Guideline 5: Symptoms Getting in the Way During some interviews, the characteristic symptoms of schizophrenia make it difficult to secure sufficient and sound information, for example, when the interviewee is actively hallucinating or delusional; displaying disorganized thought or behavior; and presenting severe negative symptoms, cognitive impairments, or comorbid symptoms such as anxiety. Common effects of these symptoms and impairments are distractions that disrupt the flow of the interview and hinder collaboration. There are various ways to address such disruptions. One way is to break up the interview into smaller parts to accommodate the person’s short attention span. This can involve taking more frequent rest breaks or conducting the interview over a few days. This approach can also be used within the interview by breaking questions down into smaller ones, so that the person can more easily retain and process them. Finally, it is also often useful to explain the benefits of the interview and provide token rewards, so that the person participates as fully as possible in the interview.

Guideline 6: Beyond Isolated Symptoms: The Importance of the Context Another challenge may be a lack of sufficient information on the personal or cultural context within which the diagnostic information may be meaningfully understood. This may occur in transcultural situations, in which the interviewer is not versed in the interviewee’s language and culture. Because the interviewer functions as a yardstick to some degree to evaluate the interviewee’s beliefs, it is imperative that he or she be familiar with, or at least be sure to assess, the interviewee’s general and health beliefs in relation to those of the culture to which the person belongs. To understand the personal context it is useful to explore how symptoms relate to various domains of a person’s life. To gather such information, it is important that the interviewer ask about a range of other contexts, including work, living, leisure, and social relationships, to try to identify the often complex mutual influences between these contexts and symptoms.  Another important aspect of the context is its longitudinal course (e.g., time of onset of the first psychotic episode), which may have an impact on the developmental abilities of the interviewee (e.g., educational level and interpersonal experiences). The interviewer should also be sensitive to paranoia or to a traumatic history on the part of the interviewee that may disrupt the interview, and use appropriate communication skills to build trust. For instance, the interviewer should fully disclose the possible risks and expected benefits of the interview, give the interviewee as much control as possible over the interview (e.g., by asking open-ended questions and inviting the person to tell his or her life story), use empathic verbalizations, and more. Last but not least, the interviewer should be sensitive to the interviewee’s cultural (and spiritual) context by using an interpreter when needed, recognizing that the interviewee’s health beliefs and health-related behaviors may be very different from those of the interviewer.