‘Despite major advances…there are no laboratory procedures as informative as observing, listening to and interacting with the patient, and none as yet are more than supplementary to the information gathered by the psychiatrist interview.’ In this text, Tasman et al. explore the psychiatric interview as the heart of psychiatric practice on which accurate diagnosis and treatment plan rely.
The book is well structured and proceeds in a methodical manner. It begins with chapters exploring some of the basic constructs of every interview namely the concepts of listening, the physician–patient relationship and cultural context.
After setting the scene, the reader moves to the specific information to be gleaned from the psychiatric interview itself. A structured approach to this is outlined and emboldened headings make an easy read. Following on, formulation is reviewed and the reader is challenged to look beyond the DSM Axes to develop an explanatory hypothesis about the patient’s current difficulties. Physical examination, laboratory and neurophysiologic assessment, risk, differential diagnosis and initial treatment plan are also covered. The text combines both conventional and new knowledge. It places emphasis on integrating the patient’s experience with biological, psychological and social factors of the illness. Professional ethics and boundaries are also discussed and while some of the examples delve more into the specifics of working in the American health system, it still gives cause for thought.
The authors use a variety of styles. A lengthier, reflective narrative is pursued to explore ideas. This is combined with the use of clinical vignettes that are effective in illustrating practical issues and resonate easily with the reader. Summary tables are also used to condense information into key points. Use of these different techniques is one of the strengths of this text.
Another strength is the authors’ ability to challenge preconceived ideas of psychiatric practice. For example, in the chapter dedicated to interviewing special populations they begin by describing a pop-culture view of psychiatry – ‘the patient and clinician sit comfortably in soft leather chairs in the psychiatrist’s office surrounded by objets d’art…,’ before proceeding to explore contrasting settings for an interview. These ranged from the more usual scenario of the emergency department, to more unusual ones involving mass casualties and even telepsychiatry! Nonetheless, important points are raised in dealing with each of these settings and recommendations are helpfully summarized.
The take home messages from this book are good. Each chapter has its own theme with its own important points to make. References are also included at the end of each chapter for convenience. While there is a natural flow linking the chapters, each could also be read in isolation to address a specific need. While this has its advantages, it does result in some repetition. But this is not a bullet point reference guide, and nor does it claim to be. It acts as a valued reference text and its style allows the reader to reflect on aspects of the psychiatric interview that are often not considered, or, are taken for granted. The authors state to have a target audience ranging from medical students to psychiatry residents as well as practising psychiatrists, and indeed I feel there is something for all these groups in this text.
