The Psychiatric Database
The body of information to be gathered from the interview may be termed the psychiatric database (Tables 3.2 to 3.4). It is a vari-able set of data: either very specific or general, mainly limited to the present state or focused on early life, dominated by neuro-logical questions or inquiry into relationships. To avoid setting the impossible task of learning everything about every patient, one must consider certain factors which modify the required database.
Whose questions are to be answered – the patient’s con-cern about himself, a family or friend’s concern about him, another physician’s diagnostic dilemma, a civil authority’s need to safeguard the public, or a research protocol require-ment? Who will have access to the data gathered and under what circumstances? What is the setting of the interview? Pri-orities in an emergency room differ from those in an office setting (Meyers and Stein, 2000). Is the interview to be the
first session of a psychotherapy regimen, or is it a one time only evaluation? What is the nature of the pathology? For ex-ample, negative responses regarding the presence of major psychotic symptoms, coupled with a history of good occupa-tional function, will generally preclude a detailed inventory of psychotic features. A missed orientation or memory question will require careful cognitive testing. Patients with person-ality disorder symptoms warrant careful attention to the his-tory of significant relationships (Nurnberg et al., 1991), work history and the feelings evoked in the interviewer during the evaluation process. The database should be expanded in areas of diagnostic concern to support or rule out particular syn-dromes. The amount and nature of the data obtained is also, of necessity limited, by the patient’s ability to communicate and his cooperativeness.