PSYCHOPATHOLOGY

Uni
tI:Normal
ity-
Ment
alHeal
th,Cl
ass
ifi
cat
ion,As
ses
smentofMent
alDi
sorders
(Normalit
yandMent alHealth-Model sofMent alhealt
h-Def ini
tionofment aldisorderCl ass
ifi
cati
ons ystems-
DSM 5,ICD-10.Cas ehistorytaking-Hi storyofPresentIl
lness-Pas tPsychiatri
candMedi calHi s
tory–Tr eatment
Hist
ory-Fami lyHist
or y-PresentHi story-Premor bidPersonali
tyMent alStat
usExami nation-Gener al
Appearanc eandBehavi our-Speec h-Rate,Volume,Tone,Flow -MoodAndAf fect–Qual i
ty,Reacti
vity,Persi
stenc
e
-Thought-Stream andFor m oft hought-Cont entofThought-Per cept i
on:-Hal luci
nations-I l
lusi
onsand
Misi
nterpretations-Deper s
onalization/Dereal
izati
on-Cogni t
ion:Or ientati
on–At t
enti
on–Conc entr
at i
on–
Memor yI ntelli
gence-Abs tractThinki ng–Insight–Judgment )

Normal
ityandMent
alHeal
th
 Normali
tyisbehavi
orthatiscons
ist
enti
naper
son’susualwayofbehaving.I
tisc
onformitytosoci
etal
st
andardsaswellasthi
nkingandbehavi
ngs
imilar
lytothemajor
ity,andassuchisgener
allyseenasgoodi
n
t
hiscontext
.
 Normal it
yisal
sobehavi ort
hatisexpect
edand/orappr opriat
et ot
hes i
tuat
ion.Itmayal s
obej ustbeing
average,asist
hec aseinpsychol
ogic
alstat
ist
ics
.Itinvolvesbeingabletoadjusttot
hes urroundings,manage
orcont r
olemotions,bei
ngabletowor ksat
isf
actori
lyaswel lasbuildrel
ati
onshipsthatarefulfi
lli
ngoratleast
acceptable.
 Mentalheal
threferstoc
ognit
ive,behavior
al,andemoti
onalwel
l-
bei
ng.Itisal
labouthow peopl
ethink,f
eel
,
andbehave.Peoplesometi
mesus etheterm“ ment
alheal
th”t
omeant heabsenceofamentaldis
order.
 Ment
alheal
thc
anaf
fec
tdai
lyl
ivi
ng,r
elat
ions
hips
,andphys
icalheal
th.
 Acc
or di
ngtotheWorl
dHealthOrganizat
ion(WHO),Healt
hisas
tat
eofc
ompl
etephys
ical
,ment
alands
oci
al
well
-bei
ng,andnotmerel
yabsenceofdiseas
eori
nfir
mi t
y.
 Nor
malment alheal
th,muchlikenormalheal
th,i
sar at
herdi
ffi
cultconceptt
odefine.Ther
ear
esever
al
model
savai
lableforunder
standingwhatmayc onst
itut
e‘nor
mal i
ty’(s
eeTable1.
1).
 Alt
hough,normalit
yisnotaneas
yconc
eptt
odef
ine,s
omeoft
hef
oll
owi
ngt
rai
tsar
emor
ecommonl
yfoundi
n
‘
normal’i
ndividual
s.
1.Real
it
yor
ient
ati
on.
2.Sel
f-
awar
enes
sands
elf
-knowl
edge.
3.Sel
f-
est
eem ands
elf
-ac
cept
anc
e.
4.Abi
li
tyt
oexer
cis
evol
unt
aryc
ont
rolovert
hei
rbehavi
our
.
5.Abi
li
tyt
ofor
m af
fec
tionat
erel
ati
ons
hips
.
6.Pur
suanc
eofpr
oduc
tiveandgoal
-di
rec
tiveac
tivi
ti
es.

Tabl
e1.
1:SomeMode
lsofNor
mal
it
yinMe
ntalHe
alt
h
1.Medic
alModel(Nor
mal i
tyasHeal
th)
:Normalmentalheal
thi
sconc
ept
ual
izedast
heabs
enc
eofany
psyc
hiatri
cdi
sorder(
‘di
sease’
)orps
ychopathol
ogy.
2.St
ati
sti
calModel(
Normali
tyasanAverage
):St
ati
sti
call
ynormalment
alheal
thf
all
swi
thi
ntwos
tandar
d
devi
ati
ons(SDs)oft
henormaldis
tri
but
ioncurveforthepopul
ati
on.
3.UtopianMode
l(Nor
mal
it
yasUt
opi
a):I
nthi
smodel
,thef
ocusi
ndef
ini
ngnor
mal
it
yison‘
opt
imal
func
t i
oning’
.
4.Subj
ecti
veModel
:Accor
dingtot
hismodel
,normali
tyisvi
ewedasanabs
enc
eofdist
res
s,di
sabil
it
y,orany
help-
seeki
ngbehavi
ourresul
ti
ngther
eof
.Thisdef
ini
ti
onissimi
lari
nmanywayst
othemedicalmodel.
5.Soci
alMode
l:Anor
malper
son,ac
cor
dingt
othi
sdef
ini
ti
on,i
sexpec
tedt
obehavei
nas
oci
all
y‘ac
cept
abl
e’
behaviour
.
6.Proce
ssModel(
Nor mal
it
yasaPr oc
ess
):Thi
smodelvi
ewsnormali
tyasadynamicandchangi
ngpr oc
ess
,
rathert
hanasastat
icconcept
.Thi
smodelcanbecombinedwi
thanyothermodelmenti
onedhere.
7.Continuum Mode
l(Normali
tyasaCont i
nuum) :Normal
ityandment aldi
sorderareconsi
deredbythismodel
asfal
lingatthetwoendsofac ontinuum,r at
herthanbeingdispar
ateentit
ies
.Accordi
ngt ot
hismodel,i
tist
he
severi
ty(scor
esabovethe‘
cut-off
’)thatdetermineswhet
herapar ti
cularperson’
sexperi
encecons
tit
utesa
symptom ofadisorderorf
all
sont heheal t
hys i
deofthecontinuum.

DEFI
NINGMENTALHEALTH
Severalst
epsarenecessar
yindefi
ningposit
ivement alheal
th.Thef i
rsts
tepistonotethat"average"isnot
healt
hy;ital
waysincludesmixi
nginwi t
htheheal t
hyt hepreval
entamountofps ychopathologyinthe
populati
on.Forexample,int
hegeneralpopulat
ion,beingof"average"weightoreyesi
ghtisunheal t
hy.
Thes
econds
tepi
ndi
scus
singment
alheal
thi
stoappr
eci
atet
hec
aveatt
hatwhati
sheal
thys
omet
imes
 dependsongeogr
aphy,c
ultur
e,andthehist
ori
calmoment.Si
c kl
ecel
ltr
aiti
sunhealt
hyi nNew Yor
kCi
ty,but
inthetr
opic
s,wheremalar
iaisendemic
,thesi
ckli
ngofr
edbl oodcel
lsmaybeli
fesaving.
Thethi
rds t
epistomakeclearwhet
heronei
sdiscus
singtr
aitorstat
e.Whoisphysic
allyheal
thi
er-anOl
ympic
mil
erdisabledbyasimpl
ebuttemporar
y(st
ate)s
prainedankleoratype1diabet
ic(t
rait
)withatemporar
ily
normalbloodsugar
?
Thefourthandmos timportants
tepistoapprec
iatethetwof
olddangerof"
contaminati
onbyvalues
."Onone
hand,cul
turalanthr
opologyteachesushow f
all
ac i
ousanydefi
nit
ionofmentalhealt
hcanbe.Competit
ivenes
s
andscrupulousneatnes
smaybeheal t
hyinonec ult
ureandregar
dedaspersonal
itydis
order
sinanother.

MODELSOFMENTALHEALTH

Itcontrast
ss ixdifferentempi ricalappr oachestoment alhealth.Fi r
s t,mentalhealthc anbec oncept uali
zedas
abovenor malandament alst
atet hatisobjecti
velydes i
rable,asi nSi gmundFr eud'sdef init
ionofment al
healthwhi chi sthec apacitytowor kandt olove.Sec ond,from t hevi ewpointofheal thyadul tdevel opment ,
ment alhealthc anbec onceptualizedasmat uri
ty.Thi rd,ment alheal thcanbec onceptualizedi ntermsof
posit
iveps ychology- asepitomizedbyt hepr es
enc eofmul t
iplehumans t
rengths.Four th,ment alheal t
hc anbe
conceptualizedasemot i
onalintelligenceands uc c
es sf
ulobjec trelations.Fi
fth,ment alheal t
hc anbe
conceptualizedass ubject
ivewel l-being-ament alstatethatiss ubjectivel
yexper iencedashappy,c ontented,
anddes ir
ed.Si xth,ment alhealthc anbec onceptualizedasr esilience,asthec apacityfors uccessf
uladapt at
ion
andhomeos t
as i
s.

