Patient interview

Rewatch the same Patient Interview…

.. You will now write the mental status exam portion of the psychiatric report. The mental status exam can be written in bulleted or narrative format, but should include the following sections:  Appearance – personal identification, behavior, psychomotor activity, general description Speech Mood and affect Thinking and perception – form of thinking, content of thinking, thought disturbances, perceptual disturbances Sensorium – alertness, orientation, memory, concentration, fund of knowledge, abstract thinking Insight Judgement

An example is outlined on page 24 of Kaplan & Sadock’s Synopsis of Psychiatry textbook.

II. Mental Status
A. Appearance
1. Personal identification: May include a brief nontechnical description of the patient’s appearance and
behavior as a novelist might write it; attitude toward examiner can be described here—cooperative,
attentive, interested, frank, seductive, defensive, hostile, playful, ingratiating, evasive, guarded
2. Behavior and psychomotor activity: Gait, mannerisms, tics, gestures, twitches, stereotypes, picking,
touching examiner, echopraxia, clumsy, agile, limp, rigid, retarded, hyperactive, agitated, combative,
3. General description: Posture, bearing, clothes, grooming, hair, nails; healthy, sickly, angry, frightened,
apathetic, perplexed, contemptuous, ill at ease, poised, old looking, young looking, effeminate,
masculine; signs of anxiety—moist hands, perspiring forehead, restlessness, tense posture, strained
voice, wide eyes; shifts in level of anxiety during interview or with particular topic
B. Speech: Rapid, slow, pressured, hesitant, emotional, monotonous, loud, whispered, slurred,
mumbled, stuttering, echolalia, intensity, pitch, ease, spontaneity, productivity, manner, reaction time,
vocabulary, prosody
C. Mood and affect
1. Mood (a pervasive and sustained emotion that colors the person’s perception of the world): How
does patient say he or she feels; depth, intensity, duration, and fluctuations of mood—depressed,
despairing, irritable, anxious, terrified, angry, expansive, euphoric, empty, guilty, awed, futile, selfcontemptuous, anhedonic, alexithymic
2. Affect (the outward expression of the patient’s inner experiences): How examiner evaluates patient’s
affects—broad, restricted, blunted or flat, shallow, amount and range of expression; difficulty in
initiating, sustaining, or terminating an emotional response; is the emotional expression appropriate to
the thought content, culture, and setting of the examination; give examples if emotional expression is
not appropriate
D. Thinking and perception
1. Form of thinking
a. Productivity: Overabundance of ideas, paucity of ideas, flight of ideas, rapid thinking, slow thinking,
hesitant thinking; does patient speak spontaneously or only when questions are asked, stream of
thought, quotations from patient
b. Continuity of thought: Whether patient’s replies really answer questions and are goal directed,
relevant, or irrelevant; loose associations; lack of causal relations in patient’s explanations; illogic,
tangential, circumstantial, rambling, evasive, perseverative statements, blocking or distractibility
c. Language impairments: Impairments that reflect disordered mentation, such as incoherent or
incomprehensible speech (word salad), clang associations, neologisms
2. Content of thinking
a. Preoccupations: About the illness, environmental problems; obsessions, compulsions, phobias;
obsessions or plans about suicide, homicide; hypochondriacal symptoms, specific antisocial urges or
3. Thought disturbances
a. Delusions: Content of any delusional system, its organization, the patient’s convictions as to its
validity, how it affects his or her life: persecutory delusions—isolated or associated with pervasive
suspiciousness; mood congruent or mood incongruent
b. Ideas of reference and ideas of influence: How ideas began, their content, and the meaning the
patient attributes to them
4. Perceptual disturbances
a. Hallucinations and illusions: Whether patient hears voices or sees visions; content, sensory system
involvement, circumstances of the occurrence; hypnagogic or hypnopompic hallucinations; thought
b. Depersonalization and derealization: Extreme feelings of detachment from self or from the
5. Dreams and fantasies
a. Dreams: Prominent ones, if patient will tell them; nightmares
b. Fantasies: Recurrent, favorite, or unshakable daydreams
E. Sensorium
1. Alertness: Awareness of environment, attention span, clouding of consciousness, fluctuations in
levels of awareness, somnolence, stupor, lethargy, fugue state, coma
2. Orientation
a. Time: Whether patient identifies the day correctly; or approximate date, time of day; if in a hospital,
knows how long he or she has been there; behaves as though oriented to the present
b. Place: Whether patient knows where he or she is
c. Person: Whether patient knows who the examiner is and the roles or names of the persons with
whom in contact
3. Concentration and calculation: Subtracting 7 from 100 and keep subtracting 7s; if patient cannot
subtract 7s, can easier tasks be accomplished—4 × 9; 5 × 4; how many nickels are in $1.35; whether
anxiety or some disturbance of mood or concentration seems to be responsible for difficulty
4. Memory: Impairment, efforts made to cope with impairment—denial, confabulation, catastrophic
reaction, circumstantiality used to conceal deficit: whether the process of registration, retention, or
recollection of material is involved
a. Remote memory: Childhood data, important events known to have occurred when the patient was
younger or free of illness, personal matters, neutral material
b. Recent past memory: Past few months
c. Recent memory: Past few days, what did patient do yesterday, the day before, have for breakfast,
lunch, dinner
d. Immediate retention and recall: Ability to repeat six figures after examiner dictates them—first
forward, then backward, then after a few minutes’ interruption; other test questions; did same
questions, if repeated, call forth different answers at different times
e. Effect of defect on patient: Mechanisms patient has developed to cope with defect
5. Fund of knowledge: Level of formal education and self-education; estimate of the patient’s
intellectual capability and whether capable of functioning at the level of his or her basic endowment;
counting, calculation, general knowledge; questions should have relevance to the patient’s educational
and cultural background
6. Abstract thinking: Disturbances in concept formation; manner in which the patient conceptualizes or
handles his or her ideas; similarities (e.g., between apples and pears), differences, absurdities; meanings
of simple proverbs (e.g., “A rolling stone gathers no moss”) answers may be concrete (giving specific
examples to illustrate the meaning) or overly abstract (giving generalized explanation); appropriateness
of answers
F. Insight: Degree of personal awareness and understanding of illness
1. Complete denial of illness
2. Slight awareness of being sick and needing help but denying it at the same time
3. Awareness of being sick but blaming it on others, on external factors, on medical or unknown organic
4. Intellectual insight: Admission of illness and recognition that symptoms or failures in social
adjustment are due to irrational feelings or disturbances, without applying that knowledge to future
5. True emotional insight: Emotional awareness of the motives and feelings within, of the underlying
meaning of symptoms; does the awareness lead to changes in personality and future behavior;
openness to new ideas and concepts about self and the important persons in his or her life
G. Judgment
1. Social judgment: Subtle manifestations of behavior that are harmful to the patient and contrary to
acceptable behavior in the culture; does the patient understand the likely outcome of personal behavior
and is patient influenced by that understanding; examples of impairment
2. Test judgment: Patient’s prediction of what he or she would do in imaginary situations (e.g., what
patient would do with a stamped addressed letter found in the street)

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