Have an upcoming psych interview

[luysion]

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Hey guys,
Have a psychiatry interview coming up. Haven't done much psych (I am in Egypt and our system is different here we don't need to do a preliminary year to apply to psychiatry)

I am preparing for a interview and wanted to discuss a few things if people didn't mind helping

- If you are in a situation where a 23year old person is expressing suicidal thoughts because they are legally an adult do you still engage with their parents or is it not allowed because the patient is an adult and is all you can do admit them for compulsary treatment?
- When you're asked to see any patient in the emergency department, what are some tips for conducting a "safety risk assessment"? Is it just the general history you take and then add in the psych elements and see what protective and risk factors they have?
- How would you deal with a patient or their family members disagreeing with your diagnosis? For this I would sort of say SPIKE approach but was wondering if someone had a good way to tackle this question.

Thanks guys

 

[luysion]

Any takers? Will be willing to provide gifts

 

[hallowmann]

It kind of seems like you're asking to complete an assignment, but...

1. Obtaining collateral information is an important part of any assessment, so as long as they allow you to talk with relatives/friends, you can do so. In the event that true safety is a concern there are situations you can ask about them even without express permission, but this is more nuanced area.

2. You can Google what's typically involved in a suicide risk assessment. Usually you are obtaining information about risks, access to means and protective factors to determine suicide risk. Realistically data suggests we are very bad at this though, but it's an important part of the assessment.

3. SPIKES I suppose is one way of doing it, but that's more about delivering bad news than explaining diagnoses. I would try to get more information about why they disagree, be open about imperfections in our diagnostic criteria, and say that at this time the most likely diagnosis is X. I will say this answer depends heavily on who you're talking to and what approach they like, but I suspect they just want to make sure you're not going to be argumentative or dismissive of the patient or their family's concerns.

 

[docksan]

1. Unless they tell you not to talk to family, talking to the family can be helpful. You don't need the family's permission to do anything unless the patient is incapacitated and no one else is available to make decisions.

2. Risk assessment is hard, there are lots of guides out there for this.

3. I always tell family or the patient when they disagree they are welcome to seek a second opinion.

 

[Desired Member]

Hey guys,
Have a psychiatry interview coming up. Haven't done much psych (I am in Egypt and our system is different here we don't need to do a preliminary year to apply to psychiatry)

I am preparing for a interview and wanted to discuss a few things if people didn't mind helping

- If you are in a situation where a 23year old person is expressing suicidal thoughts because they are legally an adult do you still engage with their parents or is it not allowed because the patient is an adult and is all you can do admit them for compulsary treatment?
- When you're asked to see any patient in the emergency department, what are some tips for conducting a "safety risk assessment"? Is it just the general history you take and then add in the psych elements and see what protective and risk factors they have?
- How would you deal with a patient or their family members disagreeing with your diagnosis? For this I would sort of say SPIKE approach but was wondering if someone had a good way to tackle this question.

Thanks guys

Just because someone is expressing suicidal thoughts doesn't mean they have to do compulsory treatment. Do they have any suicidal plan or intent? Were the suicidal thoughts fleeting or persistent? Did the patient come in on a legal hold? Did the patient come in voluntarily? Are they intoxicated? It is very, very dependent on the situation.
Risk and Protective Factors
Above is a website that I reference when writing my assessments, it lists risk factors for and protective factors against suicide. I think it is good to ask patients if they have any firearms and whether they are locked up and whether they have the key.
This may be state dependent -- I was taught that if the patient is on a LEGAL HOLD initiated by family/friend/etc and you NEED further information, you can contact family/friend/etc to GET information. However, you can't GIVE any information without patient consent. So for example, you could say "I'm Dr. Luysion, I am wondering your thoughts about PatientXYZ?" But if the patient doesn't want you to talk to them, you could NOT say "yeah so PatientXYZ that you had committed says he is no longer suicidal, he was using meth and had a break up, any concerns?"
If the patient comes in VOLUNTARILY, says they are suicidal, then says they want to leave, you have a feeling they probably aren't safe to discharge, you want to talk to family to get more info, but they refuse...you can't contact anyone, and if you have doubt about their safety upon discharge then you would commit them. You can even tell the patient, "It would help me to have information from -insert family or friend here- to clarify -insert point to clarify here-, but you are refusing to allow me to contact them to clarify this. I feel that in order to keep you safe, I need to commit you to the hospital because I am very concerned you would kill yourself if discharged now."
I don't know what SPIKE is , I guess if this happened I would just give them a printout of the criteria for their DSM diagnosis with pertinent areas underlined and say "here ya go."

 

[comp1]

This is a predominantly American board. I think some of these answers may be highly culturally specific and the first one is definitely specific to the laws in a given country or province. I'm quite sure there are countries out there where beneficence is valued a lot more than how autonomy seems prized above all in America, both culturally and legally. I don't know much about the practice of psychiatry in Egypt.