Addictive Disorders
其他与成瘾障碍相关的障碍- Schizophrenia Spectrum and Other Psychotic Disorders
精神分裂症谱系及其他精神病性障碍- Bipolar Disorders
双相障碍- Depressive Disorders
抑郁障碍- Anxiety Disorders
焦虑障碍- Obsessive-Compulsive and Related Disorders
强迫症相关障碍- Trauma- and Stressor-Related Disorders
创伤及应激相关障碍- Dissociative Disorders
分离障碍- Somatic Symptom and Related Disorders
躯体症状及相关障碍- Feeding and Eating Disorders
喂食与进食障碍- Elimination Disorders
排泄障碍- Sleep–Wake Disorders
睡眠—觉醒障碍- Human Sexuality and Sexual Dysfunctions
人类性行为与性功能障碍- Gender Dysphoria, Gender Identity, and Related Conditions
性别焦虑、性别认同及相关情况- Disruptive, Impulse-Control, and Conduct Disorders
破坏性、冲动控制及品行障碍- Personality Disorders
人格障碍- Other Conditions that May be a Focus of Clinical Attention
其他可能成为临床关注重点的情况B. Treatment Across the Lifespan
贯穿生命周期的治疗
- Psychopharmacology
精神药理学
- Antipsychotics
抗精神病药- Antidepressants
抗抑郁药- Mood Stabilizers
心境稳定剂- Anxiolytics
抗焦虑药- Drugs Used to Treat Sleep Disorders
用于治疗睡眠障碍的药物- Stimulants
兴奋剂- Drugs Used to Treat Substance Use Disorders
用于治疗物质使用障碍的药物- Drugs Used for Cognitive Enhancement
用于认知增强的药物- Drugs Used to Treat Sexual Disorders
用于治疗性功能障碍的药物- Drugs Used to Treat the Side Effects of Psychotropic Drugs
用于治疗精神药物副作用的药物- Nutritional Supplements and Related
营养补充剂及相关制剂- Other Somatic Therapies
其他躯体治疗方法- Psychotherapy
心理治疗- Psychiatric Rehabilitation and Other Interventions
精神康复及其他干预措施- Consultation to Other Disciplines
为其他学科提供会诊
- Consultation-Liaison Psychiatry
会诊联络精神病学- Geriatric Psychiatry
老年精神病学- Psychiatric Emergencies
精神科急症- Level of Care
照护等级C. Other Issues Relevant to Psychiatry
与精神病学相关的其他问题
- Ethics and Professionalism
伦理与职业素养- Forensic and Legal Issues
司法精神病学与法律问题- End-of-Life Issues and Palliative Care
临终问题与姑息治疗
- Death, Dying, and Bereavement
死亡、濒死与丧亲- Palliative Care
姑息治疗- Euthanasia and Physician-Assisted Suicide
安乐死与医师协助自杀- Community Psychiatry
社区精神病学- Global and Cultural Issues in Psychiatry
精神病学中的全球与文化问题D. Contributions from the Sciences and Social Sciences to Psychiatry
科学与社会科学对精神病学的贡献
- Normal Development and Aging
正常发育与衰老
- Infant, Child, and Adolescent Development
婴儿期、儿童期与青少年期的发展- Adulthood
成年期- Old Age
老年期- Contributions from the Neurosciences
神经科学的贡献- Contributions from the Behavioral and Social Sciences
行为科学与社会科学的贡献
- Contributions from the Psychosocial Sciences
心理社会科学的贡献- Normality and Mental Health
正常状态与心理健康- Contributions from the Sociocultural Sciences
社会文化科学的贡献- Theories of Personality and Psychopathology
人格与精神病理学理论- A Brief History of Psychiatry
精神病学简史Glossary of Terms Relating to Signs and Symptoms
体征与症状相关术语表Index
索引
A Clinical Psychiatry
Examination and Diagnosis of the Psychiatric Patient
1.1 The Adult Patient
Psychiatric interview, History, and Mental Status Examination
Psychiatric interview = 精神科访谈
History = 病史采集
Mental Status Examination = 精神状态检查
The psychiatric interview is the most crucial element in the evaluation and care of persons with mental illness.
