PSYCHIATRY III EVALS 10

PSYCHIATRIC INTERVIEW: MENTAL STATUS EXAM TRANS 02

Dr. Anna Josefina Vazquez-Genuino, MD, MPH, FPPA, PSCAP

OBJECTIVES
TOPIC OUTLINE
Describe in detail the parts of the psychiatric history i.e. General
Part 1: Taking the Part 2: Conducting the data, premorbid personality & function, chief complaint, history of
Psychiatric History Mental Status Exam present illness, psychiatric review of symptoms, past psychiatric &
I. General Data l. Introduction medical illnesses, family profile. The last component which is the
II. Chief Complaint II. Mental Status Exam (MSE) developmental & social history will be tackled in the next session.
III. History of Present Illness A. General Description
B. Speech I. GENERAL DATA
IV. Diagnostic Question
C. Mood The Interview usually starts with getting the General or Identifying
V. Treatment History
D. Affect Data, which in a way is the start of establishing rapport. Since you
VI. Psychiatric Review of
E. Perception are showing interest in getting to know the patient. The following
Systems
F. Thought Process should be included in the General Data:
A. Mood
G. Thought Content ● Full Name
B. Anxiety
H. Sensorium & Cognition ● Age
C. Others
l. Judgement ● Sex or Gender
VII. Past Medical
J. Impulse Control → That is not just based on his physical characteristics or legal
Illnesses and Surgeries
K. Insight papers but his own sense of being male or female, as well as
VIII. Family Profile
L. Reliability his sexual orientation.
IX.Developmental and Social
lll. Ending the Interview ● Marital Status
History
lV. Summary → Maybe described as Single or Married, Living-in with
A. Prenatal and Perinatal
common law partner, separated, or Widowed
Period
→ The details of which you may gather later when you ask
B. Infancy
about the family profile or Anamnesis
C. Toddler
▪ The Anamnesis is another term for developmental and
D. Preschooler
Social History
E. Elementary School
● # Child, Sibling Order
F. Adolescence
→ You may write for example: Eldest of five siblings, Only Girl,
G. Adulthood
or Youngest boy
● Highest Educational Attainment
📢 - Lecturer’s notes/Audio Inputs
LEGEND
● Current Occupation or Job
📖 - From Book (cite sources)
IMPORTANT TERMINOLOGIES

📝 - From Old Transes 📌

Disclaimers/Transer’s notes ● Religion
🚩 - Important 💡
- Undiscussed Sections
- Nice to Know
→ Ask if he actually practices his faith or if he is a convert from
another religion
This trans follows the flow of the online video lectures posted in Moodle. ● Handedness
→ Important especially if the patient may have a neurological
INTRODUCTION
disorder as well
The topic of psychiatric interview is divided into two parts: (1)
● Ethnic Background / Nationality
taking the psychiatric history (2) conducting the mental status
● Languages Spoken
exam.
● Birthplace, Current Residence and Living Circumstances
The presentation of slides will be according to how it should be → Living circumstances i.e. living in a dorm or with his family in
written in the psychiatric report, but it’s not necessarily the order of Biñan, Laguna
how you will conduct the interview with the patient. You have to ● Circumstances Surrounding the Consult / Admission
follow the lead of the patient, actively listening to what the patient → For Example: The patient was brought in by his coworker,
is saying. You must though now then refer back to your outline and relative or police
notes, so that you don’t miss out on any part. Thus, a psychiatric ● Number of Episodes / Consult / Admission
interview is a balance between listening to the patient and letting → First or Second
him say what he feels he needs to say or wants to say versus your ● Date, Time and Where Interview Took Place
deed to complete the data you need to gather. ● Accompanying Persons
The purpose of tackling this psychiatric interview in 3rd year is for ● Informant
you at least to be able to screen and evaluate patients later on in → i.e. the patient consulted for the first time in the outpatient
your clinical practice. Also to identify patients who may need to be department, or was admitted for the 2nd time in DLSHSI
referred to a psychiatrist. In the same way that we psychiatrist medical center on Aug. 7, 2021. The patient was interviewed
conduct the exam so as to know when patients need to be referred at the emergency room and the informant was his mother.
to an internist or neurologist. The source of information gathered should also be stated.

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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
II. CHIEF COMPLAINT
● Start by asking what prompted this consult today and who may
have suggested the need for consult.
● These are usually written in Verbatim or Quotation marks
from Patient & Companions.
A. PREMORBID PERSONALITY
. you might discover possible psychosocial stressors which the
● You may ask the patient himself or his companion.
● Personality may be described as Pervasive, Motivations,
Emotions, Interpersonal Styles, Attitude & Traits
● The dark characteristic and consistently observed in a patient
● You may start by asking the patient “How would you describe
yourself?”
● To get another perspective, ask the companion “Would you
describe what kind of person the patient is?”
● The Premorbid Personality may be described as:
→ Kind, Generous, Pleasant, Helpful, Mean or Selfish for
Motivations.
→ Sullen, irritable, Cheerful, or Calm for Emotional State.
→ Friendly, Distant, prefers being alone, Shy, Attention seeker,
Dominant or Submissive for Interpersonal Styles.
→ Perfectionist, Critical, Tolerant, Industrious, or Lazy for
Attitude & Traits.
B. LEVEL OF FUNCTIONING
● Explored in terms of social relationships as well as in terms of
Work or School capability
● You may ask about the following:
→ Is the patient able to complete tasks or responsibilities as a
student?
→ Meet job expectations and deadlines at work?
→ Aside from asking how the patient gets along with his
supervisors, superiors, boss, colleagues, or coworkers and
subordinates at work?
→ And if he is a student, how does he get along with his
teachers and classmates?
III. HISTORY OF PRESENT ILLNESS
● ANSWERS: WHY NOW?
● Elicit entire Hx of Patient’s 1ry Illness in Chronological Narrative
of Symptoms from its onset to the present
● 📢 The History of Present Illness is a chronological description
of the evolution of the symptoms from the very beginning of the
problem up to the most recent episode
● What changes have occurred since the onset of symptoms till
now? In terms of the patient’s ability to work/study? In terms of
his interpersonal relationships, behavior, and physical health?
● When gathering the HPI, the STARTING POINT is from the
CHIEF COMPLAINT OF THE PATIENT or from the PATIENT’S
RELATIVE/COMPANION’S PERSPECTIVE
● 📢For example, if the reason for consult was due to feeling sad,
the next question would be
→ “When did the patient first experience this problem?
→ “How old was he when you first experienced these
symptoms?”
● It is important to explore what were the possible
PSYCHOSOCIAL STRESSORS that may have triggered his
symptoms by asking
→ “What was going on in your life at that time?
9A, 9B
→ “What could be some of the triggering events that happened
before you start feeling this way?”
● 📢 Sometimes the patient and his family are unable to identify
any stressors when asking directly about them but if you go in a
roundabout way and ask what was going on in his life a few
weeks before or a few months before the onset of symptoms,
patient and his family did not realize were connected to the chief
complaint.
● Identifying the context in which the presenting problem first
arose can help in understanding the etiology of the psychiatric
problem.
● Psychosocial stressors may include situations at home, at work,
or at school. They may include legal issues, medical
comorbidities, interpersonal difficulties as well as illness in the
family or even possibly traumatic events that happen in their
neighborhood
● Any change no matter how trivial may be a stressor for the
patient
● It is possible that the triggers or stressors may not be always
evident or uncovered during the first encounter with the patient.
● The history of present illness when written in a psychiatric report
should ALWAYS BEGIN WITH A PSYCHOSOCIAL
STRESSOR and not the onset of symptoms or behavioral
changes as we always assumed there must have been a
reason for the psychiatric problem and the psychiatric problem
does not occur randomly or out of the blue.
● After starting the history from the very first time the patient
experiences his symptoms, you then have to ask for all the
subsequent episodes.
● Taking note that the patient’s age, the possible triggers of each
episode and the whole life context or situation surrounding each
episode
→ “Since then how many episodes have you had?”
→ “When was the last episode?”
● Make sure you take note of what symptom started and when
they started, how long does the patient experience these
symptoms, and perhaps how did the symptoms end
● Also, how intense or severe and to what degree was their
functioning affected by these symptoms
● It is important to take note of factors that alleviate or exacerbate
these symptoms such as medications, support from family or
friends, coping skills of the patient themselves, the time of day,
season, or even anniversary dates
→ “What events may have triggered the previous episodes?”
→ “What may have caused your problems to get worse?”
● Aside from the chief complaint, what were the other symptom
experience:
→ “Do they get worse? If so, how bad was it?“
→ “How did it affect the patient's ability to work or study?“
→ “How did it affect his relationship with others?“
→ “How did the patient cope with the situation or condition?“
→ “How did the family deal with the patient's symptoms?“
→ “What has helped the patient or his family cope or deal with
the behavioral or mood changes?“
● Until eventually we come to the current episode, so “Now let’s
talk about this current episode,
→ “When did it start?”
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ “How long have these symptoms been present?“
→ “Have there been any fluctuations in the nature or severity of
these symptoms?“
● Ask about the preceding few weeks
→ “What were some of the life changes you’ve had to deal with
in the past few weeks, in the past few months, before the
symptoms started?”
→ “How has this affected you & your family?”
→ “How different was this episode?“
→ “Has it gotten worse or just remains the same with those
previous episodes?“
● Finally, find out what pushes the family to eventually seek
consult today
→ “What eventually made you decide to seek consult today?”
● Because ultimately the HPI should answer the question, why did
the patient and his family decide to see a doctor or psychiatrist
at this point in time
● The HPI describe the progression of how the
symptoms/mood/behavioral changes have worsened through
time up to the point where it affected the patient's ability to cope
that is probably has caused a deterioration in the patient level of
social and work/school functioning
● Sometimes though, the answer to why now did the patient seek
consult may be for practical or economic reasons like it is only
now they have the budget for it or it is only now that they find
out that they have psychiatric services in the area
● Before you end this part of the history taking, make sure you
ask
→ “What are your expectations from this psychiatric consult?”“
▪ This will aid you in focusing on addressing the patient
concern
IV. DIAGNOSTIC QUESTIONS
● IMPACT ON PATIENT: LEVEL OF FUNCTION RE. LOVE,
WORK, FUN VS PRE-MORBID
→ Since the HPI should help you diagnose the patient, you
need to review quickly what you have gathered as far and
see if you have enough basis to arrive at a psychiatric
diagnosis
→ If not then perhaps you need to ask for more symptoms or
other symptoms based on the DSM-5 criteria depending on
what your current diagnostic impression is at this point
V. TREATMENT HISTORY
📢 All
.
● throughout the episodes, be sure to get a thorough
treatment history to determine what MEDICATIONS or
THERAPIES have worked, and which did not.
● 📢Ask about previous consultations:
→ “With whom?”, “What medications were prescribed and
taken? And if taken, taken religiously or irregularly?”, “What
was the dosage?”, “For how long were they taken?”, “Any
side effects noted?”
→ It is good to know if a patient has had adverse effects with
certain medications, so is that to make the mistake of
prescribing them again.
→ “What were the beneficial effects observed by the patient or
his family?”, “Were they effective? Or not?”, “What relieved
or worsen his symptoms?”, “What other therapies like
electroconvulsive therapy or other psychotherapy that the
9A, 9B
patient has undergone and how long were they continued?”,
“Were they helpful?”, “In what way?”, “For how long were
they continued or not continued?”
