GOOD MORNING

THE PSYCHIATRIC INTERVIEW, HISTORY,

and MENTAL STATUS EXAMINATION

Joge Los Baños, MD

THE PSYCHIATRIC INTERVIEW

Interview of Psychiatric PatientTime managementArrangement of SeatingArrangement of OfficeTaking of NotesFollow-up InterviewsInterviewing Variations

Depressed and Potentially Suicidal patientsAggressive Patients

THE PSYCHIATRIC HISTORY

Outline of the Psychiatric History

Identifying Data

Chief Complaint

History of Present Illness

Past Illness

Personal History (Anamnesis)

Outline of the Psychiatric History

Personal History (Anamnesis) Prenatal and Perinatal History Early Childhood (Birth through Age 3 Years Middle Childhood (Ages 3 to 11 Years) Late Childhood (Puberty Through Adolescence) Adulthood

(Marital, Education, Religion, Social, Current, Legal) Sexual History Family History Fantasies and Dreams

THE MENTAL STATUS EXAMINATION

The Mental Status Examination describes the sum total of the examiner’s observations and impressions of the psychiatric patient at the time of the interview

The MSE can change from day to day or hour to hourIt is the description of the patient’s appearance, speech, actions, and thoughts during the interview

Outline of the Mental Status Examination

General description Mood and affectivity Speech characteristics Perception Thought content and mental trends Sensorium and cognition Impulsivity Judgment and insight Reliability

I. General Description

Age Height Nutritional status Body type, Healthy, sickly, Old looking, young

looking Disheveled Childlike, bizarre Hairstyle Complexion

A. Appearance

PosturePoise At easeClothingGrooming, jewelry,

makeup, nailsSigns of anxiety (moist

hands, perspiring forehead, tense posture, wide eyes)

B. Overt Behaviour and Psychomotor Activity

Mannerisms, tics, gestures, twitches Stereotyped behaviour Echopraxia Hyperactivity Agitation Combativeness Flexibility, rigidity Gait Agility Restlessness, wringing of hands, pacing Psychomotor retardation, generalized slowing down,

aimless, purposeless activity

C. Attitude towards examiner

Cooperative, friendly, attentive, interested, seductive, frank, defensive, contemptuous, perplexed, apathetic, hostile, playful, ingratiating, evasive, guarded

Level of rapport established

II. Mood and Affectivity

 A. Mood

Does the patient remark voluntarily about feelings or is it necessary to ask the patient how he/she feels

Depth Intensity Duration Fluctuations Depressed, despairing, irritable,

anxious, angry, expansive, euphoric, empty, guilty, awed, futile, self-contemptuous,

frightened, perplexed, labile

B. Affect Range: within normal (Broad),

constricted, blunted or flat Difficulty in initiating, sustaining

or terminating emotional response

Mood congruent of incongruent

C. Appropriateness of affect

III. Speech Characteristics  Amount

Talkative, garrulous, voluble, taciturn, unspontaneous, normally responsive to cues from the interviewer

Tone, monotone, rhythmic Rate of production

Rapid or slow, pressured, hesitant, staccato Quality

Emotional, dramatic, loud, whispered, slurred, mumbled, accent

Speech impairment

stuttering, dysprosody

 

IV. Perception Hallucinations

Sensory system involved

Auditory

Visual

Tactile

Gustatory

Olfactory

Command

Content of hallucinatory experience

Time of occurrence

Circumstances

Hypnogogic

Hypnopompic

Illusions

Déjà vu

Jamais vu

Hypersensitivity to light, sound, smell

Distorted perceptions of time

Misconception of movement, perspective and size

Changes in body perceptions

 Depersonalization and derealization

A. Thought process

Loosening of associations

Flight of ideas

Racing thoughts

Tangentiality

Circumstantiality

Word salad or incoherence

Neologisms

Clang associations

Punning

Thought blocking

Vague thought

V. Thought content and mental trends

    B. Thought content

Delusions

Persecution

Reference

Influence

Thought broadcasting

Grandiose delusions

Somatic delusions

Delusional love

Nihilism

Capgras syndrome (belief that people have been taken

away & replaced by duplicates

Preoccupations

Obsessions

Compulsions

Phobias

Plans

Intentions

Suicide/homicidal ideas

Hypochondriacal symptoms

Specific antisocial urges

Ideas of reference

Poverty of content

 

VI. Cognition and sensorium

Clouded

Somnolence

Stupor

Coma

Lethargy

Alertness

fugue state

obtunded

A. Consciousness

B. Orientation and memory

Orientation to time, place & person

Do they know how long they have been in the hospital?

Do they know the people around them and their relationship with them?

Do they know who the examiner is?

Memory

Remote (childhood memories)

Recent past (news events from past few months)

Recent (What did you have for breakfast? What did you do these past few days)

Recall & immediate retention (the interviewer’s name? 6 digits forward and back)

 

C. Concentration and attention

Concentration

Subtracting serial 7’s, 3’s

Attention

Spell “world” backward span, name 5 things that start with a particular letter

 

Read a sentence (ex. “Close your eyes.”) and then do what the sentence says

Write a simple but complete sentence

D. Reading and writing

E.      Visuospatial ability

Copy a clock face or interlocking pentagons

F.      Abstract Thought

Concrete or overly abstract

(Explain similarities of an apple and a pear, between truth and beauty, meaning of simple proverbs)

 

G. Information and intelligence

Counting change, how many 25 centavos in 1.25 pesos, vocabulary, general fund of knowledge (relative to educational background, socioeconomic status), past presidents

Is the patient capable of controlling sexual, aggressive and other impulses?

VII. Impulsivity

Judgement

Social Judgement – can the patient understand the likely outcome of his behaviour

Test Judgement - imaginary situation, smell smoke in a crowded movie theater; better still, situation pertinent to patient’s case

VII. Judgement and Insight

complete denial slight awareness of being sick blaming others for the illness

illness is caused by something unknown

Intellectual insight (no application to future experiences)

True emotional insight

Insight

IX. Reliability

In percent, poor, good

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