crucial = 至关重要的
element = 组成部分、要素
evaluation = 评估、评价
A significant purpose of the initial psychiatric interview is to obtain information that will establish a criteria-based diagnosis.
obtain = 获得
criteria-based = 基于诊断标准的、依据标准的
This process, helpful in the prediction of the course of the illness and the prognosis, leads to treatment decisions.
prediction = 预测、预判
course of the illness = 疾病病程 = 疾病发展的过程
prognosis = 预后 = 指疾病未来结局的判断
leads to = 导向、促成
A well-conducted psychiatric interview provides a multidimensional understanding of the disorder’s biopsychosocial elements.
well-conducted = 进行得当的、实施良好的
multidimensional = 多维度的
biopsychosocial = 生物、心理、社会的
It provides the information necessary for the psychiatrist, in collaboration with the patient, to develop a person-centered treatment plan.
collaboration = 合作，协作
Equally important, the interview itself is often an essential part of the treatment process.
essential = 必要的，极其重要的
From the very first moments of the encounter, the interview shapes the nature of the patient-physician relationship, which can have a profound influence on the outcome of treatment.
encounter = 会面，接诊，医患接触
patient-physician = 医生与患者之间的
physician = 医生
nature of the patient-physician = 医患关系的性质
nature = 性质，本质profound = 深刻的、深渊的、强烈的、重大的、极大的
The settings in which the psychiatric interview takes place include psychiatric inpatient units, medical nonpsychiatric inpatient units, emergency rooms, outpatient offices, nursing homes, other residential programs, and correctional facilities.
setting指的是环境、场所
take place = 发生，进行
psychiatric inpatient units = 精神科住院病房
inpatient = 住院病人
unit = 病房medical nonpsychiatric inpatient units = 非深刻的普通医疗住院病房
other residential programs = 其他住院式项目
correctional facilities = 惩教机构（监狱等矫正机构）
The length of time for the interview, and its focus, will vary depending on the setting, the specific purpose of the interview, and other factors (including concurrent competing demands for professional services).
vary = 变化、不同、有差异
Nevertheless, some basic principles and techniques are essential for all psychiatric interviews, and these will be the focus of this section.
Nevertheless = 然而，尽管如此，不过
There are particular issues in the evaluation of children that will not be addressed.
particular = 某些特定的
address = 处理、讨论、说明、对应
This section focuses on the psychiatric interview of adult patients.
General Principles
Agreement as to Process.
就程序达成一致
At the beginning of the interview, the psychiatrist should introduce themself and, depending on the circumstances, may need to identify why he or she is speaking with the patient.
depend on = 取决于；依靠；视……而定
circumstance = 具体情况
Unless implicit (the patient coming to the office), consent to proceed with the interview should be obtained, and the nature of the interaction and the approximate (or specific) amount of time for the interview should be stated.
implicit = 默认存在的，含蓄的，不言明的
consent = 同意、许可
obtain = 获得、获取
interaction = 互动、交流
The patient should be encouraged to identify any elements of the process that he or she wishes to alter or add.
identify = 明确说出，指出，识别
A crucial issue is whether the patient is, directly or indirectly, seeking the evaluation voluntarily or has been brought involuntarily for the assessment.
crucial = 关键的、非常重要的
voluntarily = 自愿的
involuntarily = 非自愿的
This issue should be established before the interview begins, and this information will guide the interviewer, especially in the early stages of the process.
stage = 阶段
Privacy and Confidentiality. Issues concerning confidentiality are crucial in the evaluation/treatment process and may need to be discussed on multiple occasions.