● 📢 Ask about any EMERGENCY CONSULTS or
HOSPITALIZATIONS or if they have seen an ALBULARYO OR
TRADITIONAL HEALER, PRIEST OR PSYCHOLOGIST for
their problem and the outcome of each. If the dosage was
inadequate or the patient was non-compliant to the treatment
plan or follow-up schedules, you need to ask the reasons for
these, so that these issues can already be discussed even if
this is just an evaluative assessment. In this way we can hope
to eliminate the misconceptions or dissolve the resistance
regarding taking psychotropic medications or undergoing any
psychiatric treatment.
VI. PSYCHIATRIC REVIEW OF SYSTEMS
📢 Similar to the REVIEW OF SYSTEMS.
.
●
● 📢 After taking the history of illness, we need to ask for
symptoms or other psychiatric disorders so as to not miss out
other comorbidities, thus, the need to know the symptoms of all
other psychiatric illnesses or disorders so as to rule in or rule
out psychiatric disorders accordingly.
● 📢These are divided into 4 CATEGORIES:
→ MOOD
▪ Major Depression/Dysthymia; Manic/ Hypomanic
→ PSYCHOSIS
▪ Psychotic
→ ANXIETY
▪ Generalized anxiety, panic, phobias, post- traumatic
stress disorder, obsessive compulsive disorder
→ OTHERS
▪ Impulse control (ex. trichotillomania), kleptomania,
attention deficit and hyperactivity disorder, eating disorder,
dissociative disorder, somatoform, hypochondriasis, body
dysmorphic disorder, dementia
● 📢Do realize though, that if a patient is already consulting for a
MOOD DISORDER for example, then all symptomatology or
associated issues and factors regarding his MOOD should
already be included in the HISTORY OF PRESENT ILLNESS
and no longer in the PROS.
A. MOOD
● 📢 Ask about MANIA or DEPRESSION
● 📢 For MAJOR DEPRESSIVE DISORDERS (MDD) specifically,
we can use the acronym SIGECAPS to facilitate remembering
what to ask.
● DIGFLAST on the other hand can be asked for screening for
MANIA
● SIGECAPS (MDD):
→ S: Sleep, I: Interest, G: Guilt, E: Energy, C:
Concentration, A: Appetite, P: Psychomotor, A: Agitation
or Slowing, S: Suicidality
→ Aside from asking if either he/she feels sad or tearful
● DIGFLAST (MANIA):
→ D: Distractibility & Easily Frustrated
→ I: Irresponsibility & Erratic Uninhibited Behavior
▪ For example:
− Going on shopping spree
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
− Spending money needlessly beyond one’s economic
needs
→ G: Grandiosity
→ F: Flight of Ideas
→ L: Libido Increased
▪ For example:
− Sexual promiscuity
− Engaging in intimate relationships that will eventually
hurt the person emotionally
→ A: Activity increased and Weight loss
▪ Due to excessive energy
→ S: Sleeplessness
→ T: Talkativeness and Racing Thoughts
● 📢In connection to DEPRESSION, we also need to explore the
risk of suicide.
→ Ask the following questions to screen for suicidal risk:
▪ Have you ever considered hurting yourself or wanting to
kill yourself?
▪ What happened during that time in your life that led you to
feel that way or think of hurting yourself?
▪ Did you act on your feelings or thoughts? o How did you
act when you tried to hurt yourself?
▪ Did you seek consultation?
▪ With whom did you seek consultation?
▪ Were you brought to the emergency room or admitted to
the hospital?
▪ What treatment was given?
▪ For how long were you admitted? And how are you after
that?
B. ANXIETY
● 📢 For anxiety, we can ask the patient:
→ “Do you worry a lot about everything and anything?”
→ “Are you often tense, irritable, restless or feel tired most of
the time?”
→ “Do you have difficulty concentrating when you are reading
newspapers or books?”
→ “Do you suddenly feel nervous to the point where you're
rattled and overwhelmed but you don't know what to do?”
→ “Do you ever feel your heart racing, beating loudly with or
without shortness of breath? Do you ever have difficulty
swallowing? When you experience these physical symptoms
do you think you're going to have a heart attack that you are
dying?”
→ “Do you experience any nightmares?”
→ “Are you easily startled or afraid of certain people or
animals?”
→ “Are there situations like the dark or heights, riding cars,
elevators or planes, speaking in front of many people or just
being in a crowd? Do these frighten you?”
→ “How do you feel when you are eating alone in a restaurant
full of people or have to call out your stop while riding a
jeepney or a bus? Do you feel nervous in these situations?”
C. OTHERS
● 📢 For the OTHERS category, I will mention the commonly
diagnosed conditions
9A, 9B
OBSESSIVE COMPULSIVE DISORDER
● 📢 Here are some questions you can ask to screen for this
disorder:
→ “Do you repeatedly do certain things like washing hands,
double checking if you have unplugged the appliances or
locked the door, even to the point of being late at school or
work or appointments because you spend so much time
repeating your rituals?”
→ “Do you get upset when things are not in the right place or
books aligned on a shelf?”
→ “Are you meticulously careful in cleaning or bathing?”
→ “Do you have any disturbing or unacceptable thoughts or
images that keep coming into your mind yet, you can't stop
them, even if you want to and do try to stop?
PSYCHOSIS
● 📢 To explore the possibility of PSYCHOSIS, take note of
following symptoms:
→ HALLUCINATIONS
→ DELUSIONS OF PERSECUTION
→ Includes the suspicion of anybody doing the ff:
▪ Thinks that someone is harming the patient/ patient’s
family in any way
▪ Thinks that someone is intending to destroy patient’s
name and/or reputation
▪ Thinks that someone is monitoring/recording patient’s
activities with a hidden mic/camera
▪ Thinks that people are talking behind patient’s back
▪ Thinks FB post or news on TV are referred to the patient
directly
▪ Thinks that he/she experienced his/her thoughts being
broadcasted on social media or on the radio
▪ Thinks that he/she feels that other people can hear his/her
thoughts
VIOLENT BEHAVIORS
● 📢 With regards VIOLENT BEHAVIOR, we can ask the patient
or the companion if:
→ Patient has ever thought, attempted, or actually hurt anyone.
▪ “What triggered such feelings and actions?”
→ Describe what exactly happened during the violent outburst.
▪ “Was the patient brought for consultation? To whom?”
▪ “What were the interventions implemented? Did they
work?”
→ Then referring to the present time, ask if the patient still
thinks of hurting others at this time.
→ “What might have triggered these feelings and thoughts
now?”
SUBSTANCE ABUSE
● 📢 For screening for SUBSTANCE ABUSE, you need to be
thorough and non-judgemental so as to make the patient
comfortable enough to become honest about his/her habit.
● 📢Ask similar questions for each of the following substances:
→ NICOTINE or CIGARETTES, CAFFEINE or COFFEE,
ALCOHOLIC BEVERAGES, and ILLICIT DRUGS like
SHABU (methamphetamine), COCAINE, ECSTASY,
RUGBY, MARIJUANA, VALIUM and OTHER
BENZODIAZEPINES or SLEEPING TABLETS, or even
OTHER PRESCRIPTION DRUGS.
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ 📢For starters you can casually ask
▪ “Have you taken Marijuana?”
▪ “Do you drink beer or other alcoholic beverages? Daily?
Weekly?” If yes, you can proceed to ask more about the
kind of substances being used.
− “What route of use?”
− “Frequency and amount?”
− “In what context?”
− “Alone? or with friends?”
− “At what age did you start taking these substances?”
− “How did you get started?”
− “How would you take this and with whom?”
− “How much would you take and how often?”
− “Have you ever gotten drunk or high? How did you feel
or act then?
− “Did you get into any trouble or quarrel or accident
when you drank a lot of alcoholic beverages or were
high on drugs?
− “What did you like about smoking? Drinking? Taking
these substances?”
● 📢 There is a need to check for TOLERANCE and
WITHDRAWAL SYMPTOMS, as well as its impact on a
person’s life, in terms of relationships and ability to work by
asking:
→ “Did you need to take more and more of the substance to get
the same pleasurable feeling or high?”
→ “Did you want to continue taking it? Until when?”
→ “In what way do you think it has affected you? Has it affected
your physical health? Your mood or ability to concentrate?
What does your family say?”
→ “Have you ever tried to stop taking these substances? How
are you able to tolerate not taking these substances? How
did you feel when you stopped taking these substances?”
→ “Do you crave these substances? Are you able to resist
these cravings?”
→ “Did the use of these substances affect your ability to study,
work or accomplish your tasks and responsibilities?”
→ “How did your use of these substances affect your
relationships at home or at work?”
→ “How did you get your supply of these substances? Have
you had to sell things so you could continue taking these
substances? Whose things did you sell”
→ “Were you ever brought to the emergency room or admitted
to the hospital for your substance abuse?”
→ “Have you ever joined any support or self-help groups for
alcoholics or drug users, like alcoholics anonymous or
narcotics anonymous? How did you like the sessions? Did it
help lessen your use or urge to take alcoholic beverages or
other substances?”
→ “Have you or your family ever considered letting you enter a
rehabilitation program?”
● Sometimes, there may be a need to ask another family member
regarding the patient’s use of alcohol or illicit substances.
SCREENING FOR ALCOHOL ABUSE
● There is a short screening questionnaire to identify alcohol
abuse known as CAGE, which consists of 4 questions:
→ Have you ever CUT down on your drinking?
→ Have people ANNOYED you by criticizing your drinking?
9A, 9B
→ Have you ever felt bad or GUILTY about your drinking?
→ Have you ever had a drink first thing in the morning as an
EYE-OPENER to steady your nerves or get rid of a
hangover?
OTHER ADDICTIONS
● 📢 Aside from substance use, there are also other addictions
that you may have to explore, such as, GAMBLING or
GAMING, that is spending hours or the whole day just engaging
in such activities to the point of skipping school, failing to meet
obligations, stealing or selling possessions just to stay in that
habit.
● Also inquire into other addictions, like OVEREATING, SEXUAL
PROMISCUITY and PORNOGRAPHY on the internet or
otherwise, SHOPPING or INTERNET USE as these can all
become problems if it begins to adversely affect relationships
and ability to keep up with schoolwork or work requirements and
responsibilities.
SOMATOFORM DISORDERS
● 📢 For which we ask:
→ “Have you ever consulted for physical symptoms but doctors
would say they couldn’t find anything wrong, despite a
thorough physical exam and a lot of laboratory work-ups?”
→ “What were these symptoms? Do you think there was
something wrong with you physically or do you think there IS
something wrong with you physically?”
DEMENTIA
● Commonly seen in the elderly; though there is also early onset
dementia, thus the need to ask adult patients or their
companions about the patient:
→ Forgetting what he was supposed to do or going to the
kitchen for example, but not remembering what he was
supposed to get from there, forgetting where they place
things, or that they get disoriented, like forgetting the date
today, names of familiar people, even those at home or
where he is.
