MD

2023 PSYCHIATRIC HISTORY & MENTAL STATUS

EXAMINATION І Dr. Ray Davidson Pascual

PSYCHIATRIC HISTORY AND MENTAL ✓

IDENTIFYING DATA
Name, age, marital status, sex, occupation,
STATUS EXAMINATION language (if other than English), ethnic
background, and religion, insofar as they are
Psychiatric diagnosis vs. Medical diagnosis: pertinent, and the patient's current living
✓ Absence of etiological certainty in psychiatric circumstances
disorders. ✓ Whether the current disorder is the first episode
✓ Lack of external validating criteria for the patient
o e.g. laboratory tests ✓ Whether the patient came in on his or her own,
was referred by someone else, or was brought in
by someone else
THE PSYCHIATRIC HISTORY ▪ Meant to provide a thumbnail sketch of
▪ Patient's life story told to the psychiatrist in the potentially important patient characteristics that
patient's own words from his or her own point of may affect diagnosis, prognosis, treatment, and
view compliance.
▪ Includes information about the patient obtained
from other sources, such as a parent or spouse
A case of R. F., 21 years old, male, single, Filipino,
▪ The most important technique for obtaining a
Jehovah’s Witness, currently a medical student,
psychiatric history is to allow patients to tell their
residing in Valenzuela City, was brought by mother for
stories in their own words in the order that they
the first time at Fatima Medical Center on July 12,
consider most important.
2010.
▪ Elusive picture of patient’s individual personality
characteristics.
HISTORY OF PRESENT ILLNESS
OUTLINE OF A PSYCHIATRIC HISTORY ▪ Comprehensive and chronological picture of the
I. Identifying data events leading up to the current moment in the
II. Chief complaint patient's life.
III. History of Present Illness ✓ When was the onset of the current episode, and
A. Onset what were the immediate precipitating events or
B. Precipitating factors triggers?
IV. Past illnesses ✓ Why now?
A. Psychiatric ✓ Why did the patient come to the doctor at this
B. Medical time?
C. Alcohol and other substance history ✓ What were the patient's life circumstances at the
V. Family history onset of the symptoms or behavioral changes,
VI. Personal history (anamnesis) and how did they affect the patient so that the
A. Prenatal and perinatal presenting disorder became manifest?
B. Early childhood (Birth through age 3) ✓ What past precipitating events were part of the
C. Middle childhood (ages 3 - 11) chain leading up to the immediate events
D. Late childhood (puberty through ✓ In what ways has the patient's illness affected his
adolescence) or her life activities (e.g., work, important
E. Adulthood relationships)?
1. Occupational history ✓ What is the nature of the dysfunction (e.g., details
2. Marital and relationship history about changes in such factors as personality,
3. Military history memory, speech)?
4. Educational history ✓ Are there psycho-physiological symptoms?
5. Religion
6. Social activity
7. Current living situation
8. Legal history
F. Sexual history
G. Fantasies and dreams
H. Values
I.
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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual

