Clinical communication and the psychiatric interview — structured clinical viva

Reject the framing first. "Get him on board with a depot" is a compliance frame, and it is how alliances die. The task is a conversation the patient can participate in, not a signature on a plan.^[5][6]

Structure. Calgary-Cambridge arc: protected setting; introduction and consent; his perception first — "what do you make of what has happened?" — before any label; signposted transitions; at least one verbal summary; close with teach-back. Micro-skills: funnelled questioning, silence tolerance, no stacked questions.^[1][2]

Engage the psychosis, not just the checklist. McCabe's conversation analysis showed patients attempt to discuss their psychotic experiences and clinicians often answer with more questions, after which patients withdraw. "That sounds frightening — tell me what it was like" keeps the channel open; "those beliefs aren't real" closes it. Neither endorse nor ridicule; acknowledge the distress as real.^[4]

Breaking the news. SPIKES: Setting, Perception, Invitation, Knowledge (warning shot, plain language, treatable frame, uncertainty about course after a first episode), Empathy for the emotional response, Strategy and summary. The mother's demand for "full truth" is managed through the patient's consent — ask him what he wants shared, with her present or not.^[3]

Negotiating treatment. Elwyn's sequence: choice talk (options exist and his view matters), team talk, option talk (oral versus depot with honest harms, psychological and family work, no-treatment consequences), decision talk (what matters most to him — sedation, injections, frequency). Deegan and Drake: medication as a tool he hires for his own recovery goals, with a planned review date, not a life sentence.^[5][6]

Document. Who consented to what sharing; his perception in his own words; information given; options with harms; the plan as agreed; and the check-back. Write the note he could read.^[7]