● 📢In general, for all these signs and symptoms, we need to ask
the onset, course, duration, severity, frequency or
recurrence as well as consultations, medications taken, and
hospitalization
● You may also ask about previous diagnoses given by other
doctors, you need not assume that this is true, nor do you need
to agree with the diagnosis. You have to come up with your own
diagnosis based on the psychiatric history and mental status
exam that you have taken
IMPULSIVE-CONTROL DISORDERS
● We ask:
→ “Have you ever had uncontrollable urges like playing with
fire, taking things that don’t belong to you, shoplifting, or
“nangungupit sa magulang (”swindle money from your
parents’ wallet”) or “binubunot ang buhok hanggang
magkaroon ng bald spot” (pulling your hair until it leaves a
bald spot)”
ADHD (Attention Deficit and Hyperactivity Disorder)
● Inquire about the following symptoms that should have started
in childhood:
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ “Do you recall being more active and full of energy compared
to other children?”
→ “Did your teachers complain that you were talkative or would
walk around the room during class and disrupt class?”
→ “Did you often leave the classroom for whatever reason and
you couldn’t sit still?”
→ “Did you often lose things and couldn’t recall where you
placed them?”
→ “Did you often catch yourself daydreaming in class?”
→ “And now that you're older, do you have difficulty sustaining
relationships or keeping a job?”
→ “Do you easily get bored and often feel impatient or
restless?”
EATING DISORDERS
● You can ask:
→ “Were you ever unhappy with your figure or felt you were too
fat? What did you do about it? Did you go on a diet, exercise
a lot, or take medications to help you lose weight?”
→ “Did you eat a lot when you were stressed or feeling down?”
→ “Did you feel guilty about eating too much? What did you do
after overeating?”
VII. PAST MEDICAL ILLNESS AND SURGERIES
● MIDRAS
→ Medications (name and dose of prescription drug)
→ Medical/Psychiatric Illness
→ Primary care Doctor
→ Medical Review of systems
▪ Many physical or medical illnesses may either cause
psychiatric problems or exist along with psychiatric d/o
▪ always deal with the whole human rather than
compartmentalize their health issues
▪ OB-Gyne: Pregnancy, feelings about having children or
not wanting children, use of birth control, spontaneous or
induced abortions, and sexually transmitted diseases.
→ Allergies
→ Surgeries
VIII. FAMILY PROFILE
→ You may gather from the patient and a family member
● Entails gathering:
→ Medical and psychiatric illnesses
→ Addiction to substances
→ Gambling or internet use among family members
▪ Parents, siblings, grandparents, aunts, uncles, first
cousins on maternal and paternal side, and children of the
patient
A. FAMILY HX - MEDICAL
● Diagnosis, treatment, hospitalization
B. FAMILY HX - PSYCHIATRIC
● Family Hx: PSYCHIATRIC illness, Addiction
→ “Has any blood relative ever had nervousness, nervous
breakdown, depression, mania, psychosis or schizophrenia,
alcohol or drug abuse, suicide attempts or hospitalization for
nervousness?”
→ Any psychiatric illness in the Family? Substance use?
Addiction to Gambling or Gaming>
→ Suicde or Violent behavior in the family?
9A, 9B
C. FAMILY MEMBERS
● List and Describe Family Members
→ Identifying data, personalities, roles, vices of all family
members
→ Relations and interactions with each other
→ Reaction, attitude, and insight to patient’s illness
→ All members of the family
▪ Family of origin, where the patient came from
▪ Siblings - half siblings, step siblings
▪ Progeny - spouse, children
▪ Grandparents and grandchildren, other relatives who live
with the patient and have grown up with
▪ Others who play a significant part of the patient’s life
→ Name, age, gender, marital status, highest education
attainment, current occupation, religion, role in the family
→ Ask the patient to describe members of the family can reveal
how the patient feels toward them and hint to what kind of
relationship they have with that family member
→ Describing the relationship
▪ each family member with the patient, as well as with other
family members helps understanding the family dynamics
that helps contribute to the patient’s condition and
situation
▪ gathered from the patient or a family member
▪ “Can you tell me about your family?”
▪ “How did your parents get along?”
▪ “How did you get along with your parents? Siblings?”
▪ “How did your parents discipline you and your siblings?”
▪ “Who were you closest to while growing up?”
▪ “Were there other important adults in your home?”
D. FAMILY TIMELINE
● Family Timeline
→ Patient from birth to the present time
→ The persons who lived with the patient
→ Family life situation
→ Changes from birth up to NOW
▪ parents separation, siblings leaving, residential moves,
births/separations/divorce/deaths of family members
E. GENOGRAM
● Genogram
→ Provide the following info:
▪ Age
▪ Sex
▪ Sibling order
▪ Family Medical History
▪ Family Psychiatric History
▪ Relational Dynamics
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
Figure 1. Genogram
Age written inside box or circle; Circle is female, square is male; Can
include up to the third generation, indicating marriages and their children;
Enclosed circle of group indicates living together; Arrow indicates identified
patient who consulted; Crossbar indicates separation or estrangement of
spouses
IX. DEVELOPMENTAL AND SOCIAL HISTORY
● This entails the gathering of developmental milestones from
birth to the present age.
● For those who are 18 years old and above, we need to explore
further the various areas for their lives such as the following:
→ Religion → Educational
→ Social → Occupational
→ Marital and relationship → Legal
history → Military history
→ Sexual → Current living situation
● The learning objective is to describe the parts of the
developmental & social history in detail
● Purpose of taking the developmental & social history
(anamnesis)
→ Get to know patient as person vs diagnosis
→ Approach diagnosis of personality disorder
● This can be asked from the patient if they are logical and calm
enough to describe their life history or from a relative preferably
an older one especially when asking regarding the prenatal,
perinatal, infancy, and toddler period.
→ Most likely the patient will not remember this part of his life,
he may though have heard stories from parents and
grand-parents about his early years.
→ If our only informat is the patient we can still ask what does
he know about certain circumstances surrounding his birth
and if anyone has told him how he was as a baby or toddler.
→ Usually, we forget all that has happened to us before we
were 3 or 4 years old. That is there is a massive repression
of all our memories before 3 or 4 years old.
● We can also start the developmental history from the patients’
earliest memory depending on what we can gather from the
patient himself.
A. PRENATAL & PERINATAL
● Because the prenatal and perinatal period already has an
influence on the child's psychological development as well as
an impact on the mother and child relationship it is important to
note the events that happened during this period in one's life.
9A, 9B
● It is best to gather this information from a parent, older sibling,
or relative.
● We need to ask how was the marital relationship of the patient's
parents around the time that the patient was born.
→ Did they want to have a child then? were they ready to have
a baby at that time?
→ Did the mother consider and actually attempt to abort the
child while in her womb?
→ How did the mother feel about being pregnant?
▪ Was she sad, happy, distressed?
▪ Was she working?
→ What was the family situation just before and when the
patient was born,
→ Did the mother smoke, take coffee or alcoholic beverages or
illicit drugs? or any medications during the prenatal period.
→ How was the pregnancy?
▪ Were there difficulties of complications during pregnancy
or after the delivery?
▪ Did the mother get sick during the pregnancy or after
giving birth?
▪ Was it a normal delivery or was it a cesarean section?
What was the indication for the cesarean section?
→ How was the mother after giving birth?
→ How was the patient?
B. INFANCY (BIRTH - 1 ½ years)
● In gathering the developmental history it is important to review
the normal developmental milestones of children from birth
onwards and describe accordingly at each stage if the patient
was able to achieve the specific milestones or not.
● Don't just put that he has achieved normal development but
give specific capabilities at each age and if at par or behind
compared to peers or siblings at that age
● For the infancy period from birth to 1 ½ years old, we need to
explore the following
→ Was the patient breast or bottle fed?
→ Who took care of the patient when he was newly born?
→ How was his sleep?
→ Were there any problems noted with feeding or sleeping?
→ Did he have any illnesses or hospitalization?
→ DId mother notice any head bangging, body rocking, or
inconsolable crying?
→ Was the infant responsive to faces or sounds?
→ Was he difficult to care for as an infant?
C. TODDLER (1 ½ - 3 years)
● As a toddler from 1 ½ to 3 years of age, we again ask for
changes regarding feeding and sleeping arrangements,
mother-child interactions
● Since this is the anal stage, we also ask at what age did patient
learn to go to the bathroom to urinate or defecate
→ How did the parent toilet train the patient?
▪ Was he spanked for soiling underwear or wetting his bed?
▪ When did he stop wetting the bed?
→ How was he disciplined?
▪ Did parents have the same dos and don'ts?
▪ Was he spanked? and for what reasons?
● You need to ask about the expected developmental milestones
for this age
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ That is gross and fine motor development
→ In terms of language development we ask about
comprehensive language that is could the patient understand
and follow simple commands like
▪ Get your shoes
▪ Put your glass on the table
→ For expressive language
▪ At what age did the patient say his first word?
▪ What was his first word?
→ Regarding self care skills
▪ What could the patient perform at this age?
▪ Could he feed himself, wash his hands, or undress
himself?
→ Was there any separation anxiety, fears of any kind, or
tantrums?
→ How did parents handle such behaviors?
→ What was the patient's personality and behaviour during
these toddler years?
▪ Was he easily frustrated?
▪ Was he more hyperactive compared to other children?
▪ Did he go to any daycare or nursery school?
▪ How did he fair?
→ Could parents leave him alone in school?
▪ If not, how did they handle this?
D. PRESCHOOL (3-6 YEARS)
● At this age, the preschooler can now recall some details
→ So we can ask the patient of his earliest memory which
would be probably at this stage.
→ You can also ask the parent or older siblings to describe the
patient during his preschool years
● Feeding & Sleeping
→ We ask about nightmares or sleepwalking
→ Any feeding or eating difficulties?
→ Was he able to use a spoon? Fork and a knife when eating?
● Developmental Milestones: 3 R’s, Self-Care
→ Could he do the following on his own?
▪ Brushing of teeth?
▪ Dressing up?
▪ Putting on socks and shoes?
▪ Putting toys back or fixing his bed upon waking up?
→ Some children by 5 or 6 years old can answer the phone or
memorize cell phone numbers of their parents.
▪ They can also call up their parents’ office and ask to
speak to their parents.
● Discipline:
→ How was he disciplined at this point?
→ For what reasons he was scolded?
→ How did the patient react to being scolded or punished?
What does he remember about this?
● Behavior: Bed Wet? Soil? Fears? Set fire? Cruelty to Animals?
Masturbation? Play? Gender Role?
→ Did he have any fears at this point in his life? Was he afraid
of the dark? Dogs? Spiders? Being alone? Thunder? Band
playing?
→ Does he recall masturbating or his parents catching him
doing this at home or in school? How did his parents or
teacher react when they saw him?
9A, 9B
→ Was the patient aggressive towards animals or other
children?
→ Was he still bed wetting? Soiling his pants? How did the
parents manage such behaviors?
→ If he went to preschool, how was he? Was he willing to be
left alone in school? How did he get along with the other
children? Was he attentive? Did he enjoy school?
→ When did he learn how to read and write?
→ With what kind of toys did he prefer to play? How would he
play with these toys?
● Personality: Cooperative, Talkative, Participative, Aggressive,
Friendships
→ Ask the patient or a relative to describe the patient’s
personality or what kind of child he was at that time.
E. ELEMENTARY SCHOOL (6-21)
● Cognitive & Motor Development: Learning interests, Difficulties/
Disability, Academic Performance
→ How did he do with academics or extracurricular activities?
As well as his relationships with people in school and at
home?
→ Did he have any difficulties with reading, writing or math?