ModelA:Ment
alHeal
thasAboveNormalThisf
irs
tperspec
tivedif
fersfr
om t
het
radi
ti
onalmedi
calappr
oac
h
t
ohealt
handill
nes
s.Nomanifes
tpsyc
hopathol
ogyequalsmentalhealt
h.
 I
nthismedicalmodel
,ifoneweretoputal
lindivi
dual
sonac ont
inuum,nor
mal
it
ywoul
denc
ompas
sthe
maj
orporti
onofadults,andabnor
malit
ywoul dbethesmal
lremainder
.
 Thi
sdefi
nit
ionofheal
thcorrel
ateswit
hthetr
adit
ionalr
olemodeloft
hedoc
torwhoat
tempt
stof
reehi
s
pat
ientf
rom gr
oss
lyobservabl
es i
gnsofi
ll
ness
.
 Inotherwords ,i
nthiscont
exthealthr
efer
stoareasonabl
e,rat
herthananopti
mal ,s
tateoffunc
tioning.Yet,
asalreadypointedout,mentalheal
thi
snotnormal;i
tisaboveaver
age.Somebeli
evet hatt
ruement alhealt
h
ist
heexc ept
ion,nottherule.
 Mor
eover
,unt
ilr
ecent
lys
omebel
ievedt
hatment
alheal
thwasi
magi
nar
y.

ModelB:MentalHeal
thasMatur
ityUnl
ikeot
heror
gansoft
hebodyt
hatar
edes
ignedt
ost
ayt
hes
ame,t
he
br
ainisdes
ignedtobeplas
tic
.
 Ther
efore,j
ustasopt
imalbr
aindevel
opmentr
equi
resal
mos
tal
ifet
ime,s
odoest
heas
ses
smentofpos
iti
ve
mentalheal
th.
 A10-year
-ol
d'sl
ungsandkidneysaremoreli
kelyt
orefl
ectopt
imalf
unc
tiont
hanar
ethos
eofa60-
year
-ol
d,
butt
hatisnottr
ueofa10-year-
old'
scent
ralner
voussys
tems.
 Tos
omeext
ent
,then,adul
tment
alheal
thr
efl
ect
sac
ont
inui
ngpr
oces
sofmat
urat
ionalunf
oldi
ng.
 Stat
isti
cally,physic
all
yhealthy70-
year-ol
dsarement al
lyhealt
hiert
hantheywereatage30year
s;f
or
exampl e,Laur aCarst
ens
enf oundthroughprospec
tivestudi
esthati
ndivi
dualsar
eles
sdepres
sedandshow
greateremot ionalmodulat
ionatage70yearsthant heydidatage30years.
 Er
ikEr
iks
onc
onc
ept
ual
izedt
hats
uchdevel
opmentpr
oduc
eda"
wideni
ngs
oci
alr
adi
us.
"
 I
nEr iks
on'smodeltheadultsoc
ialradiusexpandedoverti
methroughthemast
eryofc
ert
aintas
kssuchas
"
Identit
yversusIdenti
tyDif
fusi
on,""I
nt i
macyversusIs
olat
ion,
""Gener
ati
vit
yvers
usSt
agnat
ion,
"and
"
Integri
tyversusDespair
.
 "Identi
ty.I
ns uchamodelt hesoc i
alradi
usofeac hadultdevelopmentaltas
kf i
tsinsi
det henext .Fi
rst
,
adolesc
entsmus tac
hieveanIdentit
ythatallowsthem tobecomes eparat
efrom theirpar ents,f
orment al
healthandadul tdevel
opmentc annotevolvethroughafalseself
.ThetaskofIdentit
yr equiresmas t
eringthe
las
ttaskofchildhood:sust
ainedseparati
onf rom soc
ial
,resi
dential
,economic,andideologi c
aldependenc eon
familyofori
gin.
 I
nti
mac y.Then,youngadul
tsshoul
ddevel
opI
nti
mac
y,whi
chper
mit
sthem t
obec
omer
eci
proc
all
y,andnot
s
elf
ishl
y,involvedwit
hapar t
ner.
 CareerCons olidati
on.Car eerConsolidati
onisat askthatisus uall
ymas teredtoget herwi thorthatfoll
owsthe
mas t
eryofi ntimac y.Masteryofthistaskper mitsadult
stof indac areerasval uableast heyonc efoundplay.
Therear efourc ruc i
aldevelopment alcri
teri
athatt r
ansform a" job"orhobbyi ntoa" career:"Contentment,
compens ation,compet ence,andc ommi tment.Tot heoutsiderthepr ocessofCar eerCons oli
dationoften
appears" s
elfish,
"butwi thouts uc
h" self
ishness"onebecomes" self
less
"andhasno" sel
f"togiveawayi nthe
nextstageofgener ati
vit
y.Per s
onswi thschizophreniaandi ndividualswi t
hs evereper sonalit
ydisorderoft
en
mani f
estal if
elongi nabi
litytoachieveeitherintimacyors ustained,grati
fyingempl oyment.
 Gener
ati
vit
y.Gener
ati
vit
yinvol
vest
hedemons
trat
ionofac
learc
apac
ityt
ocar
eforandgui
det
henext
 gener ati
on.Res ear
c hrevealsthats ometimebet weenage35and55year sourneedf orachievementdec l
ines
andourneedf orcommuni tyandaf fi
li
ati
oni ncreases.Dependi ngont heoppor t
uni tiest
hatthes ocietymakes
available,generati
vityc anmeans ervingasac ons ult
ant ,guide,mentor,orcoacht oyoungadul t
sint helar ger
society.Likeleadership,gener ati
vitymeanst obei nac aringrelati
onshipinwhi chonegi vesupmuc hoft he
controlt hatparentsretainoveryoungc hildren.Goodment orslearn"toholdloosely"andt oshar e
respons ibil
it
y.Itsmaster yisstronglycorrelat
edwi t
hs uc ces
sfuladaptati
ontool dage.Thi sisbecaus einold
aget herear einevi
tablel os
s es
,andt hesemayover whel m usi fwehavenotc ontinuedt ogrow beyondour
immedi atefamily.
 Integrity.Finall
y,inoldagei tisc ommont ofeelthats omel i
feexist
saf t
erdeathandt hatonei spartof
somet hinggr eaterthanone' sself.Thus ,t
helastlifetas kinEr i
kson'swor dsisIntegrit
y,thet as
kofac hievi
ng
somes enseofpeac eanduni t
ywi threspectbotht oone' sli
feandt othewhol ewor l
d.Eriksondes cribed
integrityas" anexper i
encewhi chc onveyssomewor l
dor derands pir
itualsense.Nomat t
erhow dear lypaid
for,iti
st heac ceptanceofone' soneandonl yl i
fec ycl
eass omethingt hathadt obeandt hat ,bynec essit
y,
per mittedofnos ubsti
tuti
ons."Itmus tbekeptinmi ndt hatmas teryofonel if
et askisnotnec essar
ilyheal t
hier
thanmas t
eryofanot her,foradul tdevelopmenti snei theraf ootracenoramor alimperati
ve.Onec anbea
mat ure20- year-old,t
hatis,healthy.
ModelC:Ment
alHeal
thasPos
iti
veor'
'
Spi
rit
ual'
'Emot
ions
.
 Thismodeldef
inesbothment
alands
pir
itualheal
thast
heamal
gam oft
hepos
iti
veemot
ionst
hatbi
ndust
o
otherhumanbeings.
 Love,hope,j
oy,f
orgi
veness
,compas
sion,f
ait
h,awe,andgr
ati
tudec
ompr
iset
hei
mpor
tantpos
iti
veand
"moral"emoti
onsinc
ludedinthi
smodel.
 Ofgreati
mpor tanc
e,thes
es el
ect
edpos
iti
veemot
ionsal
linvol
vehumanc
onnec
tion.Noneoft
heemot
ions
l
ist
edisjustaboutthesel
f.
 Negat
iveemotionsor
igi
natinginthehypot
hal
amussuchasfearandangerareel
abor
atedinthehuman
amygdala(
lar
gerinhumanst haninothermammals
).Oftr
emendousimpor t
ancetoi
ndivi
dualsur
vival
,the
negat
iveemoti
onsareallabout"me."
 Negat
iveemotionsar
ec ruci
alforsurvivali
npr
esentt
ime.Theposit
iveemotionsaremor eexpans
iveandhel
p
ustobroadenandbuild.Infut
uretime,theywi
denone'stol
eranc
ef orst
rangers,expandone'smoral
compass,andenhanceone'screat
ivit
y.
 Pos
iti
veemot
ions
,es
pec
ial
lyj
oy,maket
houghtpat
ter
nsmor
efl
exi
ble,c
reat
ive,i
ntegr
ati
ve,andef
fic
ient
.
 Theeff
ectofposi
ti
veemot
ionontheaut
onomi
c(vi
scer
al)ner
vouss
yst
em hasmuc
hinc
ommonwi
tht
he
rel
axat
ionresponset
omedit
ati
on.
 I
ncontras
ttot hemetabol
icandcardiacarousalt
hatthefi
ght-or
-fl
ightr es
ponseofnegativeemoti
oninduces
i
noursympat heti
cautonomicnervoussystem,posi
ti
veemot i
onviaourpar as
ympat het
icnervoussys
tem
r
educesbasalmetaboli
sm,bloodpressur
e,heartrat
e,res
pirator
yr ate,andmus c
letension.
 Posi
ti
veemotionshaveabiologi
calbas
is,whichmeanst
hatt
heyhaveevolvedt
hroughnaturalselec
tion.The
pros
ocialemoti
onsprobabl
yr ef
lec
tadaptat
ionst
hatper
mitt
edthesur
vivalofr
elat
ivel
ydefense-l
essHomo
sapi
ens.
ModelD:MentalHeal
thasSoc
ioemoti
onalInt
elli
genceHi
ghs oc
ioemoti
onalint
ell
igenceref
lec
tsabove-
average
mentalheal
thi
nthesamewayt hatahighi
ntell
igenc
equoti
ent(IQ)r
efl
ectsabove-aver
ageint
ell
ect
ualapti
tude.
 Suchemoti
onali
ntell
igenc
el i
esattheheartofpos
iti
vement
alheal
th.I
ntheNi
comac
heanEt
hic
s,Ar
ist
otl
e
def
inedsoc
ioemoti
onalintel
li
genceasfol
lows:
 "
Anyonec
anbecomeangry-
thati
seasy.Buttobeangrywit
htherightper
son,t
other
ightdegr
ee,att
her
ight
t
ime,f
ort
her
ightpur
pose,andintherightway-
thati
snoteas
y."
 Allemotionsexisttoassi
stbasi
cs ur
vival.Althoughtheexactnumberofpri
maryemoti
onsisar
guable,seven
emotionsar ecurrentl
ydist
inguis
hedac cordingtocharact
erist
icf
aci
alexpr
ess
ionsc
onnot
inganger,fear,
excit
ement ,int
erest,s
urpri
se,di
sgust,ands adness
.
 Thecapac
ityt
oident
ifyt
hes
edi
ffer
entemot
ionsi
nour
sel
vesandi
not
her
spl
aysani
mpor
tantr
olei
nment
al
heal
th.
 Thes
ebenef
itsi
ncl
udedbei
ngbet
teremot
ional
lyadj
ust
ed,mor
epopul
ar,andmor
eres
pons
ivet
oot
her
s.
 Empat
hicc
hil
dren,wi
thoutbei
ngmor
eint
ell
igent
,dobet
teri
nsc
hoolandar
emor
epopul
art
hant
hei
rpeer
s.
 Atthesametimethechi
ldmustbeablet
ocommuni
cat
ehi
sorherneedsandt
um t
oteac
her
sforhel
p.
Et
hologic
all
y,emoti
onsarec
rit
icalt
omammali
ancommuni
cat
ion.
 Putdi
fferentl
y,t
hemor eoneisski
ll
edinempat
hy,t
hemor eonewi
llbeval
uedbyot
her
s,andt
hust
hegr
eat
er
wil
lbes oci
alsuppor
ts,s
elf
-es
teem,andint
imat
erel
ati
ons
hips.
 Soc
ialandemot
ionali
ntel
li
genc
ecanbedef
inedbyt
hef
oll
owi
ngc
rit
eri
a:
 Ac
cur
atec
ons
ciousper
cept
ionandmoni
tor
ingofone'
semot
ions
.
 Modif
icat
ionofemoti
onssothatthei
rexpres
sioni
sappr
opri
ate.Thi
sinvol
vest
hec
apac
ityt
osel
f-
soot
he
per
sonalanxi
etyandtoshakeoffhopel
ess
nessandgl
oom.
 Ac
cur
ater
ecogni
ti
onofandr
espons
etoemot
ionsi
not
her
s.
 Ski
lli
nnegot
iat
ingc
los
erel
ati
ons
hipswi
thot
her
s.
 Capac
ityf
orf
ocus
ingemot
ions(
mot
ivat
ion)t
owar
dades
iredgoal
.
ModelE:Ment
alHealt
hasSubjec
tiveWel
l-
BeingPos
iti
vement
alheal
thdoesnotj
usti
nvol
vebei
ngaj
oyt
oot
her
s;
onemustal
soexper
iences
ubject
ivewel
l-
being.
 Heal
thybl
oodpr
ess
urei
stheobj
ect
iveabs
enc
eofhypot
ens
ionandhyper
tens
ion,buthappi
nes
sisl
essneut
ral
.
 Subject
ivewell
-bei
ngisnotj
ustt
heabsenc
eofmis
ery,butt
hepresenc
eofpos
iti
vecont
ent
ment
.Nevert
heles
s,
ifhappines
sisanines
capabl
edimensi
onofment
alhealt
h,happi
nessi
sof
tenregar
dedwit
hambival
ence.
 Subjecti
vehappinesscanhavemaladapti
veaswel
lasadapt
ivef
acet
s.Thes
ear
chf
orhappi
nes
scanappear
sel
fish,nar
cis
sis
tic,s
uperf
ici
al,andbanal
.
 Pl
eas
uresc
anc
omeeas
ilyandbes
oongone.Happi
nes
sisof
tenbas
edoni
ll
usi
onorondi
ssoc
iat
ives
tat
es.
 I
ll
usor
yhappi
nes
siss
eeni
nthec
har
act
ers
truc
tur
eas
soc
iat
edwi
thbi
pol
aranddi
ssoc
iat
ivedi
sor
der
s.
 Mal
adapt
ivehappi
nes
scanbr
ingt
empor
arybl
issbuthasnos
tic
kingpower
.

