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The first encounter with a patient begins with taking a clinical history, just as in other specialties. The novice may feel some anxiety about approaching and interviewing people with mental illnesses, but largely because they have been portrayed in the media in such disturbing ways. Furthermore, psychiatric history-taking requires the interviewer to ask unusual questions such as “Do you hear voices when no one is around?” or to ask about areas of life that are especially private and intimate, such as sexual preferences and practices. However, it is a bit like learning to ski or swim. Once you head down the mountain (or get in the water), you will find history-taking to be surprisingly easy, interesting, and even fun. Demands placed on the interviewer will vary, of course, depending on the type of illness the patient has and its severity. Patients with milder syndromes, such as anxiety disorders or personality disorders, are usually more capable of describing their symptoms and history clearly and articulately. The severely ill depressed, manic, or psychotic patient presents a real challenge, and clinicians may have to depend on informants, such as family members or friends, in addition to the patient.
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