→ What were his other interests and hobbies?
→ Did he like or enjoy school? What did he like or not like about
school?
→ How did he feel about his academic performance? How
would he describe himself as a student compared to his
classmates or siblings?
● Relationships & Role:
→ What did parents say about his grades?
→ Were they strict with him about his studies?
→ Did he feel any pressure about his studies? From whom? His
father? His mother?
→ How was his mood and behavior this time?
→ Were there any behavioral problems noted such as skipping
school, running away, stealing, lying, or hurting classmates
or siblings, pulling hair or being very meticulous and orderly?
● Emotions: Depression, Anxiety, Inferior, Angry
→ Was this a happy time for him or not? What made it so?
→ Did he feel scared or anxious about anything then?
● Behavior: Truancy, Running Away, Cheating, Stealing, Lying,
Hurting, Hair Pulling, Obsessive-Compulsive, Bullying/Bullied
→ Will there any be behavioral problems such as skipping
class, running away, lying, stealing, cheating in class or
exams
→ Did he get into fights? With whom?
→ Did he experience any sibling rivalry
→ Did he ever get into trouble? At home or in school? For what
reasons?
→ What did parents or teachers do about him for his behavior?
→ Was he bullied? Or did he bully or tease others?
→ Was he very meticulous and orderly?
→ Did he have any repetitive behavior? such as washing of
hands, checking and double checking, pulling hair, or biting
his nails?
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
F. ADOLESCENCE (12-21)
● Cognitive & Motor Development: Intellectual Pursuits? Sports?
Hobbies?
→ Ask about academic performance in reference to parental
expectation
→ Were there any difficulties in understanding or concentrating
with studies?
→ What were his extracurricular activities?
→ Other interests and hobbies?
→ How did he compare himself with his siblings or classmates?
→ Was he popular?
→ Was he a leader or a follower?
→ Did he ever get into any trouble in school? Or in the
community?
● Social History: Academic? Interests? Extracurricular?
Popularity? Leader/Follower? Learning Difficulties? Disciplinary
Problems? Absences?
● Relationships: Family? Friendships? Gang?
Homosexual/Heterosexual Interests, Crushes, Dating, Going
Steady, Mutual Understanding
→ With regard to peer relationships, did he have few or many
friends?
→ Did he join any gang or fraternity?
● Sexuality: Onset of Puberty, Sex Identity & Orientation?
Masturbate? Fantasies? Pre marital Sex, Promiscuity, Parental
Attitude?
→ We ask about onset of physical changes that is
→ secondary sexual characteristics expected of this age and
→ his reaction to the development of such How did he feel
about his body?
→ Did he like his figure or himself?
→ What did he consider his assets or flaws?
● In terms of physical looks, as well about his personality self
→ How did he view his sexual identity or gender?
→ Was the patient attacted to the same or opposite sex?
→ Did he go on dates? Did he have a girlfriend or boyfriend?
How many romantic relationships did he have as a
teenager?
→ Did he engage in premarital sex? Masturbate, how often?
Did he have any feelings of guilt?
→ Did you use any birth control methods?
→ If so, what were his usual fantasies?
→ What were his parents/families attitude towards sex? and his
sexuality or sexual activities?
● Personality: Shy, Odd, Inferiority Complex? Mood? Temper?
Self-Esteem, Body Image
● Behavior: Sleep, Eating, Smoke, Addictions, Gamble,
Misconduct, Delinquency, Run Away, Suicide/Homicide
→ What was he during his adolescent years?
→ How did he feel most of the time?
→ Was he happy? Sad? Angry? or Anxious?
→ Did he ever feel depressed?
→ Did he ever think of or try to hurt himself or others?
→ Did he smoke?
→ Drink coffee?
→ Take alcoholic beverages?
9A, 9B
→ Did he ever try any illicit drugs? How did he get started on
these? Who introduced him to such substances? How often
and how much would he take? How did he get his supply?
▪ What was the effect on him?
▪ Did he like the effect on him? or not?
→ Did he skip class? run away? or gamble?
Factors Indicative of Future Psychiatric Illness
● During Childhood/Adolescence the following factors are
indicative of strong possibility of psychiatric illness in later life
and thus the need for anticipatory care and parental awareness
→ Loss of a parent at an early age
→ Excessive Separation Anxiety
→ Problems in appetite & sleep
→ Problems in making & keeping friends
→ Severe shyness
→ Bullied/Bullying
→ Problems with temper
→ Disciplinary problems at home and in school
→ School absences for medical/ other problem
→ Delays in learning to read, write, do math
→ Problems in paying attention, finishing school work or
completing homework, Failure in school work, Completing
homework, Failure in school
G. ADULTHOOD (≥ 21 YEARS)
● Ask about Function:
→ Work, Occupation, Income
→ Role in Society
→ How is he doing at work?
→ Any praises or complaints about his ability to do his job?
→ How is his relationship with colleagues, bosses,
subordinates?
→ Is he content with his achievements and economic status?
→ If still in college, ask about academic performance and
relationships with teachers and classmates.
→ What is he taking up?
→ Does he or did he like his college course? Why or why not?
● Regarding Love and Relationships:
→ Ability to relate, depth of friendships and commitment, ability
to love and establish exclusive and lasting intimate
relationships
→ Is he involved with anyone right now? How long has the
relationship been going on?
→ How serious are they?
→ Do they get along?
→ What does he like about her/ him?
● Depending on the patient's age, recall the developmental
issues of early, middle, and late adulthood based on
Sigmund Freud and Erik Erikson’s Theory and inquire about
them accordingly.
→ Example: If the patient is in middle adulthood, that is 40
years old above, ask about the following:
▪ Were there any regrets about life?
▪ Did he ever think of ending his life?
▪ Does he feel satisfied and fulfilled with self and his
accomplishments?
▪ Are there any other current issues that are disturbing and
causing him to be anxious, worried, or depressed?
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
▪ How is he dealing with his problems? How is he coping?
▪ Is it affecting his ability to continue with work obligations
and maintain stimulation with people around him?
IX. SOCIAL HISTORY
. → Areas of agreement or disagreement?
● Although adulthood supposedly starts at 21 years of age, this
other half of the anamnesis otherwise now known as Social
History should include questions for those ≥ 18 years old (late
adolescence)
● The 18-21 years is the transitional period between adolescence
and adulthood and in some countries, an 18 year old is already
considered a young adult.
● For those ≥ 18 years old, the succeeding life areas should be
included in their Social History:
H. RELIGION
T/N: Tagged as H since this is still part of the developmental and social history.
Social history only applies for those 18 years old and above.
● Family background, attitude toward religion, practice of faith,
opinion regarding illness, suicide and psychiatry
● How does religion affect your life?
● Aside from knowing the patient's religion, the crux of the matter
would be whether he really believes in God and if he actually
practices or adheres to his chosen religious faith if any.
● Does his religion play a part in how he lives his daily life?
● If the patient doesn’t believe in God, ask what led him to this
point in his life?
● What are the religious beliefs of his family members and if
different from his own, has it led to any argument or quarrel?
● What does his religion think of mental illness, suicide and
psychiatry?
I. SOCIAL ACTIVITY
● Nature of Friendships
→ Quality, depth, duration, shared interests, same or opposite
sex, isolated? anxieties?
● We ask whether the patient has friends and the quality of these
friendships.
● What are their shared interests, what do they enjoy doing
together?
● Do any of his friends smoke, drink alcoholic beverages? Does
he engage in the same activities?
● How do friends react if he joins them or not?
J. MARITAL AND RELATIONSHIP HISTORY
● Refers to significant, romantic or intimate relationships either
with the same/ opposite sex.
● When did the patient have his first boyfriend or girlfriend?
● What did he like/ dislike about her / him? What attracted him to
her/ him?
● How long did the relationship last? What precipitated the break
up?
● The same questions should be asked for the succeeding
relationships.
● If patient has live in or common law partner or gotten married:
→ Ask the patient to describe the courtship from the time they
met to the moment they got married.
→ How long did marriage last?
→ How many times have you been married?
→ Divorced or annulled?
9A, 9B
→ What was different about this person/ relationship compared
to previous relationships?
→ What do you love about your spouse? What does he think
made the relationship last/not?
→ How do they resolve their differences/ quarrels?
→ How open and honest are they to each other?
→ Any infidelities on either party?
→ How did he get along with your in-laws?
→ How did you and your spouse differ in attitude towards
having / dealing with their children?
→ Areas of agreement? Money matters?
→ Sexual adjustments?
● What attracted you to your current partner?
● How would you describe your marriage?
● Do you have any close friends aside from his spouse?
● How often do you get in touch with your family?
● How would you describe your current Relationship? (+/-)?
K. SEXUAL HISTORY
● Should not be confused with the marital and relationship history
● Traces how the patient first learned about sex and his sexual
experiences, aside from how his sexual identity, gender and
orientation came about.
● This may be initiated by first asking, if it's alright that the patient
will be asked about very personal issues and possibly traumatic
experiences yet assuring the patient that it will remain
confidential.
● The patient should be given the option to respond or not. And if
he prefers not to open up, then you should just respect that and
thank him for being candid.
● Quite often patients may be comfortable in revealing such
sensitive topics or issues.
● This topic may be introduced as part of the usual psychiatric
history and you may jump off from the Review of Systems –
after getting the gynecological and obstetrical history, you may
ask about the sexual history.
● You may also introduce this part of the psychiatric history when
you are exploring the adolescent period, or you may simply
introduce this part of the social history as an important part of
the psychiatric interview, and explaining that all aspect of one’s
life may be helpful in understanding the total person.
● From the adolescent period you may transition to this part of the
analysis by asking:
→ When did you first begin dating?
→ When was your first time to engage in sex?
→ have you had any intimate or sexual relationships? with
whom?
→ Who are you attracted to?
→ Are you sexually active? frequency? with whom?
→ How do you feel about sex?
→ Have you noticed any changes or problems with sex
recently?
→ Are you satisfied with your sex life?
● then moving on to more sensitive issues
→ Have you ever been sexually abused? if so could you tell
me about it?
● Clarify Sexual Problems
Page 10 of 24
PSYCHIATRY III Psychiatric Interview: Mental Status Exam

→ clarification of sexual problems would entail going through ● “Have you ever been arrested? Have you ever been
the phases of the sexual cycle. imprisoned? for what? How many times?
● desires- Fantasies? Object? Initiate? ● Any pending legal charges vs you? Have you ever filed any
● Excitement: Arousal? Erection? Lubrication? Foreplay? cases vs others?”
● Orgasm: Ejaculation? Satisfied? ● Legal History entails inquiring about getting involved in any
● Resolution: feelings? illegal activities
● Any paraphilias or sexual perversion?
O. MILITARY HISTORY
● do not use the technical term and sexual perversion but rather
● ROTC
describe the symptomatology. for example:
● Adjustment to the Military
→ do you like looking at naked pictures?
● Disciplinary Action
→ do you surf the internet for pornography sites?
● Combat Experience
→ what do you enjoy about it?
● Injury, Illness
→ do you prefer having sex with children?
● Ask about any military experience
→ do you get sexually aroused if you wear the clothing of the
→ that may have traumatized the patient
opposite sex?
P. CURRENT LIVING SITUATION
L. EDUCATIONAL HISTORY
● Describe: Neighborhood, House- Number of rooms and people,
● Highest level of Educational attainment ?
sleeping and bathroom arrangements, privacy, Nudity,
● Academic Performance: Own progress vs. Other Siblings?
