Interviewing Young People with Early Psychosis

Power [42] described the approach to interviewing young people suspected of having an early psychotic disorder. Establishing rapport should begin with putting the patient at ease by spending time with introductions and explanations of one's role, acknowledging, listening carefully, respecting the patient's viewpoint, and trying to identify common ground. At the same time, the patient's appearance, responsiveness, attention span, affect, level of anxiety, agitation, hostility and unpredictability can be observed, as well as movements, communication, responses and willingness to engage.

Attention should be given to the setting of the interview (for example, seating arrangements) and use of body language to minimize confrontation, particularly with paranoid, anxious or manic patients. The interviewer should be positioned side-by-side with the patient, avoiding direct face-to-face contact, and yet allowing adequate ''personal space'' for an agitated person to move around. With patients who are highly aroused or hostile, more than one clinician should be present. The clinician should be able to reach the door, and retreat from a situation should it escalate. One should avoid stating a position if there are not the resources to support it.

Once the interview is established, the patient's view of recent experiences may be explored with open-ended questions, which allow patients to provide their own account. At the same time, thought form, stream and content, evidence of perceptual disturbances and level of insight can be assessed. Empathic language should be simple and attuned to the focus of distress or suffering (''that must be awful/very distressing'', not ''I know how you feel/I understand what it's like''), and any immediate fears about treatment should be identified and dealt with.

Specific interview techniques include the ''Colombo technique'' of adopting an excessively naive stance and asking a series of very basic questions to evoke greater disclosures from a cautious or guarded patient.

At the end of the interview, provide initial feedback to the patient together with options for the next step, and link these ideas with the problem areas that have been identified by the patient, e.g. ''I can't get to sleep . . . I don't feel comfortable with my friends... I can't concentrate at work''.

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