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July 5, 1995

The Clinical Interview Using DSM-IV, vol 2: The Difficult Patient

Author Affiliations

University of Illinois College of Medicine Chicago

JAMA. 1995;274(1):79-80. doi:10.1001/jama.1995.03530010093043

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


In this volume the authors make an extremely valuable contribution to the psychiatric literature by thoroughly discussing and illustrating how to interview four types of difficult patients: patients who use symptoms to communicate their distress, patients who have psychotic communications, patients with cognitive impairments, and patients who engage in self-protective and deceptive behavior.

The text begins by suggesting that, rather than being wed to only one school of thought that professes to having all the answers about the nature of psychiatric disorders and how to interview patients, it makes more sense to realize that different approaches may work well with different groups of disorders. Accordingly, the Othmers suggest that patients who manifest their problems through "pseudoneurological, unexplained, somatic or psychological symptoms" should be interviewed differently than patients who are in their own world and are shutting out reality. Further, these two types of patients should be interviewed differently from the

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