CASEHI
STORYTAKI
NG
Fami
li
arit
ywi t
hthetechni
queofpsychi
atr
icasses
smenti
simpor
tantnotonl
yforaps
ychi
atr
istbutal
sof
ora
medi
calprac
tit
ioneroranymentalheal
thprof
essi
onal
.
I
ntervi
ew Techni
que
 I
nnoot
herbr
anc
hofMedi
cinei
sthehi
stor
ytaki
ngi
nter
view asi
mpor
tantasi
nPs
ychi
atr
y.
 Duri
ngt hei
nter
view s
ess
ion(
s),t
hepat
ients
houl
dbeputateas
eandanempat
hicr
elat
ions
hips
houl
dbe
es
tabl
ished.
 I
npsyc
hiat
ricas
sess
ment,hi
storytaki
ngint
erview andmentalstat
usexami
nat
ionneednotal
waysbe
c
onduct
edsepar
atel
y(t
hought heymustberecordedindi
vidual
ly).
 Duri
ngas
ses
sment,t
hei
nter
viewershoul
dobs
erveanyabnor
mal
it
iesi
nver
balandnonver
bal
communi
cat
ionandmakenoteoft
hem.
 I
tishelpfult
or ec
ordpati
ent’
sresponsesver
bati
mr at
herthanonlynamingthesi
gns(forexample,rat
her
t
hanjus twri
tingdel
usi
onofper s
ecuti
on,iti
sbettertorecor
dinadditi
on:“myneighbouristr
yingtopois
on
me”)
.Itisbestdoneinthepati
ent’
sowns pokenlanguage,wheneverposs
ibl
e.
 I
tisus
efultoaskopen-endedandnon-di
recti
vequesti
ons(
forexample,“
how ar
eyouf eel
ingt
oday”
?)r
ather
t
hanaskingdir
ect,l
eadingquest
ions(
forexample,“
areyoufeel
ings
adatpresent”
?).
 Arguablyt
hemostimportanti
ntervi
ewingski
ll
sareli
stening,anddemons t
rati
ngthatyouareint
eres
tedi
n
li
steni
ngandat
tendingt
ot hepati
ent.I
tisi
mportantt
or emembert hatl
ist
eningisanacti
ve,andnotapas
sive,
process
.
 Confidenti
ali
tymus
talwaysbeobs
erved.However
,inc
asesofs
uic
idal
/homi
cidalr
iskandc
hil
dabus
e,an
exceptionmayhavetobemade.
 Pat
ient
ssuffer
ingfr
om psychi
atr
icdis
ordersar
eus ual
lynomor evi
olentt
hant
hegener
alpopul
ati
on.
However,i
tisimportantt
oensures
afetyi
fanyr i
sksareappar
ent.
 Ac
ompr
ehens
iveps
ychi
atr
ici
nter
view of
tenr
equi
resmor
ethanones
ess
ion.