3 days PTA, patient was noted with poor sleep, blank OUTLINE OF A DEVELOPMENTAL HISTORY
stares, mumbling to self, and was restless, hence
consult. A. Prenatal and perinatal
The patient was apparently doing well as a second 1. Full-term pregnancy or premature
year medical student, living alone in a rented room 2. Vaginal delivery or caesarian
near Fatima University, when 3 days PTA, he failed the 3. Drugs taken by mother during pregnancy
surprise quiz in Psych 2. Since then he was observed to (prescription and recreational)
be irritable and argumentative towards his girlfriend. 4. Birth complications
He was restless, and had poor sleep. He refused to go 5. Defects at birth
to class and isolated himself in his room. When his B. Infancy and early childhood (0 – 3)
mother visited, he was ungroomed, foul-smelling and 1. Infant and mother relationship
was seen mumbling to himself. He was brought for 2. Problems with feeding and sleep
consult. 3. Significant milestones
▪ Standing/walking
PAST ILLNESS ▪ First words/two-word sentences
▪ Transition between the story of the present illness ▪ Bowel and bladder control
and the patient's personal history 4. Other caregivers
✓ Past episodes of both psychiatric and medical 5. Unusual behaviors (e.g., head-banging)
illnesses C. Middle childhood (3 – 11)
✓ Patient's symptoms, extent of incapacity, type of 1. Preschool and school experiences
treatment received, names of hospitals, length of 2. Separations from caregivers
each illness, effects of previous treatments, and 3. Friendships/play
degree of compliance 4. Methods of discipline
✓ Major medical or surgical illnesses and major 5. Illness, surgery, or trauma
traumas, particularly those requiring D. Adolescence
hospitalization 1. Onset of puberty
✓ Causes, complications, and treatment of any 2. Academic achievement
illness 3. Organized activities (sports, clubs)
✓ Alcohol and other substances use 4. Areas of special interest
5. Romantic involvements and sexual
FAMILY HISTORY experience
▪ Any psychiatric illness, hospitalization, and 6. Work experience
treatment of the patient's immediate family 7. Drug/alcohol use
members 8. Symptoms (moodiness, irregularity of
✓ History of alcohol and other substance abuse or sleeping or eating, fights and arguments)
of antisocial behavior E. Young adulthood
✓ Describe each family member 1. Meaningful long-term relationship
✓ Check for family history of schizophrenia, bipolar 2. Academic and career decisions
disorder etc. 3. Military experience
4. Work history
PERSONAL HISTORY 5. Prison experience
▪ Anamnesis 6. Intellectual pursuits and leisure activities
▪ Thorough understanding of the patient's past and F. Middle adulthood and old age
its relation to the present emotional problem. 1. Changing family constellation
▪ Predominant emotions associated with the 2. Social activities
different life periods 3. Work and career changes
4. Aspirations
5. Major losses
6. Retirement and aging

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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual

SEXUAL HISTORY OUTLINE OF THE MENTAL STATUS EXAMINATION

Screening questions 1. Appearance

▪ Are you sexually active? 2. Overt behavior
▪ Have you noticed any changes or problems 3. Attitude
with sex recently? 4. Speech
Developmental 5. Mood and affect
▪ Acquisition of sexual knowledge 6. Thinking
▪ Onset of puberty/menarche ▪ Form
▪ Development of sexual identity and ▪ Content
orientation 7. Perceptions
▪ First sexual experiences 8. Sensorium
▪ Sex in romantic relationship ▪ Alertness
▪ Changing experiences or preferences over ▪ Orientation (person, place, time)
time ▪ Concentration
▪ Sex and advancing age ▪ Memory (immediate, recent, long
▪ Clarification of sexual problems term)
▪ Desire phase ▪ Calculations
Presence of sexual thoughts or fantasies ▪ Fund of knowledge
When do they occur and what is their object? ▪ Abstract reasoning
Who initiates sex and how? 9. Insight
▪ Excitement phase 10. Judgment
Difficulty in sexual arousal (achieving or
maintaining erections, lubrication), during GENERAL APPEARANCE
foreplay and preceding orgasm ▪ Describes the patient's appearance and overall
▪ Orgasm phase physical impression:
Does orgasm occur? o As reflected by posture, poise, clothing,
Does it occur too soon or too late? and grooming
How often and under what circumstances ▪ Signs of anxiety are noted:
does orgasm occur? o Moist hands, perspiring forehead, tense
If orgasm does not occur, is it because of not posture, wide eyes
being excited or lack of orgasm despite ▪ Patient's attitude toward the examiner:
being aroused? o Cooperative, friendly, attentive,
▪ Resolution phase interested, frank, seductive, defensive,
What happens after sex is over (e.g., contemptuous, perplexed, apathetic,
contentment, frustration, continued arousal)? hostile, playful, ingratiating, evasive, or
guarded
THE MENTAL STATUS EXAMINATION ▪ Physical characteristics of speech
▪ Describes the sum total of the examiner's o Quantity, rate of production, and quality
observations and impressions of the psychiatric o Rapid or slow, pressured, hesitant,
patient at the time of the interview emotional, dramatic, monotonous, loud,
▪ Can change from day to day or hour to hour whispered, slurred, staccato, or
▪ Even when a patient is mute, is incoherent, or mumbled
refuses to answer questions, the clinician can ▪ Mannerisms, tics, gestures, twitches, stereotyped
obtain a wealth of information through careful behavior, echopraxia, hyperactivity, agitation,
observation. combativeness, flexibility, rigidity, gait, and agility.

