Psychiatric Interviews for Teaching: Psychosis
Please note that this video has been made by the University of Nottingham for teaching purposes. The psychiatrist is a real psychiatrist but the patient is played by an actor. No real names or personal details have been used.
In this film, an on-call psychiatrist is assessing a young man who has been referred urgently by his GP. The psychiatrist takes a history in which she elicits persecutory delusions, third person auditory hallucinations, running commentary, thought insertion, and somatic hallucinations. She then makes a risk assessment, takes a drug history and assesses risk.
The patient is clearly suffering from a psychotic disorder and the most likely diagnosis is schizophrenia. Differential diagnoses would include a drug-induced psychosis.
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Now I'm just a free thinker. I'm very good with people and I'm very perceptive based off of my experiences and in my opinion. I feel like it might be a sickness, but as we learn more and more about the human body and our reality in general, I can't help thinking what if we just can't hear the things that they hear. I'm not saying it's 100% true but sometimes I wonder. Even like people who say they see ghosts. With all the things I know about our reality and the way things work, it doesn't necessarily seem that crazy to think that some people have seen that. Anyway, I'm getting off track. My point is we should continue to think outside the box. Obviously we should diagnose people by based off of what we know, but also we shouldn't think that what we know is 100% correct.
My partner went through a lot of this for a few years. The weirdest thing I saw was catatonia. Lasted about 20mins, during which she was completely frozen.
I have witnessed this and it’s so scary and disturbing because no matter how much you reassure them that it’s not real they will start to become distressed and be suspicious of you and it’s so hard to deal with but it’s just so sad to see.
The dr is moving too fast for my liking
The actor playing patient is really good! I believed he was psychotic.
Guys, read the description: this is staged for learning purposes.
The situation is definitely one that students will probably encounter once they get into practice but this particular interview isn't real. 😅
cannabis causes schizophrenia. cannabinoids mimic reverse neurotransmitters that affect Gaba and glutamate, which regulate dopamine and serotonin. It increases dopamine production, that's how it causes psychosis.
I am in psychosis too, not fun to hear voices i think their mind readers in the sides of the ears.
Do any of you in psychosis experience dejavu jamivu, chills, anger. See stuff with your eyes closed? Like alive human beings ? Or see people shrunk down? Do your eyes black out when your eyes are closed?
Over the course of the interview the psychiatrist takes no notes, even though we can only retain so little of what we can hear and see. Proper due-diligence should be taught and reflected in learning materials with more consistency. Rapport and trust can also be ensured with offering a debrief toward the end of a session.
I am writing this because I had some very serious false diagnosis over the course of my life that were largely based on de-contextualized details and anchoring bias, among others. In a much later examination I ended up on the opposite of the spectrum than the misdiagnoses that turned my life upside down. What an irony. Needless to say, I have massive distrust in psychiatric practice nowadays.
So, please aim to do better folks! It affects people in very serious ways, if you don't do your work properly. Practice some professional humility, please! You can be wrong or even be entirely unqualified for the job. Diagnosis criteria exists to be adhered to (obviously, the presented case is quite clear).
Stay true to the oath you take!
Thank you.
I think she did a fabulous job, the only critical thing I would say is that she filled the silence to quickly. Let him finish, let him think and respond.
Really fascinating! The actor does a great job!
his insight seems to b ok any leads?
it's nice that she says "it must be very difficult for you" a lot, it's very comforting
The "right" and "ok" come across as robotic. It might get the job done in many cases, but it is not genuine empathy. The rest is conducted very well, albeit it feels like a speedrun. No space for thinking to happen, lots of interruptions. The patient looks very convincing, maybe he has at least dealt with it before. Would have obviously preferred a real consultation with someone dealing with psychosis, but I can see why there is no way to get consent for that while under psychosis… You have to understand there is no distress shown in this video – from the patient, nor from the therapist. This is what separates "doing a technique" from "real therapy". In the absence of real empathy and genuine care for the client, they will not open up, and they will not feel safe. Simple as that. Interesting to see how a doctor would approach such a situation – as that is what a psychiatrist is, compared to a counsellor or non-medically trained therapist. It feels like problem solving and like going through a narrative, as if there is something to play out – instead of the genuine terror of encountering psychosis in the therapeutic room.
Don’t do meth, don’t even try it.
I hear voices, too. It's so irritating. It happens every night before I go to sleep, which can make falling asleep terrifying and incredibly confusing.
She interrupts him constantly. And she doesn't wait long to do so – maybe half a millisecond, give or take.
She also constantly stop him to clarify what he is saying to put it in her own words. She's doing the interview and answering the questions. This is great
What if he was speaking the Truth though? interesting
This is so helpful, thank you. Why does she ask about whether his parents are involved in the delusions? Is there a specific purpose, like seeing the systematisation?