I
DENTI
FICATI
ONDATA
 Iti
sbesttostar
tt heinterview byobt
ainingsomei dent
ifi
cat
iondatawhic hmayincludeName( inc
luding
ali
asesandpetnames ),Age,Sex,Mari
talst
atus,Educat
ion,Occupati
on,Income,Res
identi
alandOf f
ice
Address(
es)
,Religion,andSoc ioec
onomicbac kgr
ound,asappropriateac
c ordi
ngtot
hes et
ting.
 I
tisus
efult
orec
ordt
hes
our
ceofr
efer
raloft
hepat
ient
.
I
NFORMANTS
 Sincesometimesthehist
oryprovidedbyt hepatientmaybei
ncomplete,duetofact
orssuchasabs
entins
ight
orunc ooper
ati
veness,i
tisi
mpor tanttotakethehistor
yfr
om pat
ient
’srelat
ivesorfr
iendswhoactas
infor
mant sandsourcesofcol
lat
er ali
nformation.
 Iti
simport
anttot
akethepat
ient
’sc
ons
entbef
oret
aki
ngt
hisc
oll
ater
alhi
stor
yunl
esst
hepat
ientdoesnot
havecapac
ityt
ocons
ent.
 Theinfor
mants
’ident
ifi
cati
ondatas
houldberecordedalongwiththei
rrel
ati
ons
hipt
othepat
ient
,whet
her
theyst
aywit
hthepatientornot
,andthedur
ationofstaytoget
her.
 Finall
y,acommentshoul
dbemaderegar
dingther
eli
abili
tyoft
hei
nformat
ionprovi
ded.Ther
eli
abi
li
tyoft
he
infor
mat i
onprovi
dedbythei
nfor
mantsshoul
dbeasses
sedonthef
oll
owingparameter
s:
1.Rel
ationshipwithpatient,
2.Int
ell
ec t
ualandobs ervati
onalabi
lit
y,
3.Familiari
tywiththepat i
entandlengthofs
taywi
tht
hepat
ient
,and
4.Degreeofc onc
ernr egardingt
hepatient
.
Thesour
ceofrefer
ral(s
uchasalet
terf
rom pat
ient
’sgeneralprac
tit
ioneroralet
terofr
eferralf
rom
ther
efer
ringphysi
cian/
sur
geon)of
tenprovi
desval
uableinformati
onr egar
dingt
hepatient
’scondi
ti
on.

PRESENTI NG( CHI EF)COMPLAI NTS

 Thepr esent i
ngc ompl aintsand/ orreasonsforconsultat
ionshoul dberecorded.
 Bot ht hepat ient’sandt hei nformant ’
sver si
onshouldber ecorded,ifr
elevant.
 I ft
hepat ienthasnoc ompl aints(duetoabs enti
nsight)thi
sfactshouldalsobenoted.
 I ti
si mpor tantt ous epat ient’
sownwor dsandtonot ethedurationofeachpr es
enti
ngcompl
aint
.Someoft
he
additionalpoi ntswhi chs houldbenot edi ncl
ude:
1.Onsetofpr esenti ll
nes s/
sympt om.
2.Durat i
onofpr es
enti ll
nes s/sympt om.
3.Cours eofs ympt oms /
il
lnes s.
4.Predispos ingf actor s.
5.Precipitatingf actor s(includel i
fes t
ress
or s
).
6.Perpetuat ingand/ orr eli
evi ngfac t
ors.

HI
STORYOFPRESENTI LLNESS
 Whent hepati entwaslastwelloras ympt omat i
cshouldbec l
earl
ynoted.Thi
sprovi
desusefulinf
ormati
on
aboutt heons etaswellasdur ati
onofi l
lnes s.
 Establishi
ngthet imeofons etisreallyi
mpor tantasitpr
ovidescl
arit
yaboutthedurat
ionofill
nessand
sympt oms .
 Thes ympt omsoft heill
ness,from theear li
esttimeatwhi c
hac hangewasnotic
ed(t
heons et
)untilt
hepres
ent
ti
me,s houl dbenar rat
edc hronological
ly,inac oherentmanner.
 Thepr es
enti
ng(chi
ef)complai
ntsshoul
dbeexpanded.I
nparti
cul
ar,anydis
tur
banc
esi
nphys
iol
ogi
cal
func
tionssuchassl
eep,appeti
teandsexualf
unct
ioni
ngshoul
dbeenquired.
 Oneshoul
dal
waysenqui
reaboutt
hepr
esenc
eofs
uic
idali
deat
ion,i
deasofs
elf
-har
m andi
deasofhar
mto
ot
her
s .
 I
tisal
soes
s ent
ialtoconsiderandr
ecor
danyi
mpor
tantnegat
ivehi
stor
y(s
uchashi
stor
yofal
cohol
/dr
ugus
e
i
nnew onsetpsychos
is).
 Ali
fechart(
Fig.2.
1)provi
desaval
uabledis
playofthecours
eofil
lnes
s,epis
odi
csequenc
e,pol
ari
ty(
ifany)
,
s
everi
ty,f
requency,rel
ati
onshi
ptost
ress
ors,andrespons
etotr
eatment,i
fany.

PASTPSYCHI
ATRI
CANDMEDI
CALHI
STORY
Anyhi st
oryofanypas
tpsychi
atri
cil
lnes
sshoul
dbeobtai
ned.Anypasthis
toryofhavingrecei
vedany
psychotropi
cmedic
ati
on,al
coholanddrugabus
eordependence,andps
ychiat
richospit
ali
sati
onshoul
dbe
enquired.
Apas
thi
stor
yofanyseri
ousmedic
alorneur
ologi
cali
llnes
s,s
urgicalprocedure,ac
cidentorhospi
tal
isat
ion
s
houl
dbeobtai
ned.Thenat
ureoft
reat
mentrecei
ved,andall
ergi
es,ifany,shouldbeascert
ained.
Apasthist
oryofrelevantaet
iol
ogic
alc ausess
uchasheadinj
ury,convuls
ions,unc
onsc
iousness,di
abetesmell
it
us ,
hyper
tension,c
oronaryarter
ydisease,acutei
nter
mit
tentporphyr
ia,syphil
isandHIVposi
tivi
ty(orAIDS)should
beexplor
ed.
TREATMENTHI
STORY
Anytreat
mentr ec
ei vedinpresentand/orpreviousepi
sode(s
)s houl
dbeaskedal
ongwit
hhistor
yoftr
eat
ment
adherenc
e,res
pons et otr
eat
mentr ecei
ved,anyadvers
eeffectsexperi
enc
edoranydrugal
ler
gieswhi
chshoul
d
beprominentl
ynot edi nmedic
alr ecords.
FAMI
LYHI
STORY
Thefamilyhis
toryusual
lyincludesthe‘f
amilyoforigi
n’(i
.e.thepat
ient
’spar
ents,si
bli
ngs,gr
andparents
,uncles
,
et
c.)
.The‘famil
yofprocreati
on’(i.
e.thepat
ient
’sspouse,chil
drenandgrandchi
ldren)isc
onventi
onallyrec
orded
undertheheadingofpersonalhist
ory.
Fami
lyhi
stor
yisus
ual
lyr
ecor
dedundert
hef
oll
owi
ngheadi
ngs
:
1.Famil
ys t
ructur
e:Drawingofa‘famil
ytr ee’(pedi
greechart
)canhel pi
nr ecor
dingallt
her el
evantinfor
mation
inveryli
ttl
espacewhichiseasil
yreadable.Itshouldbenotedwhet hert
hef amilyisanucl
ear,extendednucl
ear
orjoi
ntfamily.Anyconsangui
neousrelat
ions hipsshoul
dbenot ed.Theageandc auseofdeath(i
fany)offamily
member sshouldbeasked.
2.Fami
lyhis
tor
yofsimil
arorotherpsyc
hiat
rici
ll
nesses
,maj
ormedi
cali
ll
nes
ses
,al
coholordr
ugdependenc
e
andsui
cide(
andsui
cidalat
tempts)s
houldberec
orded.
3.Curre
ntsoci
alsit
uation:Homeci
rcumstanc
es,percapi
tai
ncome,s
oci
oeconomicstat
us,l
eaderofthefamily
(nominalaswellasfuncti
onal
)andcurr
entatti
tudesoff
amil
ymemberstowardsthepati
ent’
sil
lnes
ss houl
dbe
noted.
Thecommuni
cat
ionpat
ter
nsinthefamil
y,rangeofaf
fec
tivi
ty,c
ult
uralandr
eli
giousval
ues
,ands
oci
als
uppor
t
sys
tem,s
houl
dbeenqui
redabout,wher
er el
evant
.

