What are the primary steps and considerations when conducting an admitting psychiatry intake interview for a patient with potential underlying mental health conditions?

Admitting Psychiatry Intake Interview: Essential Components and Approach

Begin with a structured assessment that prioritizes safety, obtains collateral information, and uses cognitive function—not arbitrary lab values—to determine when psychiatric evaluation can proceed. 1

Immediate Safety and Environmental Setup

Place the patient in a safe environment immediately upon arrival, conducting a personal and belongings search, changing them into hospital attire, and positioning them in a room without easy access to medical equipment under close staff supervision if suicidal ideation or self-harm is suspected. 2

• Ensure staff have access to appropriate personal protective equipment and maintain safety protocols throughout the interview. 2
• Designate one primary staff member to conduct the interview, as multiple interviewers can confuse and agitate patients. 3

Critical Pre-Interview Decisions

Medical Clearance: When to Proceed with Psychiatric Assessment

Do not delay psychiatric evaluation waiting for arbitrary blood alcohol levels or routine lab results in alert, cooperative patients with normal vital signs and noncontributory history and physical examination. 2

• Base the decision to begin psychiatric assessment on the patient's cognitive abilities rather than specific blood alcohol levels. 2
• Routine laboratory testing, urine toxicology screens, and brain imaging are low yield, costly, and need not be performed in clinically stable psychiatric patients (alert, cooperative, normal vital signs, noncontributory history/physical). 2
• Obtain focused medical testing only when indicated by abnormal vital signs, altered mental status, new-onset psychiatric symptoms, or concerning findings on history and physical examination. 2
• Consider a period of observation to determine if psychiatric symptoms resolve as intoxication resolves. 2

When Medical Workup IS Required

Obtain directed medical evaluation for: 2

• Altered mental status or unexplained vital sign abnormalities
• New-onset or acute changes in psychiatric symptoms
• Neurological signs or history of head trauma
• Signs suggesting infection (fever, leucocytosis—bacterial meningitis can mimic psychiatric illness)

Structured Interview Components

Documentation of Identifying Information

Record the following at interview initiation: 1

• Patient demographics (name, age, gender, date of birth)
• Date and time of evaluation
• Source of information (patient, family, medical records, collateral contacts)

Chief Complaint and History of Present Illness

Document the patient's own words regarding the presenting problem and circumstances leading to hospitalization. 1

Systematically assess: 1

• Chronology of symptom development
• Psychiatric review of systems (mood, anxiety, psychosis, sleep, impulsivity)
• Anxiety symptoms and panic attacks
• Sleep patterns and abnormalities
• Assessment of impulsivity

Collateral Information: Non-Negotiable

Interview patients and caregivers both together and separately, as patients frequently minimize symptom severity or intention behind their acts. 2

• Obtain collateral information from family members or others who witnessed the patient's state of mind, as this has significant clinical utility. 2
• For adolescents interviewed alone, discuss limits of confidentiality to facilitate honest conversation. 2
• Patients who report "everything is fine" despite clear problems demonstrate poor insight; collateral information becomes essential. 4

Psychiatric History

Document comprehensively: 1

• Past and current psychiatric diagnoses
• Prior psychotic or aggressive ideas
• Prior aggressive behaviors including homicide, domestic violence, and threats
• Prior suicidal ideas, plans, and attempts with specific details: context, method, damage, lethality, and intent
• Previous psychiatric hospitalizations and treatments
• Response to prior medications

Substance Use History

Assess thoroughly: 1

• Tobacco, alcohol, and other substance use
• Misuse of prescribed or over-the-counter medications
• Current or recent substance use disorders
• Withdrawal risk

Medical and Family History

Medical history must include: 1

• Allergies and drug sensitivities
• Current medications (prescribed, non-prescribed, supplements)
• Primary care relationship
• Past/current medical illnesses and hospitalizations
• Cardiopulmonary, endocrinological, and infectious disease status (STDs, HIV, tuberculosis, hepatitis C)

Family history should assess: 1

• Psychiatric disorders in biological relatives
• History of suicidal behaviors in relatives, especially critical for patients with suicidal ideation

Personal and Social History

Identify: 1

• Psychosocial stressors (financial, housing, legal, occupational, relationship problems)
• Trauma history—failure to assess for physical abuse is a critical diagnostic pitfall 4
• Evaluate for signs of domestic violence in vulnerable populations. 2

Physical and Mental Status Examination

Physical Examination

Measure and record: 1

• Height, weight, and BMI
• Vital signs

Mental Status Examination

Conduct a thorough mental status examination including: 2, 1

• Appearance and behavior
• Speech (fluency and articulation)
• Mood and affect
• Thought process (logical, tangential, circumstantial)
• Thought content (hallucinations, delusions, suicidal/homicidal ideation)
• Insight and judgment
• Cognitive function assessment

Consider delirium screening tools when suspicion is high. 2

Risk Assessment: The Critical Component

Perform comprehensive suicide and homicide risk assessment on every patient. 2, 1

Suicide Risk Assessment

Document: 1

• Current suicidal ideas, plans, and attempts
• Documented estimate of suicide risk with influencing factors
• Risk factors: gender, comorbid substance abuse, high lethality of prior attempts

Patients at high risk requiring inpatient admission include those who: 2

• Continue to endorse desire to die
• Remain agitated or severely hopeless
• Cannot engage in safety planning discussions
• Lack adequate support system or monitoring
• Cannot receive adequate follow-up care
• Had high-lethality suicide attempt with clear expectation of death

Use safety planning rather than no-suicide contracts for patients with suicidal ideation. 1

Aggression Risk Assessment

Evaluate: 1, 4

• Current aggressive or psychotic ideas
• Whether aggression is reactive (response to triggers) versus proactive/predatory (planned, goal-directed)
• Whether aggression represents state (situational) versus trait (habitual pattern)
• Frequency, duration, and severity of episodes
• Specific triggers and response to interventions

Diagnostic Formulation and Treatment Planning

Develop a diagnostic formulation based on comprehensive assessment, considering the patient's treatment preferences. 1

Create a treatment plan with: 1

• Clear rationale for interventions
• Disposition plan (level of care determination)
• Aftercare services based on existing community resources 2

Common Pitfalls to Avoid

• Do not use fully structured interviews exclusively—they fail to capture the phenomenological nature of psychiatric symptoms and may miss critical diagnostic information. 5
• Do not assume restraints will be necessary before attempting verbal de-escalation in agitated patients. 3
• Do not order routine laboratory panels, toxicology screens, or neuroimaging without clinical indication—this is costly, low yield, and delays appropriate psychiatric care. 2
• Do not proceed with psychiatric evaluation in patients with altered mental status or unexplained vital sign abnormalities until medical causes are excluded. 2
• Do not rely solely on patient self-report when collateral information is available, especially regarding violence risk and suicidal intent. 2, 4

Special Considerations

The clinical interview requires adequate time, interest, and skill to understand the patient's problems and guide treatment through discharge—risk assessment and treatment, not just risk prediction and management, should be the goals of hospitalization. 6