Finances, Care for Children
→ Patient may compare his own academic achievement vs.
● aside from asking about the physical set up like the number of
those of his own siblings, or how he may have improved or
bedrooms and bathroom of their house. We also have to inquire
deteriorated.
who are the members of the patient’s household, and how do
● Attitude towards school?
they get along with each other.
● Be sure to describe more than just stating the patient’s highest
● if they do not get along, find out what are the usual conflicts
level of Educational attainment. as that should have been
among the family members.
mentioned in the general data.
● We should also inquire regarding the family income to have an
● Here you need to elaborate further patient’s academic progress
idea of their socio-economic status.
from the start of his schooling up to college or highest
● In regards to sleeping arrangements, ask who sleeps where,
education learning.
and with whom?
→ example: Master’s or Doctoral degree
● regarding the bathroom, ask the patient to describe if there is a
M. OCCUPATIONAL HISTORY door that can be locked to ensure privacy. We also ask about
● Career Choice, Training, and preparation family practices regarding dressing and undressing, nudity, and
● Employment Hx: number, duration, Reasons, Job Status, bathing.
● work: Enjoy? Conflict? → some of this are important risk factors for screening sexual
● Relationships: Colleagues? Boss? Subordinates? abuse in the family and neighborhood.
● Long Term Goals and Ambition
X. SUMMARY
● We can start by asking:
● This are the parts of the developmental and social history
→ What were his dreams and aspirations when he was
otherwise known as Anamnesis
younger?
→ Prenatal/ Perinatal
→ How did he pursue this?
→ Infancy
→ How did he prepare for his career options?
→ Toddler
→ Is he currently employed or self-employed?
● Preschool
→ How does he earn a living?
→ Elementary
→ Does he feel well compensated?
→ Highschool/Adolescence
→ Does he enjoy his work?
→ Adulthood
→ How does he get along with people at work?
→ Religion
● List down all previous jobs and describe his role and
→ Social
responsibilities in each.
→ Marital & Relationship
● Also ask,
→ Sexual
→ How did he get along with his co-workers?
→ Educational
→ What did he like and not like about his job?
→ Occupational
→ Why he left?
→ Legal
→ Why he was asked to resign or was he fired?
→ Military
→ Does he have other plans or ambitions?
→ Current Living Situation
N. LEGAL HISTORY
● History of assault or Violent behavior? Vs Whom?
● Use, Keep or Carry Weapons? Litigious?

9A, 9B Page 11 of 24
PSYCHIATRY III Psychiatric Interview: Mental Status Exam
Part 2: Conducting the Mental Status Exam
LEARNING OBJECTIVES
● Describe what are the parts of the MSE
● What to observe in the patient and what to ask
● Describe how to Conduct the MSE
● Describe how to interpret patient responses
● Describe how to report MSE findings
I. INTRODUCTION
● The mental status exam is the equivalent of the physical
exam for internists or surgeons or the neurological exam for
the neurologists.
● Since psychiatrists have no physical tools such as the
stethoscope or neurological hammer, they have to rely on
themselves.
● As the interviewer, the physicians are the diagnostic tool, which
🚩
means that the interview of the patient and how the patient
reacts to the physician; as well as how the interviewer reacts to
the patient are very important.
● 🚩The words used to describe the patient should be clear and
descriptive for the reader of your psychiatric report, so that they
can imagine themselves during the interview and thus aid in
correctly diagnosing the patient.
A. REVIEW OF PSYCHIATRIC INTERVIEW
● Has two parts:
→ Psychiatric History
▪ General/Identifying Data
▪ Chief Complaint
▪ Premorbid Personality & Function
▪ History of Present Illness (HPI)
▪ Past Psychiatric Illnesses (PRI)
▪ Past Medical History (ROS)
▪ Family Profile
▪ Developmental & Social History
→ Mental Status Exam
● Both of these parts are gathered during the psychiatric
interview.
● The psychiatric history may be taken from the patient and his
companion but the MSE is based only on interviewing the
patient.
→ Physicians look at the patient's attitude, responses, and
behavior as we interview them
● Both the Psychiatric History and the MSE later become the
PSYCHIATRIC REPORT which then becomes the basis for the
diagnosis and guide for managing the patient.
II. MENTAL STATUS EXAM
● Sum total of examiner’s observation & impression of the patient
at the time of the interview.
● 🚩It changes daily thus the need to repeat everyday similar
to the physical or neurological exam of a patient, which is used
to monitor the worsening of the patient’s condition or progress
and improvement with treatment.
● It evaluates the patient’s appearance, attitude, speech,
emotions, thoughts, intelligence, reality testing, behavior,
and insight.
● It is important to describe the patient’s interview as clear,
picturesque and detailed as possible in every part of the MSE.
9A, 9B
● It will be better to write the verbatim and dialogue between
the interviewer and the patient, similar to the script of a play.
● In this way, the reader can judge for themselves the quality of
the patient’s responses. Especially for mood, cognition,
judgement and insight.
● As much as possible, always put the basis of your
conclusions.
→ For example, if the patient seems sad, describe how the
patient looked or acted that made you think he was sad.
→ If you say the patient’s judgement was good, write in
quotation what was the hypothetical situation given and what
exactly did the patient say.
● Remember to be gentle and respectful on approaching and
talking to the patient. Try not to show any disgust or surprise
but remain neutral and calm throughout the interview
A. GENERAL DESCRIPTION
1. APPEARANCE
● As soon as the patient walks into the interview room,
immediately take note of his/her general appearance.
● Posture, poise, clothing, grooming
→ What is he wearing?
→ Is it appropriate for the weather?
→ What is his posture?
→ How does he carry himself?
→ Does he look at you?
→ Are his/her clothing revealing, decent or modest?
● Hair, facial hair, face, eyes (gaze), body, nails
→ Check his hairstyle.
→ Check his facial hair. Does he/she look neat, clean or is he
untidy/disheveled?
→ If a woman or even a man, is he/she wearing makeup?
● Example of how to write a patient’s appearance:
→ JJ was a tall man wearing a leather jacket with messy hair
and piercing eyes.
2. BEHAVIOR AND PSYCHOMOTOR ACTIVITY
● Observe these in terms of:
→ Quantitative
▪ Hyper/hypoactive
▪ Restless
▪ Pacing
▪ Slow
▪ Motionless
→ Qualitative
▪ Tics
▪ Twitches
▪ Tremors
▪ Mannerisms
▪ Gestures
▪ Gait
● 🚩 Describe those mentioned above as picturesque as
possible. Such as:
→ How does the patient move about the room?
→ Describe his gait as he walked into the room.
→ An example of how to write this: CC was pacing back and
forth screaming & shouting raising his fist towards the
interviewer & threatening to hurt the doctor
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam

3. ATTITUDE TOWARDS THE EXAMINER ● RATE OF PRODUCTION

● This can be helpful in determining what the possible diagnosis → How rapidly or pressured is his manner of speaking
of the patient would be. 📝
→ Rapid, pressured, hesitant, spontaneous ( Batch 2022)
● Examples: ● VOLUME
→ Seductive → Disinterested → How loudly or softly does he speak
→ Friendly → Evasive 📝
→ Loud; whispered ( Batch 2022)
→ Cooperative → Defensive ● RESPONSE TIME
→ Indifferent → Hostile → How long does it take for the patient to respond to you
→ How quickly, spontaneously, or hesitantly is the patient
Table 1. Attitude of patients towards examiner
responding to your questions
Type of patient Description 📝
→ Prolonged; interrupts ( Batch 2022)
● QUALITY
● Tend to be friendly
→ Describe the quality of speech, how pleasant,
Manic patients ● Overly familiar
melodious/monotonous is his voice when he speaks.
● Comfortable; or
→ Describe how clear/slurred/mumbled/garbled is the
● Even seductive towards the
articulation of words so that you can’t understand what the
examiner
patient is saying.
→ Take note of the accent especially if patient is a foreigner, as
● Seems not to care
well as the rhythm or flow of how the patient speaks
Depressed patients ● Indifferent
→ Does the patient say words in a disjointed, disconnected and
● Disinterested;or
abrupt manner?
● Passive
▪ Where the pauses are in unexpected parts of his
sentences; similar to when there’s bad internet connection
● Evasive
and the person sounds choppy.
Paranoid patients ● Defensive
● Suspicious of you 📌 Undiscussed Section Lifted from Handouts

● Irritated and angry

● Disturbances in speech (in terms of quality):
→ DYSPROSODY: loss of normal speech melody, monotonous
Psychotic ● Angry;
common in depressed patients.
(either delusional or ● Hostile towards the examiner
actively hallucinating) → STUTTERING: frequent repetition or prolongation of a sound or
syllable, leading to markedly impaired speech fluency
● Example of how to write this: → CLUTTERING: disturbance of fluency involving an abnormally
→ Kate did not look at the doctor and remained unresponsive. rapid rate and erratic rhythm of speech that impedes intelligibility;
Thus seems disinterested and bored during the interview. the affected individual is usually unaware of communicative
impairment
B. SPEECH
● Expression of one’s feelings and thoughts through the use of Table 2. Types of patients and their speech
language.
Type of patient Description
● Take note of:
→ How the patient speaks
● Tend to speak rapidly, in a pressured
→ How was he able to express himself
and excited manner
● QUANTITY
● Loud voice
→ How much the patient says Manic patients
● Sometimes don’t even wait to finish
→ How talkative or quiet
your question and often interrupting
→ How unresponsive or how totally mute is the patient
→ Talkative, taciturn, garrulous, voluble, unresponsive, mute ( 📝 ● Tend to speak softly, you can hardly
Batch 2022)
hear them.
📌 Undiscussed Section Lifted from Handouts Depressed and
sad patients
● Often take a few minutes before they
answer you due to slowness in
● Disturbances in speech (in terms of quantity):
process of thoughts
→ TACITURN is when the patient is reluctant to say anything, which
may be observed in depressed or suspicious patients
Agitated patients ● Tend to shout
→ GARRULOUS, on the other hand, means patient talks
excessively to the point of rambling and speaking in a roundabout
● May speak almost inaudibly as they
manner, including trivial details when responding to questions Paranoid patients may be afraid someone’s recording of
→ VOLUBLE is being fluent with a lot to say and readily so; both of
what they have to say
which may be seen in manic patients.

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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
C. MOOD
● Pervasive and sustained internal emotion that colors one’s
perception of the world
● May be evaluated in 2 ways:
→ OBJECTIVE EVALUATION
▪ Assessed based on the observation of the patient’s:
− Facial expression, posture, hand and body gestures,
tone of voice, and response time
→ SUBJECTIVE EVALUATION
▪ There is a need to ask the patient a question, “How are
you feeling today, these days or the past few weeks?”
▪ Is there a contradiction in what the patient says vs. what
you observe?
▪ Should be written in the report as:
− Patient claims he is happy but looks sad as indicated
by his stooped posture, bowed head, teary eyes and
unresponsiveness.
● DEPTH, INTENSITY, FLUCTUATION
→ Should be noted as shallow, labile, or fleeting
▪ That is shifting from happy to sad or sad to angry and so
forth within the period of interview
● QUALITY
→ The patient’s mood may be described as angry, sad,
scared, irritable, empty, elated, calm or relaxed
🚩
→ Avoid using words like dysthymic or euthymic as these
do not conjure an image in one’s mind.
