Assessing Psychosis: A Clinician’s Guide

June 2, 2016

Methods of identifying and understanding the intricacies of psychosis in clinical settings.

BOOK REVIEW

by James H. Kleiger and Ali Khadivi;
New York: Routledge; 2015
262 pages • $49.95 (softcover)

In Assessing Psychosis: A Clinician’s Guide, Drs. Kleiger and Khadivi offer a comprehensive guide for clinicians and provide practical guidelines and methods of identifying and understanding the intricacies of psychosis in various clinical settings. The authors draw from their extensive clinical backgrounds to present readers with examples from their own practices to demonstrate the diagnostic challenges involved in the assessment of psychotic disorders.

The book is divided into 4 sections, each with well-organized chapters that refer to previous discussions. Chapters also end with clinical guidelines and highlights.

Part 1 focuses on understanding the core symptoms of psychosis. The authors provide examples of patient encounters to demonstrate the importance of understanding the subjective experience of the person with these symptoms. The authors review the research and theories behind each major symptom and provide a historical context for the evolution of how psychiatrists think and communicate with patients concerning psychosis.

The next part of the book focuses on sharpening differential diagnosis development, reviewing how major thinkers like Kraepelin, Bleuler, and Schneider would have arrived at their diagnoses in particular clinical cases. The authors emphasize the importance of diagnostic hierarchy relying on presence/absence of mood symptoms, duration of illness, and precipitating factors such as substance use or medical conditions.

In the third section, assessment methods for evaluating psychotic disorders are described. Drs. Kleiger and Khadivi painstakingly demonstrate that despite myriad advances in neuropsychiatry, the clinical interview remains the clinician’s single most valuable tool for evaluating psychotic disorders. They assert that the psychiatric interview is analogous to the physical examination for clinicians in other disciplines. The objective of the interview is to understand the “patient’s symptoms, experiences, subjective meaning of their experiences, and their beliefs, including their reasoning.”

Practical guidance is provided to help psychiatrists sharpen interview techniques and ask appropriate follow-up questions when assessing for psychotic symptoms. The role of psychological testing is also explored in this section and the limited situations where this can be helpful.

The final section explores special assessment issues and populations. The authors address the challenging task of evaluating psychosis in culturally diverse patient populations. In addition, the authors devote the last chapters to identifying high-risk patients, evaluating suicide and violence potential, and understanding psychosis in children and adolescents.

This book helps with case conceptualization in many presentations that do not lend themselves to straightforward diagnosis. Clearly, it will serve as an invaluable resource for practicing psychiatrists to achieve a better understanding of psychosis and to clarify complex issues.

Disclosures:

Dr Lee is a graduate of the University at Buffalo School of Medicine and Biomedical Sciences. She is currently a Second-Year Resident in Psychiatry at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, New York.