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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual
MOOD AND AFFECT
▪ Mood is defined as a pervasive and sustained
emotion that colors the person's perception of
the world.
o Depressed, despairing, irritable, anxious,
angry, expansive, euphoric, empty, guilty,
hopeless, futile, self-contemptuous,
frightened, and perplexed
o Labile, fluctuating or alternating rapidly
between extremes (e.g., laughing loudly
and expansively one moment, tearful and
despairing the next).
▪ Affect can be defined as the patient's present
emotional responsiveness, inferred from the
patient's facial expression, including the amount
and the range of expressive behavior.
o Normal range of affect - can be variation in
facial expression, tone of voice, use of
hands, and body movements.
o Constricted affect - the range and intensity
of expression are reduced.
o Blunted affect - emotional expression is
further reduced.
o Flat affect - virtually no signs of affective
expression
o Appropriateness of affect
PERCEPTION
▪ Auditory, visual, taste, olfactory, or tactile
▪ Hallucination
o False sensory perception occurring in the
absence of any relevant external
stimulation of the sensory modality
involved.
▪ Circumstances of the occurrence of any
hallucinatory experience
o Hypnagogic hallucinations (occurring as
a person falls asleep)
o Hypnopompic hallucinations (occurring
as a person awakens)
o Have much less serious significance than
other types of hallucinations.
▪ Can also occur in particular times of stress for
individual patients.
▪ Depersonalization and derealization
o Extreme feelings of detachment from the
self or the environment
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THOUGHT CONTENT AND MENTAL TRENDS
▪ Process refers to the way in which a person puts
together ideas and associations, the form in
which a person thinks.
o Can be logical and coherent or
completely illogical and even
incomprehensible
▪ Content refers to what a person is actually
thinking about
o Ideas, beliefs, preoccupations,
obsessions
FORMAL THOUGHT DISORDERS
Circumstantiality Overinclusion of trivial or irrelevant
details that impede the sense of
getting to the point.
Loss of capacity for goal-directed
thinking
Clang Thoughts are associated by the sound
associations of words rather than by their meaning
(e.g., through rhyming or assonance).
Derailment Synonymous with loose associations.
A breakdown in both the logical
connection between ideas and the
overall sense of goal-directedness.
The words make sentences, but the
sentences do not make sense.
Flight of ideas A succession of multiple associations
so that thoughts seem to move
abruptly from idea to idea; often (but
not invariably) expressed through
rapid, pressured speech.
Neologism The invention of new words or phrases
or the use of conventional words in
idiosyncratic ways.
Perseveration Repetition of out of context of words,
phrases, or ideas.
Tangentiality In response to a question, the patient
gives a reply that is appropriate to the
general topic without actually
answering the question; patient loses
the thread of the conversation,
pursues divergent thoughts stimulated
by various external or internal
irrelevant stimuli, and never returns to
the original point.
Example:
Doctor: Have you had any trouble
sleeping lately?
Patient: I usually sleep in my bed, but
now I'm sleeping on the sofa.
Thought A sudden disruption of thought or a
blocking break in the flow of ideas; interruption
of the train of thought before an idea
has been completed
Word Salad Incoherent or incomprehensible
connections of thoughts
Punning Association by double meaning
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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual

THOUGHT CONTENTS JUDGEMENT

▪ Does the patient understand the likely outcome
Delusions Fixed, false beliefs out of keeping of his or her behavior, and is he or she influenced
with the patient's cultural
by this understanding?
background; persecutory or
▪ Can the patient predict what he or she would do
paranoid, grandiose, jealous,
in imaginary situations ?
somatic, guilty, nihilistic, or erotic
Ideas of Reference Person's belief that the television
or radio is speaking to or about INSIGHT
him or her. ▪ Degree of awareness and understanding about
Ideas of Influence Beliefs about another person or being ill.
force controlling some aspect of
one's behavior. Levels of Insight:
✓ Complete denial of illness
SENSORIUM AND COGNITION ✓ Slight awareness of being sick and needing help,
but denying it at the same time
1. Alertness Observation
✓ Awareness of being sick but blaming it on others,
2. Orientation What is your name? Who am I?
on external factors, or on organic factors
What place is this? Where is it located?
What city are we in? ✓ Awareness that illness is caused by something
3. Starting at 100, count backward by 7 unknown in the patient
Concentration (or 3). ✓ Intellectual insight: admission that the patient is ill
Say the letters of the alphabet and that symptoms or failures in social adjustment
backward starting with Z. are caused by the patient's own particular
Name the months of the year irrational feelings or disturbances without
backward starting with December.
applying this knowledge to future experiences
4. Memory
Repeat these numbers after me: 1, 4, 9,
✓ True emotional insight: emotional awareness of
Immediate
2, 5 the motives and feelings within the patient and
the important persons in his or her life, which can
Recent What did you have for breakfast? lead to basic changes in behavior.
What were you doing before we
started talking this morning?
I want you to remember these three RELIABILITY
things: a yellow pencil, a cocker ▪ Estimate of the psychiatrist’s impression of the
spaniel, and Cincinnati. After a few
patient’s truthfulness or veracity
minutes, I’ll ask you to repeat them.
▪ The conclusion of the mental status part of the
What was your address when you were psychiatric report.
Long-term in the third grade?
Who was your teacher?
What did you do during the summer
between high school and college?
5. Calculations If you buy something that costs $3.75
and you pay with a $5 bill, how much
change should you get?
What is the cost of three oranges if a
dozen oranges cost $4.00?
6. Fund of What is the distance between New York
Knowledge and Los Angeles? What body of water
lies between South America and
Africa?
7. Abstract Which one does not belong in this
Reasoning group: a pair of scissors, a canary, and
a spider? Why?
How are an apple and an orange
alike?; Interpret a verse.

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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual

MINI MENTAL STATUS EXAMINATION

▪ Useful for evaluation of cognitive impairment
▪ Useful and practical
▪ May be used to track changes in patient’s
cognitive state.
▪ Total of 30 points
o Below 25 suggests possible impairment
o Below 20 indicates definite impairment

ORIENTATION (SCORE 1 IF CORRECT)

(MAX SCORE = 10)
Name of hospital or building
What city are you in now?
What year is it?
What month is it?
What is the date today?
What state are you in?
What country is this?
What floor of the building are you in?
What day of the week is this?
What season of the year is it?

REGISTRATION
(SCORE 1 FOR EACH OBJECT CORRECTLY REPEATED)
Name three objects and have the patient repeat
them. Score number repeated by the patient.

Name the object several more times if needed for the

patient to repeat correctly (record trials)
(max score = 3)

ATTENTION AND CALCULATION

Subtract 7 from 100 in a serial fashion to 65.
Max. score = 5

RECALL REFERENCES
Score 1 for each object recalled)
• Dr. Hyacinth Manood’s Lecture PPT
Max score = 3
Do you recall the three objects named before?

LANGUAGE TESTS Keep going, future doctor ;

Confrontation naming: 2
Repetition: = 1 DISCLAIMER: The content of this transcription is from the references
Comprehension = Pick up paper in right hand, fold it mentioned above. If you have any correction / objection, feel free to do
your own correction using the school’s prescribed reference materials.
in half, and set it on the floor = 3
Read and perform the command = 1 USE AT YOUR OWN RISK! #MD2023
Write any sentence = 1

CONSTRUCTION NOT FOR SALE

Copy the design below: 1

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2023 PSYCHIATRIC HISTORY & MENTAL STATUS
EXAMINATION І Dr. Ray Davidson Pascual

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