ATypi
calFami
lyTr
eeandCommonPedi
greeSymbol
s

PERSONALANDSOCI
ALHI
STORY
 I
nayoungerpat
ient
,iti
sof
tenpos
sibl
etogi
vemor
eat
tent
iont
odet
ail
sregar
dingear
lierper
sonalhi
stor
y.
 I
nol
derpat
ient
s,i
tiss
omet
imeshar
dert
ogetadet
ail
edac
countoft
heear
lyc
hil
dhoodhi
stor
y.
 Parentsandol
ders
ibl
ings
,ifal
ive,c
anof
tenpr
ovi
demuc
haddi
ti
onali
nfor
mat
ionr
egar
dingt
hepas
tper
sonal
his
tory.
 Notallquest
ionsneedtobeaskedf
rom allpat
ient
sandpers
onalhi
stor
y( muchli
kerestofthehi
storytaking)
shoul
dbei ndivi
duali
sedforeac
hpati
ent.Pers
onalhi
stor
ycanberecordedunderthef
ollowingheadings:
Peri
nat
alHi
story
 Di
ffi
cult
iesi
npregnanc
y( par
ticul
arl
yinthefi
rstthreemont
hsofgest
ati
on)suc
hasanyf ebri
leil
lnes
s,
medicat
ions
,dr
ugsand/oralcoholus
e;abdominaltr
auma,anyphysi
calorps
ychiat
rici
ll
nessshouldbeas
ked.
 Otherrelevantquesti
onsmayi ncludewhet hert hepati
entwasawant edorunwant edchi
ld,dateofbi
rth,
whetherdel i
verywasnor mal,anyinstrument ationneeded,whereborn(hospi
talorhome),anyperi
natal
compli
c ati
ons(cyanosis
,convulsi
ons,jaundice),APGARs core(
ifavai
labl
e),bi
rthcry(i
mmedi at
eordelayed)
,
anybirthdefects
,andanypr emat uri
ty.
Chi
ldhoodHi
story
 Whetherthepat
ientwasbroughtupbymotherorsomeoneel
se,br
eas
tfeedi
ng,weani
ngandanyhi
stor
y
s
uggesti
veofmaternaldepr
ivat
ionshoul
dbeasked.
 Theageofpas
singeachimportantdevel
opmentalmil
est
oneshoul
dbenoted.Theageandeas
eoft
oil
et
tr
aini
ngshoul
dbeas ked.Theoccurr
enceofneurot
ict
rai
tss
houldbenot
ed.
 Theseincludes
tutt
eri
ng,st
ammer i
ng,ti
cs,enur
esis
,enc
opres
is,ni
ghtt
err
ors
,thumbsuc
ki ng,nailbi
ti
ng,head
banging,bodyroc
king,morbi
dfearsorphobias
,somnambuli
sm,tempert
antrums
,andfoodf ads
.
Educat
ionalHi
story
 Theageofbeginni
ngandfi
nis
hingf
ormaleduc
ati
on,ac
ademi
cac
hievement
sandr
elat
ions
hipswi
thpeer
s
andteac
hers,s
houldbeas
ked.
 Anyschoolphobi
a,non-
attendanc
e,t
ruanc
y,anyl
ear
ningdi
ffi
cul
ti
esandr
eas
onsf
ort
ermi
nat
ionofs
tudi
es
(
ifoc
cursprematurel
y)shouldbenot
ed.
Pl
ayHi
story
 Theques t
ionstobeas
kedi ncl
ude,whatgameswereplayedatwhats
tage,wit
hwhom andwhere.
Relati
onshipswit
hpeers,par
ticul
arl
ytheopposi
tesex,shoul
dberec
orded.Theeval
uat
ionofpl
ayhi
stor
yis
obviousl
ymor eimport
antintheyoungerpati
ent
s.
Pubert
y
 Theageatmenar che,andreacti
ontomenarche(inf
emales)
,theageatappearanceofsecondar
ysexual
charact
eri
sti
cs(i
nbot hfemalesandmal
es),noct
urnalemis
sions(
inmales),masturbat
ionandanyanxiet
y
rel
atedtochangesinpubertyshoul
dbeasked.
Mens
trualandObs
tet
ricHi
story
 Theregul
ari
tyanddurat
ionofmenses,t
helengt
hofeachcyc
le,anyabnormal
it
ies
,thelas
tmens
trualper
iod,
thenumberofchi
ldr
enborn,andter
mi nat
ionofpr
egnanc
y(ifany)shoul
dbeaskedfor
.
Occupat
ionalHi
story
 Theageatstar
tingwor k;j
obshel dinchronologi
calorder;reas
onsforc
hanges
;jobs at
isf
acti
ons;ambit
ions;
rel
ati
onshi
pswi thauthorit
ies
,peer sandsubordi
nates;pres
entinc
ome;andwhet herthejobisappropr
iatet
o
theeduc
ati
onalandf ami l
ybac kground,s
houldbeas ked.
SexualandMari
talHi
story
 Sexualinf
ormation,how acqui
redandofwhatkind;mas t
urbati
on( f
antas
yandac t
ivit
y);sexpl
ay,ifany;
adoles
centsexualacti
vit
y;premarit
alandext
ramarit
alsexualrelat
ions
hips,i
fany;sexualprac
tic
es(normal
andabnor mal)
;andanygenderi denti
tydi
sor
der,ar
et heareastobeenquiredabout.
 Thedur ati
onofmar riage(
s)and/orrelati
onship(
s);ti
meknownt hepartnerbeforemar r
iage;mar riage
arrangedbypar entswi thorwithoutc onsent
,orbys el
f-choicewi t
horwi thoutparent
alc onsent;numberof
mar riages,di
vorcesors eparat
ions;rolemar r
iage;interpersonalands exualrelat
ions
;cont rac
eptive
meas uresused;sexuals at
isf
act
ion;modeandf requenc yofs exualint
er c
our s
e;andpsychos exualdys f
unc
tion
(i
fany)s houldbeas ked.Conventionall
y,thedetail
soft he‘fami l
yofpr ocreat
ion’arerecordedher e.
Premorbi
dPers
onal
ity(
PMP)
 Iti
simport
antt oel
ici
tdetail
sregardingt
hepersonal
it
yoft heindivi
dual(
temperame
nt,ift
heageislessthan
16year
s).I
nsteadofusinglabel
ss uchasschi
zoi
dorhi s
tri
onic,iti
smoreus ef
ult
odescri
betheper
s onali
tyin
somedetai
l.
 Thef
oll
owi
ngs
ubheadi
ngsar
eof
tenus
edf
ort
hedes
cri
pti
onofpr
emor
bidper
sonal
it
y.
1.I
nterpers
onalrelat
ions
hip:Int
erpers
onalr
elat
ions
hipswithfamil
ymember s
,fr
iends
,andwor
kcol
leagues
;
int
rovert
ed/ext
rovert
ed;easeofmakingandmaintai
ningsoc
ialrel
ati
ons
hips
.
2.Us
eofl
eis
uret
ime:Hobbi
es;i
nter
est
s;i
ntel
lec
tualac
tivi
ti
es;c
rit
icalf
acul
ty;ener
get
ic/
sedent
ary.
3.Predominantmood:Opt
imi
sti
c/pes
simi
sti
c;s
tabl
e/pr
onet
oanxi
ety;c
heer
ful
/des
pondent
;reac
tiont
ost
res
sful
li
feevents
.
4.Att
itudetosel
fandother
s:Self
-confi
dencel
evel
;self
-cr
iti
cis
m;s
elf
-cons
cious
nes
s;s
elf
-cent
red/t
hought
fulof
other
s;self
-appr
ais
alofabi
lit
ies
,ac hi
evement
sandf ai
lures
.
5.Att
itudetowor
kandr
espons
ibi
li
ty:Dec
isi
onmaki
ng;ac
cept
anc
eofr
espons
ibi
li
ty;f
lexi
bil
it
y;per
sever
anc
e;
for
esight.
6.Rel
igi
ousbel
ief
sandmor
alat
tit
udes
:Rel
igi
ousbel
ief
s;t
oler
anc
eofot
her
s’s
tandar
dsandbel
ief
s;c
ons
cienc
e;
alt
rui
sm.
7.Fantas
ylif
e:Sexualandnons
exualf
ant
asi
es;daydr
eami
ng-
frequenc
yandc
ont
ent
;rec
urr
entorf
avour
ite
daydreams;dreams.
8.Habi
ts:Foodf
ads
;al
cohol
;tobac
co;dr
ugs
;sl
eep.
 Oneofthemostr
eli
ablemethodsofas
sess
mentofpremor
bidper
sonal
it
yisi
nter
viewi
ngani
nfor
mant
f
amili
arwitht
hepatientpr
iortot
heonsetofi
ll
nes
s.
ALCOHOLANDSUBSTANCEHI
STORY
 Alt
houghalcoholanddrughist
oryisof
tenel
ici
tedasapartofpersonalhi
stor
y,i
tisoft
encust
omar
ytorecor
d
its
eparat
ely.Alc
oholanddrugscanoft
encontri
butetoc
ausati
onofs ever
alpsyc
hiat
ricsympt
omsandare
oft
enpresentco-mor
bidl
yalongsi
demanyps ychi
atri
cdi
agnoses.
PHYSI
CALEXAMI
NATI
ON
 Adet
ail
edgener
alphys
icalexami
nat
ion(
GPE)ands
yst
emi
cexami
nat
ioni
samus
tinever
ypat
ient
.
 Physi
caldi
seas
e,whic
hisaetiol
ogi
cal
lyimportant(forcausi
ngpsychi
atr
ics
ymptomatology),orac
cident
all
y
co-
exist
ent
,orsec
ondari
lycausedbythepsyc
hi at
riccondit
ionortr
eatment
,isof
tenpresentandcanbe
det
ectedbyagoodphysi
calexaminat
ion.
MENTALSTATUSEXAMI
NATI
ON(
MSE)
 Ment
alst
atusexaminati
onisas
tandardi
sedfor
mati
nwhi
cht
hec
lini
cianr
ecor
dst
heps
ychi
atr
ics
ignsand
s
ymptomspresentattheti
meofthei
ntervi
ew.
 MSEs houlddesc
ribeallareasofmentalfuncti
oni
ng.Somear eas,however
,maydeser
vemoreemphasi
s
accordi
ngtotheclini
calimpressi
onsthatmayar i
sefrom t
hehi s
tory;f
orexampl
e,moodandaff
ecti
n
depress
ion,andcogniti
vefuncti
onsindeliri
um anddement i
a.