D. AFFECT
● Present emotional responsiveness/expression of one’s feelings
● Often observed by looking at the patient’s face
● Described in two ways:
→ APPROPRIATENESS to setting, thought and mood
▪ Affect may change depending on what is currently being
discussed
− Appropriate to thought
o Even if the patient is sad, he may still smile when
the doctor cracks a joke or recalls a happy memory
− Inappropriate affect
o If the sad patient continues to smile even if the
doctor is asking what makes him sad or consider
suicide
→ RANGE/QUANTITY: has 4 levels
▪ FULL AFFECT
− This is the norm. When you can easily figure out the
patient’s feelings based on his facial expression.
− The emotions are fully expressed like laughing loudly
at a joke or when that patient smiles you can see all his
teeth.
▪ RESTRICTED/CONSTRICTED AFFECT
− when you can sense the patient’s emotion by looking at
him yet you remain a bit unsure if that is really how he
feels.
− There is a hint of emotional expression yet not fully
evident.
− As if the patient is limiting himself from showing his
emotions and is quite reserved in expressing his true
feelings
▪ BLUNTED AFFECT
− Even more difficult to guess how the patient is feeling
9A, 9B
▪ FLAT AFFECT
− When the patient is immobile or when the face is
immobile and there is absolutely no emotional
expression that can be detected thus leaving the
examiner at a loss as to how the patient is feeling.
E. PERCEPTION
● It is a mental process of transferring sensory stimuli into
psychological information or awareness. What are some of the
disturbances in perception?
1. HALLUCINATIONS vs. ILLUSIONS
● HALLUCINATIONS
→ These are when a person, through the five senses,
experiences sensations in the absence of external stimuli
to account for them.
▪ The patient sees things or persons that are not there.
▪ He hears voices or noises even when he is alone and
there is no radio, TV or gadget that is on.
▪ He can taste sweetness or bitterness even when there is
nothing in his mouth and assuming he has no tooth decay.
▪ He may feel ants crawling on his skin or a rat wriggling in
his anus but there are no rats or ants.
▪ He smells roses at night when there are none from miles
around
→ There are several types of hallucinations:
▪ Auditory, visual, tactile, olfactory, gustatory, internally or
viscerally (known as cenesthetic or somatic), formication,
hypnogogic, hypnopompic
📌 Undiscussed Section Lifted from Handouts
● FORMICATION is a tactile hallucination of insects crawling over the
skin commonly seen in cocaine addiction and alcohol withdrawal.
● CENESTHETIC or SOMATIC HALLUCINATION involves a physical
feeling or experience localized within the body e.g., there is a snake
swimming inside your stomach or rat wriggling in your anus.
● HYPNAGOGIC HALLUCINATIONS are those that occur when one
is about to fall asleep.
● HYPNOPOMPIC HALLUCINATIONS occur while just upon waking
up from sleep, both of which may be normal phenomena and may be
part of a dreamy state.
🚩
→ ​ The more common type for psychiatric conditions is
AUDITORY and VISUAL hallucinations.
→ 🚩 While OLFACTORY, TACTILE, and GUSTATORY
hallucinations are more common in neurological or organic
mental disorders.
● ILLUSIONS
→ These are misinterpretation of actual sensory stimuli
▪ A person hears a scratching sound on the roof, he will
think it is a thief that will enter the house; or
▪ If there is a tree outside his window, the patient will
perceive it as a witch or kapre; or
▪ If he hears firecrackers, he will believe that someone is
firing a machine gun at him.
2. DEREALIZATION vs DEPERSONALIZATION
● DEREALIZATION
→ This is when the person feels the world around him is
unreal as if he is watching a movie.
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
● DEPERSONALIZATION
→ This is when the patient feels he is not the same person,
that he is not real or actually present.
● 🚩 Both of which may be present or experienced by those who
are exhausted and under a lot of stress or when one is anxious.
It is also present in dissociative and psychotic disorders.
3. TYPES OF HALLUCINATIONS
● AUDITORY HALLUCINATIONS
→ When eliciting for auditory hallucinations from patients, you
need to ask them in this manner: “When you are alone and
there is no one around, no TV or radio on, do you hear
voices?”
▪ If the patient answers yes, then the next question to ask
is: “Do the voices come from outside of you? Like, is
someone calling for you from outside, or are these voices
inside your head?”
▪ If the patient thinks/believes the voice is coming from
outside, these are probably TRUE HALLUCINATIONS.
▪ But if he hears the voices in his head, then these are
probably not hallucinations..
→ It is also important to ask, what the voices are saying?
▪ Are they making comments about patient’s every move
and activities? Are they insulting, belittling, accusing the
patient unfairly or making fun of the patient? Are they
cracking jokes to make the patient laugh? And most
importantly, are the voices telling the patient to hurt
himself or others?
● VISUAL HALLUCINATIONS
→ You may elicit by asking: “Do you see things only you can
see but others don't?”
▪ If the patient says yes to either of these, then most likely
he is experiencing visual hallucinations
● 🚩 In general, for disturbances of perception, checking the
patient’s attitude towards any of these hallucinations or for
other types of hallucinations, it would be helpful in determining
the diagnosis and prognosis of his condition.
→ So, you can ask: What do you think about these voices,
visions, or smells? Where are they coming from? What is
causing you to sense these or have these unique
experiences? How did they make you feel? Or what are your
feelings about these sensations? It is important to determine
the patient’s thoughts and conclusions about these
hallucinations to assess his sense of reality.
● OLFACTORY HALLUCINATIONS
→ Must differentiate between actually perceiving or smelling a
foul odor emitted by his body versus the patient merely
thinking that he smells bad even if he doesn't really smell
anything.
→ If he smells a foul odor, that would be an OLFACTORY
HALLUCINATION.
→ But if he doesn’t smell anything yet believes and is
convinced that he does smell bad, that would be a
DELUSION.
● 🚩 Do not use medical or psychiatric terms like delusions or
hallucinations when talking to patients. As patients may not
understand or may feel offended by labeling their very real
experiences as false or brushing them off as just their
imagination.
9A, 9B
F. THOUGHT PROCESS
● Refers to how ideas and associations are put together and
indicate how thoughts are formulated, organized and
expressed. They may be described as linear and goal directed.
● Thought process is described in terms of:
→ Productivity of thought
→ Continuity of thought
1. PRODUCTIVITY OF THOUGHT
● How much thinking is going on? Does the patient have a lot of
ideas or none? How is the flow of his thoughts? Is it rapid or
slow?
● Paucity of ideas or overabundance
● Retarded or rapid thinking
● Examples:
→ 🚩
Manic patients tend to have an overabundance of ideas
and claim that their thoughts are racing,
→ Depressed patients with minimal ideas and slowness of
thoughts, thus the delay in response time.
→ Patients with dementia also tend to have slow mentation,
and sometimes complain of thought blocking, stopping in the
middle of their sentence as they have forgotten what they
wanted to say.
2. CONTINUITY OF THOUGHT
● This answers the question, “How is the flow of a patient’s
thoughts?”
→ Appropriateness of response
→ Relevance
→ Cause or effect explanation
→ Ideas goal directed
📝
→ Association ( Batch 2022)
● Are the patient’s responses appropriate and relevant to what
you are asking? Are his thoughts goal directed? Is he able to
get his point across? Do you as an examiner understand what
the patient is trying to say to you? Can the patient explain
himself clearly, logically, or not?
● 📢
The thought process is based on your observation on how the
patient expresses himself, how relevant are his responses to
your questions and how logical is his reasoning when talking to
you. There are many disturbances on how the patient connects
his ideas and associates topics.
📌 Undiscussed Section Lifted from Handout
● LOOSENESS OF ASSOCIATION/DERAILMENT: It is noted while
the patient tells you what happened to him, you notice that his
thoughts are unrelated and without any logical connection resulting
in a failure to communicate adequately and you are unable to make
any sense of what patient is saying.
→ “Kung baga magulong kausap..“
● FLIGHT OF IDEAS: It is the rapid succession of multiple
fragmentary thoughts, in which content changes quickly and
abruptly.
→ Patient jumps from one thought to another at a pace difficult for
listener to keep up even if the ideas are logically connected and
you can somehow see the connection between these different
ideas
▪ e.g. MD: How have you been sleeping lately?
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
▪ Patient: I sleep a lot, like sleeping beauty, I pricked my finger
when I was sewing a hole in my sock.. oh my, do you know
that when I was little we hung our stockings on the window so
santa would bring us candies.. Doc, do you invest In the stock
market.. ? Gutom na ako.. sino meron birthday today? Bili tayo
cake! Doc, mayaman ka naman di ba? Tara kanta tayo happy
birthday to you!
● TANGENTIALITY: Refers to when a patient is responding to your
questions. He may initially seem like he is answering the question
but soon mentions other ideas or topics that are irrelevant to the
original question.
→ Patient’s responses are oblique and digressive though slightly
related in a minor and insignificant manner and never returns to
original point or question.
→ Patient loses the goal of his answer but touches on the general
topic yet not exactly what you were asking.
▪ MD: How have you been sleeping lately?
▪ Patient: I sleep in my bed & wear my pajamas. I like my
pajamas with spiderman design.
● CIRCUMSTANTIALITY: Again in response to questions, the patient
may begin to answer you but then digresses into unnecessary
details that are not directly relevant to subject or question at hand.
→ i.e. beats around the bush but does eventually return to address
the subject or answer the questions.
→ The examiner can usually follow the long winding train of thought
seeing connections between sequential statements.
▪ MD: How have you been sleeping lately?
▪ Patient: well ganito yan.. when I was small my dad would tell
me bedtime stories till I fell asleep, now I listen to classical
music, I like Mozart; do you know that he was a genius.. I also
know how to play the piano and learned all his pieces.
Sometimes I like to listen to jazz. But if I listen to rock and roll I
can't sleep.. So let's see, lately I lie down at 8pm but toss and
turn till around 10pm. Thinking about a lot of things..
● BLOCKING: Is the disruption in flow of ideas; the patient is unable to
complete a thought.
→ e.g. when you ask a question, patient may start to respond to it
yet stops in the middle of his sentence and leaves the interviewer
waiting for completion of thought or sentence for a minute or so
but just remains silent; and when asked again patient will say they
don’t know or remember anymore what they wanted to say.
▪ MD: How have you been sleeping lately?
▪ Ptt: Ah.. medyo.. hmm..
● PERSEVERATION: Is when a patient merely repeats words,
phrases or sentences out of context so even if a patient is being
asked different questions he just repeats the same phrase or
sentence.
→ It reflects a tendency to focus on a specific idea or content without
the ability to move on to other topics.
▪ MD: How have you been sleeping lately?
▪ Patient: Ok thank you po..
▪ MD: Do you know where you are now?
▪ Patient: Ok thank you po..
▪ MD: Who keeps you company in the hospital?
▪ Patient: Ok thank you po..
9A, 9B
● CLANGING/CLANG ASSOCIATION: Is when thoughts are
associated by the sound of rhyming words rather than by their
meaning thus have no logical connection when a patient mentions
them.
→ This verbal behavior may dominate in patients with schizophrenia
or mania
▪ MD: How have you been sleeping lately?
