GOOD MORNING

THE PSYCHIATRIC INTERVIEW,

HISTORY,
and MENTAL STATUS EXAMINATION

Joge Los Baños, MD

THE PSYCHIATRIC INTERVIEW
Interview of Psychiatric Patient
Time management
Arrangement of Seating
Arrangement of Office
Taking of Notes
Follow-up Interviews
Interviewing Variations
Depressed and Potentially Suicidal patients
Aggressive 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 hour
It 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
A. Appearance
 Age Posture
 Height Poise
 Nutritional status  At ease
Clothing
 Body type,
Grooming, jewelry,
 Healthy, sickly, makeup, nails
 Old looking, young Signs of anxiety (moist
looking hands, perspiring
 Disheveled forehead, tense
 Childlike, bizarre posture, wide
eyes)
 Hairstyle
 Complexion
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
V. Thought content and
mental trends
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
    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
A. Consciousness

Clouded
Somnolence
Stupor
Coma
Lethargy
Alertness
fugue state
obtunded
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
D. Reading and writing

Read a sentence (ex. “Close your

eyes.”) and then do what the
sentence says

Write a simple but complete

sentence
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
VII. Impulsivity

Is the patient capable of

controlling sexual, aggressive
and other impulses?
VII. Judgement and Insight
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
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
IX. Reliability
In percent, poor, good
THANK YOU