1)GENERALAPPEARANCEANDBEHAVI
OUR
 Ar
ichdealofi
nfor
mat
ionc
anbeel
ici
tedf
rom exami
nat
ionoft
hegener
alappear
anc
eandbehavi
our
.
 Whi
leexami
ning,i
tisi
mpor
tantt
orememberpat
ient
’ss
oci
ocul
tur
albac
kgr
oundandper
sonal
it
y.
Underst
andably,generalappear
anc
eandbehavi
ourneedst
obegi
venmor
eemphas
isi
ntheexami
nat
ionofan
uncooperat
ivepatient
.
 Generalappearance
 Theimport
antpoint
stobenotedare:Phys
iqueandbodyhabi
tus(
bui
ld)andphys
icalappear
anc
e
(appr
oxi
mateheight
,weight
,andappearance)
,
 Looksc
omf
ort
abl
e/unc
omf
ort
abl
e,
 Phys
icalheal
th,
 Gr
oomi
ng,Hygi
ene,Sel
f-
car
e,
 Dr
ess
ing(
adequat
e,appr
opr
iat
e,anypec
uli
ari
ti
es)
,
 Fac
ies(
non-
ver
balexpr
ess
ionofmood)
,
 Ef
femi
nat
e/mas
cul
ine
 At
tit
udet
owardsexami
ner
 Cooper
ati
on/
guar
dednes
s/evas
ivenes
s/hos
til
it
y/c
ombat
ivenes
s/haught
ines
s,
 At
tent
ivenes
s,
 Appear
sint
eres
ted/
dis
int
eres
ted/
apat
het
ic,
 Anyi
ngr
ati
ati
ngbehavi
our
,
 Per
plexi
ty
 Comprehens
ion
 I
ntac
t/i
mpai
red(
par
tial
ly/
ful
ly)
 Gai
tandpos
ture
 Nor
malorabnor
mal(
wayofs
itt
ing,s
tandi
ng,wal
king,l
ying)
 Mot
oract
ivi
ty
 I
ncr
eas
ed/
dec
reas
ed,
 Exc
itement
/st
upor
,
 Abnor
mali
nvol
unt
arymovement
s(AI
Ms)s
uchast
ics
,tr
emor
s,akat
his
ia,
 Res
tles
snes
s/i
llateas
e,
 Cat
atoni
csigns(
manneri
sms,s
tereot
ypi
es,post
uring,waxyflexi
bil
ity,negat
ivis
m,ambi
tendenc
y,
aut
omaticobedi
enc
e,st
upor
,echopraxi
a,psyc
hologicalpi
ll
ow,forcedgrasping),
 Conver
sionanddi
ssoc
iat
ives
igns(
pseudos
eizur
es,pos
ses
sions
tat
es)
,
 Soc
ialwi
thdr
awal
,Aut
ism,
 Compul
siveac
ts,r
itual
sorhabi
ts(
forexampl
e,nai
lbi
ti
ng)
,
  Reac
tiont
ime
 Soci
almannerandnon-
verbalbehavi
our
 I
ncr
eased,decreas
ed,orinappr
opriat
ebehavi
our,Eyecontac
t(gazeaver
sion,s
tar
ingvac
ant
ly,s
tar
ingat
t
heexaminer,hesi
tanteyecont
act
,ornormaleyecontact
).
 Rapport
 Whet
herawor
kingandempat
hicr
elat
ions
hipc
anbees
tabl
ishedwi
tht
hepat
ient
,shoul
dbement
ioned.
 Hal
luci
nat
oryBehavi
our
 Smi
li
ngorc
ryi
ngwi
thoutr
eas
on,Mut
ter
ingort
alki
ngt
osel
f(non-
soc
ials
peec
h).
 Oddges
tur
ingi
nres
pons
etoaudi
tor
yorvi
sualhal
luc
inat
ions
.