▪ Ptt: Sleep?.. Beep beep.. Little bo peep had no sheep aray..
Naipit ako! Wag mo ko ipit doc! Tignan mo sipit ko.. ganda no?
Hey mo how are ya? Moo moo said the cow, bow wow said the
dog… ow owow! Wow wow willie!
● PUNNING: It is when a patient says a string of words with double
meaning yet without much sense
→ MD: How have you been sleeping lately?
→ Patient: what do you mean sleep? Sleep walking or jay walking?
Is my slip showing? Wala ako excuse slip sorry po.. I have bunny
slippers. We are all late sleepers..
● WORD SALAD: Sentences that are incorrectly constructed and thus
incoherent and incomprehensible mixture of words or phrases
usually seen in advanced cases of schizophrenia
● NEOLOGISM: Is the creation of new words by combining or
condensing several words that are not true words and whose
derivation can’t be determined, and thus not readily understandable
→ e.g. “Let's go expedotiusmercaly.” or “You are ickenspicky.” or
“Nilkedendolios.”
● VERBIGERATION: Are meaningless and stereotyped repetition of
words or phrases as seen in schizophrenia
● ECHOLALIA: Is the persistent repetition of words or phrases that
the patient hears from others.
→ MD: Good morning, I am DR JV Tan
→ Patient: Good morning, I am Dr JV Tan MD:
→ What’s your name?
→ Patient: What’s your name?
→ MD:No I want to know your name
→ Patient: No, I want to know your name
G. THOUGHT CONTENT
● What the person thinks about: ideas, beliefs
→ Preoccupations, obsessions/compulsion, idea of
reference/influence, phobia, intention to harm self/others
● Disturbances in thought content that you have to elicit from the
patient. Not by asking “Do you have any obsessions or
delusions”, but by asking the following:
→ OBSESSIONS
▪ Unwelcome and unacceptable repetitive thoughts that
intrude into the patient’s consciousness.
▪ You can ask “Do you ever have any thoughts, ideas, or
images that keep popping into your mind even if you
don’t want to think about them? And if you try to get
them out of your head, do they keep coming back?”
▪ If the patient says yes, ask him what those repetitive
thoughts are. Ask him to describe what these
unacceptable images in his mind are.
▪ If you notice some hesitancy, reassure him that whatever
he will tell you will remain confidential and you will not
judge him. But instead, it will help you in understanding
him and thus, guide you in knowing what to do about it.
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ COMPULSIONS
▪ Repetitive and ritualistic behaviour that the patient
feels compelled to do so as to avoid feeling anxious or
prevent some dreaded outcome.
▪ Common examples would be the hand washing
compulsion due to the patient thinking his hand washing
compulsion due to the patient thinking his hands are still
dirty despite washing them already. Thus, the need to
repeatedly wash them over and over again.
▪ How should we elicit compulsions which are usually
paired with an obsession?
− Do you ever feel the need to keep washing your hands
over and over again? Do you sometimes take a long
time in bathing because you have to soap, scrub, rinse,
and shampoo so many times that people at home are
complaining you are taking so long in the bathroom. Do
you sometimes have to check, double check, or triple
check if you have locked the door when you are
leaving the house or car?
→ DELUSIONS
▪ Fixed false beliefs not culturally based or shared by
most people, can’t be altered by reason, facts, or
evidence and you as the interviewer should not argue
with the patient nor question the veracity of such beliefs.
On the other hand, you should not also condone or
encourage such delusions.
▪ It is important to differentiate delusions of reference
from ideas of reference as this is a matter of degree and
spells the difference between a psychotic vs. a
non-psychotic condition.
− In DELUSIONS OF REFERENCE, the patient is
absolutely sure that the people are talking about him.
Thus, often reacts to it by being angry or possibly
seeking revenge.
− In IDEAS OF REFERENCE the patient merely
considers the possibility but is not certain if his
suspicions are true and often can just ignore such
ideas.
→ DELUSION OF JEALOUSY
▪ May be a bit tricky, as unfaithfulness among spouses is
quite common nowadays.
▪ There’s a need to ask another person who may have a
more objective perspective whether this is actually true or
not.
▪ If it is difficult to conclude if this suspicion is true or a
delusion, you need to ask the patient his basis for
thinking that his partner is unfaithful.
▪ The following questions may help you determine if the
patient has concrete and clear evidence to indicate that
his suspicions are true or not. Some of these questions:
− How do you know?How did you find out?
− What makes you think your partner is cheating on you?
− Have you seen anything that could indicate this?
− Have you seen any text messages or pictures on the
internet?
− Has there been a change in attitude, mood, or behavior
on the part of your partner?
− Does your partner come home late?
9A, 9B
− Is there a time/period you don’t know where your
partner is and if you call your partner he/she cannot be
reached?
→ 🚩📢 Do not use any psychiatric and technical terms such as
obsessions, compulsions, or delusions, but rather ask only
for symptoms that indicate such.
→ You must also give the impression that you believe the
patient without encouraging or confirming his beliefs.
→ But again, just remain neutral, nonjudgmental, nonchalant, a
matter of fact, when speaking to the patient or his family.
1. TYPES OF DELUSIONS
📌 Undiscussed Section Lifted from Handouts
● GRANDEUR DELUSIONS/DELUSIONS OF GRANDIOSITY: Are
exaggerated feelings and belief that one is an important person or
has a special identity
→ e.g. Thinking he is God or the president’s right hand man when
he is not; or that he has some great power
→ e.g. Healing power or the ability to read your mind; that he has
some secret or special knowledge/ information or truth that only
he knows.
● EROTOMANIA: belief that someone is deeply in love with them
→ e.g. Girl thinks that Justin Bieber is in love with her and the songs
he sings are specifically his way of telling her how much he loves
her
● PERSECUTORY DELUSION: belief that someone is out to hurt you
or your family either morally by destroying your name or reputation
or your family honor; or physically actually harm/kill you/your family
→ When eliciting persecutory delusions you can phrase it in this
manner: “Do you sometimes think that people are intent on
hurting you or destroying your reputation?”
● DELUSION OF REFERENCE: Thinking that others are talking or
laughing about you usually in a derogatory or unkind manner and
must be differentiated from ideas of reference.
→ “Have you ever noticed that when there are people around, and
you hear them talking or laughing, do you think they are talking
about you?
▪ If a patient says yes, the next question to ask would be “ How
do you know they are talking about you?”, “Are you sure they
are talking about you or do you feel that maybe they might be
talking about you but you are not really that sure?”
▪ If a patient is absolutely certain they are talking or laughing
about him and reacting angrily about it whether he just keeps
his anger to himself or actually wants to seek revenge, then
this is a delusion of reference.
▪ If it is just a feeling or a thought that maybe they might be
talking or laughing at me and the patient admits he is not so
sure so he just ignores them then this would be considered as
IDEAS OF REFERENCE, and the patient is not necessarily
considered to be psychotic.
● DELUSION OF CONTROL: Is the belief that someone is controlling
his thoughts, words, actions and physical movements
● DELUSION OF JEALOUSY: Is when a person believes with
certainty that partner/spouse is cheating on him/her even if there is
no evidence or truth to the suspicion.
● SOMATIC DELUSION: Is the belief that patient is sick or his body is
defective or not functioning well; e.g. patient insists he is dying of
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
cancer despite normal and extensive laboratory/diagnostic
procedures done
● DELUSION OF POVERTY: Is when a patient thinks that he has lost
all his money and is poor and destitute when it is not so.
● DELUSION OF NIHILISM: Is a delusion wherein a patient thinks the
world will soon end or that he doesn’t exist.
● DELUSION OF GUILT: Is when a patient feels disproportionately
guilty about past minor infractions.
→ e.g. an adult man feels bad that he stole a pencil from a
classmate when he was in kindergarten; or thinks that he has
done something terribly wrong that warrants his arrest when
actually he hasn’t committed any crime
● In general, Delusions can be:
→ BIZARRE/NON-BIZARRE
▪ Delusions can be bizarre, strange, and unlikely or
impossible such as believing that the patient’s
mother-in-law is an alien from Mars.
▪ Delusions can be non-bizarre which is still not true but a
possibility (a real possibility) such as having AIDS or
COVID despite negative testing or that the spouse is
philandering (readily or frequently enters into casual
sexual relationships) but actually he is not.
→ MOOD CONGRUENT/INCONGRUENT
▪ Delusions can be considered as mood congruent or
incongruent specifically:
▪ In depressed patients, the more commonly associated
delusions would be delusions of guilt, nihilism, poverty, or
somatic.
▪ In manic patients, he would most likely have grandiose
or erotic delusions.
H. SENSORIUM & COGNITION
● Assesses the following 8 areas of brain function:
→ Consciousness
→ Orientation
→ Concentration & Attention
→ Memory
→ Language
→ Visuo-spatial Ability
→ Information & Intelligence
→ Abstract Thinking
1. CONSCIOUSNESS
● The 1st part of sensorium and cognition refers to SENSORIUM
which is a hypothetical sensory center in the brain that is
involved with the clarity of awareness of oneself and one’s
surroundings, including the ability to perceive and process
ongoing events in the light of past experiences, future options,
and current circumstances. Sometimes, it is used
interchangeably with consciousness.
→ CONSCIOUSNESS refers to the state of awareness in
response to an external stimuli from the environment
● There are 7 levels of consciousness depending on the degree
of alertness and awareness, as well as the patient’s reaction to
the external stimuli.
● Most of these problems with sensorium are found in patients
with neurologic disorders such as delirium or dementia, while
most psychiatric patients are alert and awake enough to be
responsive throughout the psychiatric interview.
9A, 9B
● Note that the succeeding 7 areas refer to cognition
📌 Undiscussed Section Lifted from Handouts
● DISTURBANCES IN THOUGHT CONTENT
→ HYPERVIGILANCE: Excessive attention to and focus on all
internal and external stimuli; there is usually an increased
scanning of the environment to the point of having difficulty in
focusing or shifting attention while being interviewed.
→ ALERT WAKEFULNESS: Wherein patient responds immediately
thru all sensory modalities.
→ SOMNOLENCE: Pathological sleepiness or drowsiness from
which one can be aroused to a normal state of consciousness.
→ LETHARGY: Is a state of drowsiness (impaired awareness
associated with desire/inclination to sleep), inaction and
indifference wherein responses are delayed, sluggish, or
incomplete and there is a need for increased stimulation to elicit a
response from the patient.
→ CLOUDING OF CONSCIOUSNESS: Disturbance of
consciousness in which person is not fully awake, alert or
oriented; occurs in patients with delirium, dementia, and cognitive
disorder
→ STUPOR: State of decreased reactivity to Stimuli and less than
full awareness of surroundings; it indicates a condition of coma or
semicoma.
→ COMA: State of profound unconsciousness from which the
patient cannot be aroused; and when stimulated by calling out
name, putting pressure on the sternum there is no detectable
motor or psychological response or reduced to rudimentary
responsiveness such as withdrawal, sucking, chewing or
swallowing.
2. ORIENTATION
● Orientation in terms of time, place and person
● To test for orientation to time, ask the patient:
→ “What is the day? Date? Month? Year today?”
→ Also approximate time of day
→ In other countries, you may ask about the 4 seasons but in
the Philippines, we just have the dry/wet season.