Health Insurance Portability and Accountability Act (HIPAA) regulations must be carefully followed, and the appropriate paperwork must be presented to the patient. Confidentiality is an essential component of the patient-doctor relationship. The interviewer should make every attempt to ensure that others cannot overhear the content of the interview. Sometimes, in a hospital unit or other institutional setting, this may be difficult. If the patient is sharing a room with others, an attempt should be made to use a different place for the interview. If this is not feasible, the interviewer may need to avoid specific topics or indicate that these issues can be discussed later when privacy can be ensured. Generally, in the beginning, the interviewer should suggest that the content of the session(s) will remain confidential except for what needs to be shared with the referring physician or treatment team. Some evaluations, including forensic and disability evaluations, are less confidential, and what is discussed may be shared with others. In those cases, the interviewer should be explicit in stating that the session is not confidential and identify who will receive a report of the evaluation. This information should be carefully and thoroughly documented in the patient’s record. A special issue concerning confidentiality is when the patient indicates that he or she intends to harm another person. When the psychiatrist’s evaluation suggests that this might indeed happen, the psychiatrist may have a legal obligation to warn the potential victim. (The law concerning notification of a potential victim varies by state.) Psychiatrists should also consider their ethical obligations. Part of this obligation may be met by appropriate clinical measures such as increasing the dose of antipsychotic medication or hospitalizing the patient. Often members of the patient’s family, including spouse, adult children, or parents, come with the patient to the first session or are present in the hospital or other institutional setting when the psychiatrist first sees the patient. If a family member wishes to talk to the psychiatrist, it is generally preferable to meet with the family member(s) and the patient together after the session and after the patient’s consent has been obtained. The psychiatrist should not bring up material the patient has shared but listen to the input from family members and discuss items that the patient introduces during the joint session. Occasionally, when family members have not asked to be seen, the psychiatrist may feel that including a family member or caregiver might be helpful and raise this subject with the patient. This may be the case when the patient is not able to communicate effectively. As always, the patient must give consent except if the psychiatrist determines that the patient is a danger to himself or herself or others. Sometimes family members might telephone the psychiatrist. Except in an emergency, consent should be obtained from the patient before the psychiatrist speaks to the relative. As indicated above, the psychiatrist should not bring up material that the patient has shared but listen to the input from the family member. The patient should be told when a family member has contacted the psychiatrist even if the patient has given consent for this to occur. In educational and, occasionally, forensic settings, there may be occasions when the session is recorded. The patient must be fully informed about the recording and how the recording will be used. The length of time the recording will be kept and how access to it will be restricted must be discussed. Occasionally in educational settings, one-way mirrors may be used as a tool to allow trainees to benefit from the observation of an interview. The patient should be informed of the use of the one-way mirror and the category of the observers and be reassured that the rules of confidentiality also bound the observers. The patient’s consent for proceeding with the recording or use of the one-way mirror must be obtained, and it should be made clear that the patient’s receiving care will not be determined by whether he or she agrees to its use. These devices will have an impact on the interview that the psychiatrist should be open to discussing as the session unfolds. Respect and Consideration. As should happen in all clinical settings, the patient must be treated with respect, and the interviewer should be considerate of the circumstances of the patient’s condition. The patient is often experiencing considerable pain or other distress and frequently is feeling vulnerable and uncertain of what may happen. Because of the stigma of mental illness and misconceptions about psychiatry, the patient may be especially concerned, or even frightened, about seeing a psychiatrist. The skilled psychiatrist is aware of these potential issues and interacts in a manner to decrease, or at least not increase the distress. The success of the initial interview will often depend on the physician’s ability to alleviate excessive anxiety. Rapport/Empathy. Respect for and consideration of the patient will contribute to the development of rapport. In the clinical setting, rapport can be defined as the harmonious responsiveness of the physician to the patient and the patient to the physician. It is crucial that patients increasingly feel that the evaluation is a joint effort and that the psychiatrist is genuinely interested in their story. Empathic interventions (“That must have been very difficult for you” or “I’m beginning to