2)SPEECH
Speec
hcanbeexami
nedundert
hef
oll
owi
ngheadi
ngs
:
 Rat
eandquant
ityofs
peech
 Whet
herspeechispresentorabsent(mut
ism)
,Ifpr
esent
,whet
heri
tiss
pont
aneous
,whet
her
pr
oduct
ivi
tyisi
ncreasedordecreased,
 Rat
eisr
api
dors
low (
itsappr
opr
iat
enes
s),Pr
ess
ureofs
peec
horpover
tyofs
peec
h.
 Vol
umeandt
oneofs
peech
 I
ncr
eas
ed/
dec
reas
ed(
itsappr
opr
iat
enes
s),
 Low/
high/
nor
malpi
tch
 Fl
ow andrhyt
hm ofs
peech
 Smoot
h/hesi
tant,Bl
ocki
ng(sudden),Dysprosody,St
uttering/St
ammer i
ng/Cl
utt
ering,Anyaccent,
Ci
rcumstant
ial
it
y,Tangent
iali
ty,Verbi
gerati
on,Stereotypies(ver
bal
),Fli
ghtofideas,Cl
angassoci
ati
ons
.
3)MOODANDAFFECT
 Moodisthepervas
ivefeel
ingt
onewhi
chi
ssus
tai
ned(
las
tsf
ors
omel
engt
hoft
ime)andc
olour
sthet
otal
exper
ienceoft
heperson.
 Aff
ect
,ontheot
herhand,i
stheout
war
dobj
ect
iveexpr
ess
ionoft
hei
mmedi
ate,c
ros
s-s
ect
ionalexper
ienc
e
ofemoti
onatagivent
ime.
 Theas ses
smentofmoodincludest
esti
ngthequal
it
yofmood,whi
chi
sas
ses
seds
ubj
ect
ivel
y(‘
how doyou
feel
’)andobjec
tivel
y(byexaminat
ion).
 Theot
herc
omponentsarestabi
li
tyofmood(overaper
iodoft
ime)
,reac
tivi
tyofmood(
var
iat
ioni
nmood
wit
hsti
muli
),andper
sis
tenc
eofmood( l
engt
hoft i
methemoodlas
ts)
.
 Theaf f
ecti
ssi
milarlydes
c r
ibedunderquali
tyofaff
ect
,rangeofaf
fec
t(ofemoti
onalchangesdi
spl
ayedover
ti
me) ,dept
horintensi
tyofaffec
t(normal
,incr
easedorblunt
ed)andappropr
iat
enessofaff
ect(
inrel
ati
on
tothoughtandsurroundingenvironment
).
 Moodisdescri
bedasgener alwarmt h,euphori
a,elati
on,exalt
ationand/orecst
asy(seeni nseveremania)in
mania;anxi
ousandr est
les
si nanxietyanddepr es
sion;sad,i
rrit
able,angryand/ordespairedindepres
s i
on;
andshall
ow,blunted,i
ndif
ferent,r
es t
rict
ed,i
nappr opri
ateand/orlabil
einschizophrenia.Anhedoni
amay
occ
urinbothschizophreni
aanddepr essi
on.
4)THOUGHT
 Normalt hinki
ngisagoaldirec
tedfl
ow ofideas
,symbolsandass
oci
ati
onsi
niti
atedbyaprobl
em oratas
k,
charact
er i
sedbyrat
ionalconnect
ionsbetweensucces
sivei
deasort
hought
s,andleadi
ngt
owar dsar
eali
ty-
ori
entedc oncl
usi
on.
 Therefor
e,thoughtproces
sthati
snotgoal
-di
rected,ornotl
ogi
cal
,ordoesnotl
eadt
oar
eal
ist
ics
olut
iont
o
theproblem athand,i
snotconsi
derednormal.
 Tradi
ti
onal
ly,i
nthecl
ini
calexaminat
ion,t
houghti
sassess
ed( byt
hec
ont
entofs
peec
h)undert
hef
our
headi
ngsofstr
eam,f
orm,contentandposs
essi
onofthought.
 However,s
incet
hereiswi
despreaddi
sagreementregardingt
hissubdivi
sion,‘
thought
’isdi
scus
sedher
e
undert
hefoll
owingtwoheadi
ngsof‘s
tream andform’,and‘c
ontent’
.
 St
ream andf
orm oft
hought
 Forobviousreasons,t
he‘ s
tream ofthought
’over
lapswithexaminat
ionof‘
speec
h’.Spontanei
ty,
producti
vit
y,fl
ightofideas,prol
ixi
ty,pover
tyofcontentofs
peec
h,andthoughtblockshouldbe
mentionedhere.
  The‘conti
nuit
y’oft
houghtisassess
ed;Whetherthet
houghtproces
sesarerel
evanttothequesti
onsas
ked;
Anylooseningofas
s oc
iat
ions
,tangent
ial
it
y,ci
rcumst
anti
ali
ty,i
ll
ogicalt
hinki
ng,per
severat
ion,or
ver
bigerati
onisnoted.
 Cont
entoft
hought
 Anypr
eoc
cupat
ions
;
 Obs
ess
ions(
rec
urr
ent
,ir
rat
ional
,int
rus
ive,ego-
dys
toni
c,ego-
ali
eni
deas
);
 Cont
ent
sofphobi
as(
irr
ati
onalf
ear
s);
 Del
usi
ons(
fal
se,uns
hakabl
ebel
ief
s)orOver
-val
uedi
deas
;
Expl
orefordel
usi
ons/
ideasofper
sec
ution,r
eferenc
e,gr
andeur,l
ove,j
ealousy(
infidel
it
y),guil
t,nihi
lis
m,pover
ty,
somati
c(hypoc
hondr
iacal)s
ymptoms,hopeles
sness
,hel
ples
sness,wort
hless
ness,ands ui
cidalideat
ion.
Delus
ionsofcont
rol,t
houghti
nsert
ion,t
houghtwi
thdrawal
,andthoughtbroadc
ast
ingar
eSc
hnei
der
ianf
irs
t
ranksymptoms(SFRS).Thepr
esenceofneol
ogi
smsshouldberec
ordedhere.
5)PERCEPTI
ON
 Perc
ept
ioni
stheproces
sofbeingawareofas
ens
oryexper
ienc
eandbei
ngabl
etor
ecogni
zei
tby
compar
ingi
twithprevi
ousexperi
ences
.
 Per
cept
ioni
sas
ses
sedundert
hef
oll
owi
ngheadi
ngs
:
 Hal
luci
nat
ions
 Thepr
esenc
eofhal
luc
inat
ionss
houl
dbenot
ed.
 Ahall
ucinat
ionisapercepti
onexperi
encedint
heabsenc
eofanext
ernals
timul
us.Thehal
luc
inat
ionsc
an
bei
nt heaudit
ory,vi
sual,ol
fac
tor
y,gust
ator
yortac
til
edomai
ns.
 Audi
tor
yhal
luc
inat
ionsar
ecommones
ttypesofhal
luc
inat
ionsi
nnon-
organi
cps
ychi
atr
icdi
sor
der
s.
 Iti
sreall
yimpor
tantt
ocl
ari
fywhet
hert
heyar
eel
ement
ary(
onl
ysoundsar
ehear
d)orc
ompl
ex(
voi
ces
heard)
.
 Thehal luc
inationisexperiencedmuc hlikeatruepercepti
onandi ts
eemst ocomefrom anext ernal
object
ives pace(f
orexampl e,f
rom out
sidetheear si
nthec as
eofanaudi tor
yhall
ucinat
ion).Ifthe
halluci
nationdoesnotei t
herappeart obeat ruepercepti
onorc omesfrom asubj
ecti
veinternalspace(for
exampl e,i
ns i
detheper s
on’ sownheadi nthec as
eofauditoryhall
ucinati
on),t
henitisc
all
edasaps eudo-
halluc
ination.
 Its
houl dbefurt
herenqui redwhatwasheard,how manyvoi ceswereheard,inwhichpartoftheday,
maleorf emalevoices,how i
nter
pretedandwhetherthesearesecondpers
onort hirdper
son
hall
ucinati
ons(i.
e.,whetherthevoi
ceswereaddressi
ngthepat i
entorwerediscuss
inghimi nthi
rd
person);al
soenqui r
eaboutc ommand( i
mperat
ive)hall
ucinat
ions(whic
hgi vecommandst othepers
on).
 Enquir
ewhetherthehall
uci
nati
onsocc
urredduri
ngwakeful
ness,orweret
heyhypnagogic(
occurri
ng
whil
egoingt
os l
eep)and/
orhypnopompic(oc
cur
ringwhi
legett
ingupfrom s
leep)hal
luc
inat
ions.
 I
llus
ionsandmi
sint
erpret
ati
ons
 Whethervis
ual,audi
tor
y,ori
nothers
ensor
yf i
elds
;whetheroc
curi
ncl
earc
ons
cious
nes
sornot
;whet
her
anys
tepstakentocheckther
eal
it
yofdis
tort
edpercept
ions.
 Depers
onal
isat
ion/
dereal
isat
ion
 Depersonal
isat
ionandder eal
isat
ionar
eabnor
mal
it
iesi
ntheper
cept
ionofaper
son’
sreal
it
yandar
eof
ten
desc
ribedas‘as-i
f’phenomena.
 Somat
icpas
sivi
typhenomenon
 Somaticpas
sivi
tyisthepresenc
eofst
rangesensat
ionsdes
cri
bedbythepati
entasbeingimpos
edont he
bodyby‘someexternalagency’
,wi
ththepat
ientbeingapass
iver
eci
pient
.ItisoneoftheSc
hneider
’sfi
rst
ranksymptoms.
 Ot
hers
 Aut
osc
opy,abnor
malves
tibul
ars
ens
ati
ons
,sens
eofpr
esenc
eshoul
dbenot
edher
e.
6)COGNI
TION(
NEUROPSYCHI
ATRI
C)ASSESSMENT
 As
ses
smentoft
hec
ogni
ti
veorhi
gherment
alf
unc
tionsi
sani
mpor
tantpar
toft
heMSE.
 Asigni
fic
antdis
turbanc
eofc
ogni
ti
vef
unc
tionsc
ommonl
ypoi
ntst
othepr
esenc
eofanor
gani
c
ps
yc hi
atri
cdi
sorder.
 Iti
sus ualt
ous
eFols
tei
n’sminiment
als
tat
eexami
nat
ion(
MMSE)f
oras
yst
emat
icc
lini
calexami
nat
ion
ofhigherment
alf
uncti
ons.
 Cons
cious
nes
s
  Theintensi
tyofst
imulati
onneededtoar
ousethepati
entshoul
dbeindicat
edtodemonstr
atethelevelof
aler
tness,f
orexample,bycal
li
ngpati
ent
’snameinanor malvoi
ce,c
all
inginaloudvoi
ce,li
ghttouchon
thearm,vigor
ousshakingofthear
m,orpainf
ulsti
mul us
.
 Gr
adet
hel
evelofc
ons
cious
nes
s:c
ons
cious
/conf
usi
on/
somnol
enc
e/c
loudi
ng/
del
iri
um/
stupor
/coma.
 Anydi
stur
banceinthel
evelofc
onsci
ousnes
sshoul
dideal
lyber
atedonGlasgow ComaScale,wher
ea
numer
icvaluei
sgivent
othebestr
esponsei
neachofthet
hreecat
egor
ies(
eyeopening,ver
bal,motor
).
 Ori
ent
ati
on
 Whet herthepatienti
swel lori
ent
edtoti
me(testbyaski
ngtheti
me,date,day,mont h,year,s
eas on,and
thetimes penti
nhos pi
tal)
,place(
tes
tbyaski
ngt hepr
esentl
ocati
on,bui
lding,ci
ty,andc ountry)and
person(testbyaskinghisownname,andwhet herhecanident
ifypeopl
ear oundhim andt heirr ol
ein
thatsett
ing).
 Di
sor
ient
ati
oni
nti
meus
ual
lypr
ecedesdi
sor
ient
ati
oni
npl
aceandper
son.
 At
tent
ion
 I
stheat
tent
ioneas
ilyar
ous
edands
ust
ained;
 Askthepati
enttorepeatdigi
tsfor
wardsandbac
kwards(di
gitspantes
t;digi
tfor
war dandbac
kwardt
est
),
oneatatime(forexample,pati
entmaybeablet
orepeat5digi
tsfor
war dand3di gi
tsbac
kwards
).
 Star
twi t
htwo-digi
tnumber
sinc
reas
inggr
adual
lyupt
oei
ght
-di
gitnumber
sort
il
lfai
lur
eoc
cur
sont
hree
consec
utiveoc
c asi
ons.
 Concent
rat
ion
 Cant
hepat
ientc
onc
ent
rat
e;I
sheeas
ilydi
str
act
ibl
e;
 Asktosubtr
ac ts
erialsevensf
rom hundred(
100-
7tes
t),orseri
alt
hreesf
rom f
ift
y(50-3t
est),ort
oc ount
backwardsfrom 20,orenumer at
ethenamesoft
hemont hs(ordaysoft
heweek)inthereverseorder.
 Not
edownt
heans
wer
sandt
het
imet
akent
oper
for
mthet
est
s.
 Memory
a.I
mme
diat
eRe
tent
ionandRe
cal
l(I
RandR)
 Uset
hedigi
tspant
esttoass
esstheimmediat
ememor y;digi
tfor
war
dsanddi
gitbac
kwar
dss
ubt
est
s(al
so
us
edfort
esti
ngatt
enti
on;aredescr
ibedunderat
tent
ion).
b.Re
centMe
mor
y
 Askhow di
dthepatientcometotheroom/
hos
pit
al;whatheat
efordi
nnerthedaybef
oreorforbreakfas
t
thes
amemor ning.Giveanaddresst
obememorisedandaski
ttoberec
all
ed15minutesl
ateroratthe
endoft
heinter
view.
c
.Re
mot
eMe
mor
y
 Askf
orthedateandplac
eofmarri
age,nameandbirt
hdaysofchi
ldren,anyotherrel
evantquest
ions
fr
om t
heperson’
spast
.Noteanyamnesia(
ant
erogr
ade/r
etrogr
ade),orconf
abulati
on,ifpr
esent
.
 I
ntel
ligence
 I
ntel
li
genc
eist
heabi
li
tyt
othi
nkl
ogi
cal
ly,ac
trat
ional
ly,anddealef
fec
tivel
ywi
thenvi
ronment
.
 Askques t
ionsaboutgeneralinf
or mati
on,keepinginmindthepati
ent’
seducat
ionalandsocial
background,hisexper
iencesandi nter
ests
,forexample,as
kaboutthecurr
entandt hepastpri
me
minist
ersandpr esi
dentsofIndia,thecapi
talofIndi
a,andthenameofthevariousstat
es.
 Tes
tforr
eadi
ngandwr
iti
ng;Us
esi
mpl
etes
tsofc
alc
ulat
ion.
 Abs
tractt
hinki
ng
 Abs
trac
tthi
nki
ngi
schar
act
eri
sedbyt
heabi
li
tyt
o:
a.assumeament alsetvoluntar i
ly,
b.shiftvoluntari
lyf r
om oneas pectofasit
uat
iontoanother,
c.keepi nmi ndsimul taneouslythevariousas
pectsofasit
uati
on,
d.graspt heessentialsofa‘ whole’(f
orexample,s
ituat
ionorconc
ept
),and
e.tobr eaka‘whol e’intoitsparts.

