Interval History

0:00 this talk is about how to complete an interval history in Psychiatry an interval history or follow-up history is the history since the patient's last visit in other words you're gathering information on what has happened in the interval since the last visit depending on the treatment setting that interval might be shorter or longer for example in an intensive treatment setting like an inpatient psychiatric hospital where psychiatrists are seeing patients every day the interval will be one day but in the Outpatient Treatment setting the length between visits may be longer for example 1 month regardless of the treatment setting or interval length the principles of gathering an interval history are the same which I would distill into three major goals getting updates on the patient's mental status and current symptoms getting updates on

0:46 the patient's response to treatment and any side effects of treatment and collaboratively determining the next steps in treatment let's walk through each of these goals in more detail the first goal is getting updates on mental status and symptoms at the very minimum this includes checking in on mood appetite sleep and any safety concerns these symptoms tend to be cross- diagnostic meaning they are relevant regardless of the patient's underlying problem however I tend to start my interviews open-ended with a simple prompt like how are you doing today or how are you since our last visit to allow the patient the space to talk about what is most important to them first when needed I can then redirect with specific Focus questions about mood appetite sleep and safety to be more

1:31 concrete safety concerns might include topics such as Suicidal Thoughts homicidal thoughts or active psychosis symptoms such as hallucinations all of which could be indications for an emergency evaluation or hospitalization the second goal is getting updates on the response to treatment including symptoms specific to their diagnosis and any side effects of treatment here I focus on the patient Chief complaint again starting open-ended with the question such as have you noticed any changes in your symptoms since last visit then moving on to other specific symptoms relevant to the chief complaint for example if the patient's Chief complaint is psychosis then I would be sure to ask about auditory and visual hallucinations and delusions similarly for side effects I start open-ended with a questions such as have you noticed any side effects of

2:16 your current medications then checking in on specific side effects that are common for these medications for example for an SSRI I would ask about nausea and vomiting headaches anxiety and sleep problems among others the third and last goal is determining next steps in treatment I would check in on all current treatment modalities including biological psychological and social treatments I would also address the patient disposition disposition refers to the patient next treatment stage for example if the patient is currently hospitalized this would involve discussing the expected discharge date and the plan for follow-up Outpatient Care there are a couple ways to approach treatment planning I tend to start off by asking an open-ended question such as what do you want to do next with a question like this I am

3:02 supporting the patient and making their own Healthcare decisions however if the patient is seeking your recommendation then I might take more of a guiding stance and say something like I think we should do this next what do you think and hear their feedback regardless of how you approach treatment planning it's important to always engage in shared decision- making and I always conclude my treatment discussion by asking what questions do you have to make sure I've answered any questions and have educated my patient sufficiently so these are the things I usually cover in an interval history while leaving a lot of flexibility to discuss anything else relevant to the case at hand I'd like to conclude by sharing a pneumonic to remember this outline then Show an example of how I do this in practice the pneumonic is Masters which covers mood appetite sleep treatment plan side

3:49 effects treatment response and safety this can be a lot of information to remember if you're seeing many different patients in a day so when I am rounding I carry a template with me that has a section for each patient with these topics listed I then simply record one or two words in shorthand to recall how the patient answered my questions for example John Doe told me his mood was better appetite was normal sleep was normal denied any safety concerns said his depression was getting better denied side effects of medication and we agreed to increase his acetal pram to 15 mg in the morning as another example Jane Doe told me her mood was irritable appetite was normal sleep was poor with early insomnia denied any safety concerns reported her anxiety was 6 out of 10

4:36 reported a possible medication side effect of stomach ache and we agreed to keep her Sertraline at 50 Mig in the morning while she continued to get used to the medication that's the end of this talk I hope this is a useful guide to taking an interval history thank you