understand how awful that felt”) further increase the rapport. Frequently a nonverbal response (raised eyebrows or leaning toward the patient) or a very brief response (“Wow”) will be similarly effective. Empathy is understanding what the patient is thinking and feeling. It occurs when the psychiatrist can put himself or herself in the patient’s place while at the same time maintaining objectivity. For the psychiatrist to truly understand what the patient is thinking and feeling requires an appreciation of many issues in the patient’s life. As the interview progresses, the patient’s story unfolds, and patterns of behaviors become evident, and it becomes clearer what the patient may have experienced. Early in the interview, the psychiatrist may not be as fully confident of where the patient is or was (although the patient’s nonverbal cues can be very beneficial). If the psychiatrist is uncertain about the patient’s experience, it is often best not to guess but to encourage the patient to continue. Head nodding, putting down one’s pen, leaning toward the patient, or a brief comment, “I see,” can accomplish this objective and simultaneously indicate that this is important material. The large majority of empathic responses in an interview are nonverbal. An essential ingredient in empathy is retaining objectivity. Maintaining objectivity is crucial in a therapeutic relationship, and it differentiates empathy from identification. With identification, psychiatrists not only understand the emotion but also experience it to the extent that they lose the ability to be objective. This blurring of boundaries between the patient and psychiatrist can be confusing and distressing to many patients, especially to those who, as part of their illness, already have significant boundary problems (e.g., individuals with borderline personality disorder). Identification can also be draining to the psychiatrist and lead to disengagement and, ultimately, burnout. Patient-Physician Relationship. The patient-physician relationship is the core of the practice of medicine. (For many years, the term used was “physician-patient” or “doctor-patient,” but the order is sometimes reversed to reinforce that the treatment should always be patient-centered.) Although the relationship between any single patient and physician will vary depending on each of their personalities and past experiences as well as the setting and purpose of the encounter, there are general principles that, when followed, help to ensure that the relationship established is helpful. The patient comes to the interview seeking help. Even in those instances when the patient arrives on the insistence of others (i.e., spouse, family, courts), assistance may be sought by the patient in dealing with the person requesting or requiring the evaluation or treatment. This desire for help motivates the patient to share with a stranger information and feelings that are distressing, personal, and often private. The patient is willing, to various degrees, to do so because of a belief that the doctor has the expertise, by training and experience, to be of help. Right from the very first encounter (sometimes the initial phone call), the patient’s willingness to share is increased or decreased depending on the verbal and often the nonverbal interventions of the physician and other staff. As the physician’s behaviors demonstrate respect and consideration, rapport begins to develop. This rapport is increased as the patient feels safe and comfortable. If the patient feels secure that what is said in the interview remains confidential, he or she will be more open to sharing. The sharing is reinforced by the nonjudgmental attitude and behavior of the physician. The patient may have been exposed to considerable negative responses, actual or feared, to their symptoms or behaviors, including criticism, disdain, belittlement, anger, or violence. Being able to share thoughts and feelings with a nonjudgmental listener is generally a positive experience. There are two additional essential ingredients in a helpful patientphysician relationship. One is the demonstration by physicians that they understand what the patient is stating and emoting. It is not enough that the physician understands what the patient is relating, thinking, and feeling; this understanding must be conveyed to the patient if it is to nurture the therapeutic relationship. The interview is not just an intellectual exercise to arrive at a supportable diagnosis. The other essential ingredient in a helpful patient-physician relationship is the recognition by the patient that the physician cares. As the patient becomes aware that the physician not only understands but also cares, trust increases, and the therapeutic alliance becomes stronger. The genuineness of the physician reinforces the patient-physician relationship. Being able to laugh in response to a humorous comment, admit a mistake, or apologize for an error that inconvenienced the patient (e.g., being late for or missing an appointment) strengthens the therapeutic alliance. It is also essential to be flexible in the interview and responsive to patient initiatives. If the patient brings in an item, for example, a photo that he or she wants to show the psychiatrist, it is good to look at it, ask questions, and thank the patient for sharing it. Much can be learned about the family history and dynamics from such a seemingly sidebar moment. Also, the therapeutic alliance is strengthened. The psychiatrist should be mindful of the reality that there are no