Interviewing and Case Formulation

Author(s):  
Naomi Koerner ◽  
Heather K. Hood ◽  
Martin M. Antony

The main objective of this chapter is to provide an overview of clinical interviewing. Although clinical interviewing is often referred to as an art (Shea, 2007), the information in this chapter highlights the science of clinical interviewing as well. The chapter opens with a discussion of the general structure and content of clinical interviews that are typically conducted in mental health contexts. The reader is introduced to a variety of interviews that are used in the assessment of Axis I and Axis II conditions, including their psychometric properties; guidelines for the assessment of suicidality are also presented. This is followed by an overview of interviewing skills. Specifically discussed are ways in which information processing limitations, verbal and nonverbal cues, and style of questions can influence the clinical interview. We then turn to a discussion of case formulation, a core component of the clinical interview. Empirical research on the impact of training on quality of case conceptualization and on the association between case formulation and treatment outcome is summarized. The chapter closes with a brief overview of issues that may arise when interviewing certain populations, in particular, couples, individuals from diverse populations, and young individuals.

Author(s):  
Naomi Koerner ◽  
Heather K. Hood ◽  
Martin M. Antony

The main objective of this chapter is to provide an overview of clinical interviewing. Although clinical interviewing is often referred to as an art (Shea, 2007), the information in this chapter highlights the science of clinical interviewing as well. The chapter opens with a discussion of the general structure and content of clinical interviews that are typically conducted in mental health contexts. The reader is introduced to a variety of interviews that are used in the assessment of Axis I and Axis II conditions, including their psychometric properties; guidelines for the assessment of suicidality are also presented. This is followed by an overview of interviewing skills. Specifically discussed are ways in which information processing limitations, verbal and nonverbal cues, and style of questions can influence the clinical interview. We then turn to a discussion of case formulation, a core component of the clinical interview. Empirical research on the impact of training on quality of case conceptualization and on the association between case formulation and treatment outcome is summarized. The chapter closes with a brief overview of issues that may arise when interviewing certain populations, in particular, couples, individuals from diverse populations, and young individuals.


Author(s):  
S. Patel ◽  
M. Clancy ◽  
H. Barry ◽  
N. Quigley ◽  
M. Clarke ◽  
...  

Abstract Objectives: There is a high rate of psychiatric comorbidity in patients with epilepsy. However, the impact of surgical treatment of refractory epilepsy on psychopathology remains under investigation. We aimed to examine the impact of epilepsy surgery on psychopathology and quality of life at 1-year post-surgery in a population of patients with epilepsy refractory to medication. Methods: This study initially assessed 48 patients with refractory epilepsy using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life in Epilepsy Inventory 89 (QOLIE-89) on admission to an Epilepsy Monitoring Unit (EMU) as part of their pre-surgical assessment. These patients were again assessed using the SCID-I, QOLIE-89 and HADS at 1-year follow-up post-surgery. Results: There was a significant reduction in psychopathology, particularly psychosis, following surgery at 1-year follow-up (p < 0.021). There were no new cases of de novo psychosis and surgery was also associated with a significant improvement in the quality of life scores (p < 0.001). Conclusions: This study demonstrates the impact of epilepsy surgery on psychopathology and quality of life in a patient population with refractory surgery. The presence of a psychiatric illness should not be a barrier to access surgical treatment.


2007 ◽  
Vol 38 (10) ◽  
pp. 1435-1442 ◽  
Author(s):  
P. K. Keel ◽  
B. E. Wolfe ◽  
J. A. Gravener ◽  
D. C. Jimerson

BackgroundRecent studies suggest that purging disorder (PD) may be a common eating disorder that is associated with clinically significant levels of distress and high levels of psychiatric co-morbidity. However, no study has established evidence of disorder-related impairment or whether distress is specifically related to PD rather than to co-morbid disorders.MethodThree groups of normal-weight women [non-eating disorder controls (n=38), with PD (n=24), and with bulimia nervosa (BN)-purging subtype (n=57)] completed structured clinical interviews and self-report assessments.ResultsBoth PD and BN were associated with significant co-morbidity and elevations on indicators of distress and impairment compared to controls. Compared to BN, PD was associated with lower rates of current and lifetime mood disorders but higher rates of current anxiety disorders. Elevated distress and impairment were maintained in PD and BN after controlling for Axis I and Axis II disorders.ConclusionsPD is associated with elevated distress and impairment and should be considered for inclusion as a provisional disorder in nosological schemes such as the Diagnostic and Statistical Manual to facilitate much-needed research on this clinically significant syndrome.


2004 ◽  
Vol 94 (3_suppl) ◽  
pp. 1313-1321 ◽  
Author(s):  
Santo F. Di Nuovo ◽  
Serafino Buono ◽  
Gerardo Colucci ◽  
Anna Pellicciotta

The aim of this research was to study the psychological effects of disorders such as schizophrenia and depression associated with mental retardation. The Rorschach Inkblot Test and the Wechsler Adult Intelligence Scale were administered to a group of 97 subjects (52 women and 45 men) ages 15:10 yr. to 36:6 yr. ( M = 21:5, SD = 5:3). The subjects were divided into four subgroups according to the presence or absence of mental retardation and psychiatric diagnosis (schizophrenia versus depression). The quality of the perception in Rorschach responses and the ErlebnisTypus scores differentiated psychotic and depressed subjects well. These disorders, when associated with mental retardation, make impairment of perceptual performance worse. The interaction between Axis I mental disorders (according to DSM–IV diagnosis) and mental retardation, an Axis II disorder, is discussed.