 Abs
trac
tthi
nki
ngt
est
ingas
ses
sespat
ient
’sc
onc
eptf
ormat
ion.Themet
hodsus
edar
e:
a.Pr
over
bTes
ting:Themeani
ngofs
impl
epr
over
bs(
usual
lyt
hree)s
houl
dbeas
ked.
b.Si
milari
ties(
andalsot
hediffer
enc
es)bet
weenf
ami
li
arobj
ect
sshoul
dbeas
ked,s
uchas
:tabl
e/c
hai
r;
banana/or
ange;dog/
li
on;eye/
ear.
 Theans
wer
smaybeover
lyc
onc
ret
eorabs
trac
t.
 Theappr
opr
iat
enes
sofans
wer
sisj
udged.
  Conc
ret
isat
ionofr
espons
esori
nappr
opr
iat
eans
wer
smayoc
curi
nsc
hizophr
eni
a.
7)I
NSI
GHT
 I
nsi
ghti
sthedegr
eeofawar
enes
sandunder
standi
ngt
hatt
hepat
ienthasr
egar
dinghi
sil
lnes
s.
 Askthepatient
’satt
itudet
owardshispresents
tate;whet
herthereisanil
lnes
sornot;i
fyes,whi
chkind
ofil
lnes
s(physical
,psychi
atr
icorboth)
;isanytreatmentneeded;i
sther
ehopeforrecover
y;whati
sthe
causeofil
lness
.
 Dependi
ngont
hepat
ient
’sr
espons
es,i
nsi
ghtc
anbegr
adedonas
ix-
poi
nts
cal
e.
1.Compl etedeni alofill
nes s.
2.Sli
ghtawar enessofbei ngs i
c kandneedi nghel p,butdenyingi tatthesamet i
me.
3.Awar enessofbei ngs ick,buti tisatt
ribut edtoext er
nalorphys icalfac
tor s
.
4.Awar enessofbei ngs ick,duet os omet hingunknowni ns el
f.
5.Intell
ectualInsight:Awar enes sofbei ngi llandthatthesympt oms /f
ail
ur esinsoc i
aladjust
mentaredueto
ownpar ti
cularirrati
onalf eelings/thought s;yetdoesnotapplythi sknowl edgetot hecurrent/
fut
ure
exper i
ences.
6.TrueEmot ionalInsight:Itisdi f
ferentf r
om i ntel
lect
ualinsi
ghti nthattheawar enessleadstosi
gni
fic
ant
basicchangesi nt hefutur ebehavi our.
8)J
UDGEMENT
 J
udgementistheabil
it
ytoasses
sasit
uati
onc
orr
ect
lyandac
tappr
opr
iat
elywi
thi
nthats
ituat
ion.Bot
h
s
oci
alandtestjudgementar
easses
sed.
i.Soci
aljudgementisobser
vedduri
ngt
hehos
pit
als
tayanddur
ingt
hei
nter
view s
ess
ion.I
tinc
ludesan
evaluati
onof‘pers
onaljudgement
’.
ii
.Tes
tjudgementi
sasses
sedbyaski
ngthepat
ientwhathewoulddoincert
aint
estsi
tuat
ions,s
uchas‘
ahous
e
onfire’
,or‘amanlyi
ngontheroad’
,or‘
aseal
ed,st
amped,addr
essedenvel
opel
yingonas tr
eet’
.
 J
udgementi
srat
edasGood/
Int
act
/Nor
malorPoor
/Impai
red/
Abnor
mal
.

Ment
alSt
atusExami
nat
ion
1.Gener
alAppear
anc
eandBehavi
our
i.Gener alAppear ance
ii.At t
itudet owardsExami
ner
iii.Compr ehension
iv.Gai tandPos t
ur e
v.Mot orAc tivi
ty
vi .SocialManner
vi i.Rappor t

2.Speec
h
i
.RateandQuantit
y
i
i.VolumeandTone
i
ii.Fl
ow andRhyt
hm

3.MoodandAf
fec
t
4.Thought
i
.Stream andFor
m
i
i.Content

5.Per
cept
ion
6.Cogni
ti
on(
HigherMent
alFunc
tions
)
i.Cons c
ious ness
ii.Or i
ent ati
on
iii.Attention
iv.Conc entrati
on
v.Memor y
vi .Intell
igence
vi i.Abstractthinki
ng

7.I
nsi
ght
8.J
udgement