irrelevant moments in the interview room. At times patients will ask questions about the psychiatrist. A good rule of thumb is that questions about the physician’s qualifications and position should generally be answered directly (e.g., board certification, hospital privileges). On occasion, such a question might be a sarcastic comment (“Did you really go to medical school?”). In this case, it would be better to address the issue that provoked the comment rather than respond concretely. There is no easy answer to the question of how the psychiatrist should respond to personal questions (“Are you married?” “Do you have children?” “Do you watch football?”). Advice on how to respond will vary depending on several issues, including the type of psychotherapy being used or considered, the context in which the question is asked, and the wishes of the psychiatrist. Often, especially if the patient is being, or might be, seen for insight-oriented psychotherapy, it is useful to explore why the question is being asked. The question about children may be precipitated by the patient wondering if the psychiatrist has had personal experience in raising children, or more generally does the psychiatrist have the skills and expertise necessary to meet the patient’s needs. In this instance, part of the psychiatrist’s response may be that he or she has had considerable experiences in helping people deal with issues of parenting. For patients being seen for supportive psychotherapy or medication management, answering the question, especially if it is not very personal, such as “Do you watch football?” is entirely appropriate. A significant reason for not directly answering personal questions is that the interview may become psychiatrist-centered rather than patient-centered. Occasionally, again depending on the nature of the treatment, it can be helpful for the psychiatrist to share some personal information even if it is not asked directly by the patient. The purpose of the self-revelation should always be to strengthen the therapeutic alliance to be helpful to the patient. Personal information should not be shared to meet the psychiatrist’s needs. Conscious/Unconscious. Unconscious processes must be considered to understand more fully the patient-physician relationship. The reality is that the majority of mental activity remains outside of conscious awareness. In the interview, unconscious processes may be suggested by tangential references to an issue, slips of the tongue or mannerisms of speech, what is not said or avoided, and other defense mechanisms. For example, phrases such as “to tell you the truth” or “to speak frankly” suggest that the speaker does not usually tell the truth or speak frankly. In the initial interview, it is best to note such mannerisms or slips but not to explore them. It may or may not be helpful to pursue them in subsequent sessions. In the interview, transference and countertransference are very significant expressions of unconscious processes. Transference is the process of the patient unconsciously and inappropriately displacing onto individuals in his or her current life those patterns of behavior and emotional reactions that originated with significant figures from earlier in life, often childhood. In the clinical situation, the displacement is onto the psychiatrist, who is usually an authority figure or a parent surrogate. The psychiatrist must recognize that the transference may be driving the behaviors of the patient, and the interactions with the psychiatrist may be based on distortions that have their origins much earlier in life. The patient may be angry, hostile, demanding, or obsequious not because of the reality of the relationship with the psychiatrist but because of former relationships and patterns of behaviors. Failure to recognize this process can lead to the psychiatrist inappropriately reacting to the patient’s behavior as if it were a personal attack on the psychiatrist. Similarly, countertransference is the process where the physician unconsciously displaces onto the patient patterns of behaviors or emotional reactions as if he or she were a significant figure from earlier in the physician’s life. Psychiatrists should be alert to signs of countertransference issues (missed appointments by the psychiatrist, boredom, or sleepiness in a session). Supervision or consultations can be helpful as can personal therapy in helping the psychiatrist recognize and deal with these issues. Although the patient comes for help, there may be forces that impede the movement to health. Resistances are the processes, conscious or unconscious, that interfere with the therapeutic objectives of treatment. The patient is generally unaware of the impact of these feelings, thinking, or behaviors, which take many different forms, including exaggerated emotional responses, intellectualization, generalization, missed appointments or acting out behaviors. Resistance may be fueled by repression, which is an unconscious process that keeps issues or feelings out of awareness. Because of repression, patients may not be aware of the conflicts that may be central to their illness. In insight-oriented psychotherapy, interpretations are interventions that undo the process of repression and allow the unconscious thoughts and feelings to come to awareness so that they can be handled. As a result of these interventions, the primary gain of the symptom, the unconscious purpose that it serves, may become apparent. In the initial session, interpretations are generally avoided. The psychiatrist