2016 ◽  
Vol 209 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Yongsheng Tong ◽  
Michael R. Phillips ◽  
Kenneth R. Conner

BackgroundThere are meagre data on Axis II personality disorders and suicidal behaviour in China.AimsTo describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders.MethodPeople who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders.ResultsAxis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7–8.0 for suicide and for suicide attempts.ConclusionsAxis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.


2007 ◽  
Vol 19 (6) ◽  
pp. 357-361 ◽  
Author(s):  
Arianna Goracci ◽  
Mirko Martinucci ◽  
Anastassia Kaperoni ◽  
Andrea Fagiolini ◽  
Chiara Sbaragli ◽  
...  

Objective:This study investigates the relationship between subthreshold obsessive-compulsive disorder (OCD) and quality of life (QoL) in a sample from the Italian general population.Methods:A sample of 202 psychiatrically healthy (defined as absence of current axis I and axis II disorders) subjects was recruited by word of mouth from the residential population in the Siena, Salerno and Milano municipalities (Italy). All study subjects completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Questionnaire for Obsessive-Compulsive Spectrum (OBS-SR), which explore a wide array of threshold and subthreshold OCD symptoms, behaviours and traits. A diagnostic assessment was conducted to exclude the presence of DSM-IV axis I and axis II disorders using the Mini International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-III-R personality disorders, respectively.Results:A statistically significant correlation was found between the OBS-SR total score and the Q-LES-Q domains of physical health, subjective feelings, work, school, social relationships and general activities. There was also a statistically significant correlation between several Q-LES-Q and OBS-SR domains.Conclusions:The presence of subthreshold OCD is correlated with poorer QoL. More research is needed to evaluate if specific therapeutic interventions targeting subthreshold obsessive-compulsive symptoms can lead to a significant improvement in the QoL of the affected individuals.


2017 ◽  
Vol 65 (1) ◽  
pp. 27-38 ◽  
Author(s):  
Kay Radcliffe ◽  
Elaine McMullan ◽  
Jo Ramsden

The Offender Personality Disorder (OPD) pathway is a national initiative which co-commissions health and probation to work in partnership to enhance the criminal justice management of high risk offenders with personality disorder. Psychologically informed support is expected to augment the current provision for this client group alongside workforce training. The impact of training offender managers (OM) is uncertain and previous research has indicated training may be limited in its effectiveness. This paper examines the impact of a training and supervision model on the quality of formulations produced by offender managers and suggests that a model which teaches formulation through repeated consultation or the live supervision of practice leads to enhanced competencies in completing case formulations. The paper evaluates the quality of formulations produced by offender managers who have had their practice developed through repeated consultation with the OPD pathway (OPDOMs) in comparison with a generic group of offender managers. OPDOMs who have had the longest period of supervision with the project produced the highest quality formulations. The paper acknowledges a number of limitations but suggests that the model under scrutiny may usefully inform service delivery within the Offender Personality Disorder pathway.


2014 ◽  
Vol 120 (4) ◽  
pp. 923-930 ◽  
Author(s):  
Bernd-Otto Hütter ◽  
Ilonka Kreitschmann-Andermahr

Object Despite the progress made in the management of subarachnoid hemorrhage (SAH), many patients complain of persistent psychosocial and cognitive problems. The present study was performed to explore the significance of psychological traumatization by the bleeding with respect to psychosocial results after SAH. Methods A series of 45 patients were examined in a cross-sectional study an average of 49.4 months after SAH by means of a quality-of-life questionnaire, the Beck Depression Inventory, the German version of the Impact of Event Scale (IES), and a clinical interview (Structured Clinical Interview for DSM Disorders) to make the diagnosis of chronic posttraumatic stress disorder (PTSD). Twenty-nine patients underwent surgery for treatment of a ruptured aneurysm; the remaining 16 patients had SAH of unknown origin. Results Twelve patients (27%) exhibited PTSD, and almost two-thirds of the 45 patients in the study reported substantial fear of recurrent hemorrhage. Not only the presence of PTSD but the severity of psychological traumatization as assessed by the IES explained up to 40% of the variance of the self- and proxy-rated impairments. Multivariate analyses revealed psychological traumatization (IES) and neurological state on admission (Hunt and Hess grade) as substantial predictors of the self- and proxy-rated quality of life, explaining 31% and 42% of the variance, respectively. Conclusions Even several years after SAH, the severity of psychological traumatization by the bleeding substantially determines the degree of psychosocial impairment. In the future, this issue should be addressed in the care of these patients. Furthermore, the development of psychological interventions is called for to prevent the emergence of PTSD after SAH.


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