GENERAL DESCRIPTION

Appearance (Observed) Apparent Age:

Posture:
Gait:
Facial Expression:
Eye Contact:
Speech (Observed) Rate:
Volume:
Amount:
Characteristics:
Motor Activity (Observe) Level of activity:
Type of activity:
Unusual gesture or mannerism/ Repeated
motor movement:
Interaction during the interview (Observe) Hostile Guarded
Uncooperative Apathetic
Irritable Defensive
Suspicious Seductive

EMOTIONAL STATE
Mood (Observe) Sad Euphoric
Fearful Anxious
Hopeless Euthymic

POSSIBLE QUESTIONS FOR CLIENT:

 How are you feeling today?
 “Have you been
discouraged/depressed/low/blue
lately?”
 “Have you been
energized/elated/high/out of control
lately?”
 “Have you been angry/irritable/edgy
lately?”
AFFECT (Observe) Flat Labile
Restricted/Blunted Congruent
PERCEPTUAL DISTURBANCES
Hallucinations “Do you ever see (visual), hear (auditory),
smell (olfactory), taste (gustatory), and feel
(tactile) things that are not really there, such
as voices or visions?”
Answer:
Illusions “Do you sometimes misinterpret real things
that are around you, such as muffled noises
or shadows?”
Answer:
THINKING
Thought Content QUESTIONS:

Thought Process:
SENSORIUM AND COGNINTION
Level of Consciousness
Level of Concentration and Calculation
 “What’s been on your mind lately?”
 “What do you think about when you
are sad/angry?”
 “Are you worried/scared/frightened
about something or other?”
 “Do you think someone, or some
group intend to harm you in some
way?”
 “Do you ever feel
detached/removed/changed/different
from others around you?”
 “Does it ever seem like people are
stealing your thoughts, or perhaps
inserting thoughts into your head?
Does it ever seem like your own
thoughts are broadcast out loud?”
 “Do you have personal beliefs that are
not shared by others?” (Delusions are
fixed, false, unshared beliefs.)
Orientation:
Question:
Time: “What is today’s date”?
Place: “Where are you today”?
Person: “What is your name”?
Memory:
REMOTE: “What were the year of your
graduation from elementary, high school?”
RECENT: ”What is my name?”’
IMMEDIATE:
“I am going to ask you to remember three
words (color, object, animal – e.g., RED,
UMBRELLA, and DOG) and I will ask you to
repeat them to me in 5 minutes. Please
repeat them now after me: blue, table, and
horse.” – then after how many minutes or
question I will ask it again to the client.
After how many minutes/questions:
“What were those three words I asked you to
remember?”
Level of Concentration
(asking the client to perform certain task)
 Ask the patient to spell a 5-letter word
 forward and backward. “World” is
commonly used.
- “Spell the word ‘world.’ Now
spell the word ‘world’
backwards.”

 (Serial 3’s) “Starting with 20, subtract

3 from 20, and then keep subtracting
3 from that number as far as you can
go.” [Monitor for speed, accuracy,
effort required, and monitor patient
reactions to the request]
Information and Intelligence  Can you name who is the last mayor
and vice mayor in your City?
Judgement  Ask the patient about a hypothetical
situation requiring good judgment,
- “What would you do if you
found a stamped letter on the
sidewalk?” Placing it in the mailbox
is the correct answer; opening the
letter suggests a personality disorder.

QUESTIONS:

 What is your name?

 Where are you today?
 What is today’s date?
 How are you feeling?
 “Have you been discouraged/depressed/low/blue lately?”
 “Have you been angry/irritable/edgy lately?”
 “Have you been energized/elated/high/out of control lately?”
 “What’s been on your mind lately?”
 “What do you think about when you are sad/angry?”
 “Are you worried/scared/frightened about something or other?”
 “Do you think someone, or some group intend to harm you in some way?”
 “Do you ever feel detached/removed/changed/different from others around you?”
 “Does it ever seem like people are stealing your thoughts, or perhaps inserting thoughts
into your head? Does it ever seem like your own thoughts are broadcast out loud?”
 “Do you have personal beliefs that are not shared by others?”
 REMOTE: “What were the year of your graduation from elementary, high school?”
 RECENT:” What is my name?”’
 IMMEDIATE: “I am going to ask you to remember three words (color, object, animal –
e.g., RED, UMBRELLA, and DOG) and I will ask you to repeat them to me in 5 minutes.
Please repeat them now after me: blue, table, and horse.” – then after how many
minutes or question I will ask it again to the client.
 Can you name who is the last mayor and vice mayor in your City?
 “What would you do if you found a stamped letter on the sidewalk?”
 Ask the patient to spell a 5-letter word forward and backward. “World” is commonly used.
- “Spell the word ‘world.’ Now spell the word ‘world’ backwards.”
 (Serial 3’s) “Starting with 20, subtract 3 from 20, and then keep subtracting 3 from that
number as far as you can go.” [Monitor for speed, accuracy, effort required, and monitor
patient reactions to the request]