should make a note of potential areas for exploration in subsequent sessions. Person-Centered and Disorder-Based Interviews. A psychiatric interview should be person- (patient-) centered. That is, the focus should be on understanding the patient and enabling the patient to tell his or her story. The individuality of the patient’s experience is a central theme, and the patient’s life history is elicited, subject to the constraints of time, the patient’s willingness to share some of this material, and the skill of the interviewer. Adolf Meyer’s “life-charts” were graphic representations of the material collected in this endeavor and were a core component of the “psychobiological” understanding of the illness. The patient’s early life experiences, family, education, occupation(s), religious beliefs and practices, hobbies, talents, relationships, and losses are some of the areas that, in concert with genetic and biologic variables, contribute to the development of the personality. An appreciation of these experiences and their impact on the person is necessary for forming an understanding of the patient. It is not only the history that should be person-centered. The resulting treatment plan must be based on the patient’s goals, not the psychiatrist’s. Numerous studies have demonstrated that often the patient’s goals for treatment (e.g., safe housing) are not the same as the psychiatrist’s (e.g., decrease in hallucinations). This dichotomy can often be traced to the interview where the focus was not sufficiently person-centered but instead was exclusively or mostly symptombased. Even when the interviewer asks explicitly about the patient’s goals and aspirations, the patient, having been exposed on numerous occasions to what a professional is interested in hearing about, may attempt to focus on “acceptable” or “expected” goals rather than his or her own goals. The patient should be explicitly encouraged to identify his or her goals and aspirations in his or her own words. Traditionally, medicine has focused on illness and deficits rather than strengths and assets. A person-centered approach focuses on strengths and assets as well as deficits. During the assessment, it is often helpful to ask the patient, “Tell me about some of the things you do best,” or, “What do you consider your greatest asset?” A more open-ended question, such as “Tell me about yourself,” may elicit information that focuses more on either strengths or deficits depending on several factors, including the patient’s mood and self-image. Safety and Comfort. Both the patient and the interviewer must feel safe. This includes physical safety. On occasion, especially in hospital or emergency room settings, this may require that other staff be present or that the door to the room where the interview is conducted be left ajar. In emergency room settings, it is generally advisable for the interviewer to have a clear, unencumbered exit path. Patients, especially if psychotic or confused, may feel threatened and need to be reassured that they are safe, and the staff will do everything possible to ensure their safety. Sometimes it is useful to explicitly state and sometimes demonstrate that there is sufficient staff to prevent a situation from spiraling out of control. For some, often psychotic patients who are fearful of losing control, this can be reassuring. The interview may need to be shortened or quickly terminated if the patient becomes more agitated and threatening. Once issues of safety have been assessed (and for many outpatients, this may be accomplished within a few seconds), the interviewer should inquire about the patient’s comfort and continue to be alert to the patient’s comfort throughout the interview. A direct question may be helpful in not only making the patient feel more comfortable but also in enhancing the patient-doctor relationship. This might include, “Are you warm enough?” or “Is that chair comfortable for you?” As the interview progresses, if the patient desires tissues or water, it should be provided. Time and Number of Sessions. For an initial interview, 45 to 90 minutes are generally allotted. For inpatients on a medical unit or at times for confused patients, in considerable distress, or psychotic, the length of time that can be tolerated in one sitting may be 20 to 30 minutes or less. In those instances, several brief sessions may be necessary. Even for patients who can tolerate longer sessions, more than one session may be required to complete an evaluation. The clinician must accept the reality that the history obtained is never complete or entirely accurate. An interview is dynamic, and some Time and Number of Sessions. For an initial interview, 45 to 90 minutes are generally allotted. For inpatients on a medical unit or at times for confused patients, in considerable distress, or psychotic, the length of time that can be tolerated in one sitting may be 20 to 30 minutes or less. In those instances, several brief sessions may be necessary. Even for patients who can tolerate longer sessions, more than one session may be required to complete an evaluation. The clinician must accept the reality that the history obtained is never complete or entirely accurate. An interview is dynamic, and some aspects of the assessment are ongoing, such as how a patient responds to exploration and consideration of new material that emerges. If the patient is coming for treatment, as the initial interview progresses, the psychiatrist makes decisions about what can be continued in subsequent sessions.
一息不存，道将来契 