→ A complete answer would be for example: “Today is
Thursday, Nov. 4, 2021, 9 am, in the rainy season”
● To test for orientation to place, ask the patient:
→ “Where are we now?”, “Name of the place? City? Province?
or Country?”
→ A complete answer would be: “We are here at DLSUMC,
Dasmariñas, Cavite, Philippines.”
● To test for orientation to person, ask the patient:
→ “What is your name?”, “Who am I?”, “Who are the people
here with you? What are their names and your relationship
with them?”
→ If the patient is alone, we may ask his/her name, and
assuming you have introduced yourself prior, you may ask
for your name.
▪ Or at least the patient must be able to tell you who you
are: medical student, doctor, etc.
● 🚩Usually the patient with neurological conditions loses their
orientation to time first, and then loses orientation to the person
last.
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3. CONCENTRATION & ATTENTION
● Test for CONCENTRATION are the following:
→ Subtract Serial 7’s from 100.
→ You ask the patient, “Could you subtract 7 from 100?”, the
patient will say “100-7 is equal to 93” then you’ll say, “Please
continue doing so until the remainder is only seven.”
▪ If the patient has difficulty with subtracting Serial 7’s, try
Serial 5’s. If the patient still cannot do so, try Serial 3’s.
▪ It is better to start from Serial 7’s than Serial 3’s.
− But if one starts with Serial 3’s, and the patient gets it,
then one must move on to ask for Serial 5’s and Serial
7’s. Otherwise, the evaluation is incomplete.
→ Another test is asking the patient to say the letters of the
English alphabet backward starting from Z.
▪ If the patient has some difficulty, try the Filipino alphabet.
− Make sure that the interviewer knows the correct
sequence.
→ A third test is to ask the patient to name the months of the
year backwards, starting from December.
● Test for ATTENTION are the following:
→ Ask the patient to spell the “world” or “kabalikat” forward
and backward
→ Depending on the level of education, you may ask the patient
to spell a longer word, such as redemption or
pananampalataya forward and backward, after asking a five-
to six-letter word.
→ Another is to ask the patient to give a list, such as
→ “Name ten senators currently in office”; or ten mammals
or vegetables
● 🚩Remember to write verbatim responses of the patient to
these parts of MSE wherein cognition is being evaluated, so it is
clear to the reader what exactly is the patient's ability based on
your report. This allows the reader to make their own
conclusion, rather than rely on yours.
4. MEMORY
● Assessing memory in psychiatry, there are 4 levels, which the
physician has to ask about to determine if the patient has poor,
fair or good memory.
● 🚩 When reporting, do not just put fair, poor, or intact, as
those reading the report may not have the same standards or
opinion as to what is poor, fair or good for you.
● Therefore, it is imperative to write out the basis for your
opinion in the report. And better yet, to write the verbatim
responses of the patient to your question in quotation (“ ”)
marks.
→ True for the rest of the MSE where you have to ask specific
questions
● REMOTE MEMORY/LONG-TERM MEMORY, which happened
years ago, can be evaluated by:
→ Asking the patient to recall remote personal and childhood
data and anniversaries.
▪ “What school did you go to in elementary or highschool?”
▪ “What year did you graduate from elementary, highschool,
or college?”
▪ “When did you get married?”
▪ “Where did you live when you were a child or teenager?”
Assuming they have moved since then.
9A, 9B
▪ If appropriate, “When did your mother/father die?”
▪ “When was your 10th wedding anniversary and how did
you celebrate it?”
→ Asking for historical facts that happened several years ago
during the patient’s lifetime.
▪ “When was the EDSA revolution?”
▪ “Who was the president when you were 10 years old?”
→ Asking the patient he/she has learnt as a child or he/she has
learnt many years ago
▪ “Can you name 10 colors? 10 animals? 10 fruits? or 10
provinces of the Philippines?”
● RECENT PAST refers to information or events that happened a
few months ago
→ Can be evaluated when the examiner asks for the history of
present illness and can be verified by the companion
● RECENT MEMORY refers to information or events that
happened a few hours or few days ago
→ “What did you have for breakfast?”
→ “When were you admitted to the hospital?”
→ “How long have you been in the emergency room?”
● IMMEDIATE RECALL refers to information or events that the
patient learned just a few minutes ago. To be more thorough,
this is tested in at least two of the following ways:
→ First, when you enter the room and introduce yourself, ask
the patient to repeat your name immediately after you
have told him.
▪ For example, “Hi! My name is Dr. Vasquez-Genuino. Can
you repeat my name?”. Then a few minutes later, or
sometime in the middle of the interview, and again at the
end before leaving the patient, ask the patient if he/she
remembers your name.
→ Second, the 3-object recall is tested by telling the patient, “I
will name 3 objects and say it twice. Then, I will ask you to
repeat after me. Memorize these 3 objects and I will ask you
again after a few minutes.”
▪ Usually, these 3 things we ask the patient to remember
🚩
are unrelated. For example: Mango, Book, Jeepney
▪ Give the patient time to repeat the 3 objects. Then, you
remind the patient to remember those three items
because it will be asked again later. After a few minutes
you can ask the patient what were the 3 things you asked
him/her to remember.
▪ Halfway through the interview, you can ask the patient
again, “What were the three objects I asked you to
memorize?” and you may repeat this again toward the
end of the interview.
→ Third, the digit span, wherein you asked the patient to
repeat a six to seven digit number, forward then backward
▪ 🚩 Make sure that the numbers are not in proper
sequence like 1, 2, 3, or 9, 8, 7.
▪ ​You may start with a three digit span first then move on to
a longer chain of digits like a five, seven, or eight digit
number.
− 🚩 Only if the patient is able to memorize the
simpler task, do you move on to the more difficult
task.
▪ If the patient is able to do this well, you can now ask him
to do the same with the five digit number like 8, 5, 1, 7, 0.
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
And if he is able to do so, move on to a seven digit
number like 9, 8, 1, 4, 0, 2, 6.
▪ Always repeat the number twice before letting the
patient repeat forward, and again, repeat the
number twice before asking the patient to also
repeat the number backwards.
▪ Another option is to start with a seven digit number
and if the patient is able to recall this seven digit
number forward and backward, then there’s no need
to try either the three or five digit number.
▪ If the patient is able to repeat it forward the first try,
repeat the number twice then ask the patient to
repeat it to you backwards. For example, “I will say
the numbers twice and you’ll repeat them after me,
4,8,3. I’ll repeat the number twice again, but this time
please repeat it backwards”
→ Amnestic patients usually have difficulty while repeating
the numbers backwards due to a deficit in working
memory.
📌 Undiscussed Section Lifted from Handouts
● DISTURBANCES IN MEMORY
→ CONFABULATION: Unconscious making up of false answers to
fill up memory gaps.
▪ A useful means of checking for this is if you ask the patient do
you know me? And if he says that he has when it is actually
the first time you have met each other would be tantamount to
confabulation.
→ FALSE MEMORY: Recollection of imagined/untrue experiences
that the patient believes actually happened
→ PARAMNESIA: In which reality and fantasy are confused; they
are stimulated by an external stimuli that is misinterpreted thus
may also be considered as a disturbance in perception. They may
be observed in dreams of normal individuals, anxious, psychotic
or patients w/ organic mental disorders.
▪ DEJA ENTENDUIS: A type of illusion that what one is hearing
has been heard before.
▪ DEJA PENSE: Is a condition in which a thought never
entertained before is incorrectly considered as a repetition of a
previous thought.
▪ DEJA VU: Is an illusion that what one is seeing for the first
time has been seen or experienced before.
→ FUGUE OR DISSOCIATIVE AMNESIA: Is seen in dissociative
disorder or after being traumatized; it is characterized by a period
of almost complete amnesia, during which a person actually flees
from an immediate life situation and begins a different life pattern;
there is usually some gain such as forgetting or avoiding recall of
a painful and traumatic event/ memory of an event. Apart from the
amnesia, mental faculties and skills are usually unimpaired. May
be seen in patients suffering from dissociative, anxiety or
personality disorders wherein there is memory loss and takes on
a whole different personality alien to one’s own consciousness.
5. LANGUAGE
● 5th area of cognition encompasses the language function
● Both comprehensive and expressive language have a verbal
and written form
● COMPREHENSIVE language
9A, 9B
→ Entails both the verbal comprehension of an oral or verbal
command and comprehension or understanding of a written
command, which simultaneously evaluates the patient’s
ability to read, understand, and carry out the written
command.
→ For verbal comprehension
▪ The examiner gives an oral command by telling the
patient, for example, “Using your right hand touch your left
ear.” or “Using your left hand, touch your right knee.” This
also checks for right-left discrimination that is often
affected in patients with dementia.
→ For written comprehension
▪ The examiner writes a sentence on a piece of paper that
tells the patient to do something. You write a three-stage
command. Then, you show the patient what you have
written and ask the patient to carry it out.
▪ If you ask him to follow what the sentence says written
down on a piece of paper, for example, “Close your eyes,
clap your hands, then say, “Good morning, Doc!””. Show
this sentence to the patient. The patient has to read it
aloud. Then, ask him to carry it out.
● EXPRESSIVE Language
→ Has actually been evident since the start of the interview as
the examiner observes on how the patient has been
answering the questions and following the directions.
→ The examiner can still check for it formally and report it,
accordingly.
→ VERBAL EXPRESSION
▪ Ask the patient to name at least three to five objects seen
around the room.
▪ You can lift or point to items such as the watch, the door,
book, patient’s shoes or bag and ask the patient what
these items are.
▪ The inability for word retrieval is called ANOMIC
APHASIA.
▪ Another way of evaluating expressive language testing for
verbal fluency by asking the patient to carry any of the
following tasks
− Name five objects beginning with B or S
o 🚩
This also tests for concentration and attention
and may be also used to test for it.
▪ A more thorough means of assessing verbal fluency is to
ask the patient to repeat a tongue twister in english or in
tagalog
− “She sells sea shells at the sea shore and the shells
she sells by the sea shore are sea shells for sure.”
− “Minekaniko ng mekaniko ni moniko ang makina ng
minika ni monica”
📌 Undiscussed Section Lifted from Handouts
● TONGUE TWISTERS IN ENGLISH
→ I scream, you scream, we all scream for ice cream!
→ Fuzzy Wuzzy was a bear, if Fuzzy Wuzzy had no hair, then Fuzzy
Wuzzy wasn’t very fuzzy was he?
→ Why do you cry Willy? Why Willy? Why, why, why? Why do you
cry? Willy, Willy? Willy cry, why you cry, Willy?
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ I thought a thought, but the thought I thought wasn’t the thought I
thought I thought. If the thought I thought I thought had been the
thought I thought, I wouldn’t have thought so much.
→ If one doctor doctors another doctor, then which doctor is
doctoring the doctored doctor? Does the doctor who doctors the
doctor, doctor the doctor the way the doctor he is doctoring
doctors? Or does he doctor the doctor the way the doctor who
doctors doctors?
→ Betty Botter bought a bit of butter. “But” she said, “this bit of
butter’s bitter”, but a bit of better butter mixed with this butter
might just make my bit of bitter butter better.” So Betty bought a
bit of better butter to make her bitter butter better.
● TONGUE TWISTERS IN TAGALOG
→ Nakakapagpabagabag kapag kinakabag ka.
→ Bumili ako ng bituka ng butiki sa botika.
→ Ngumunguya at nangunguyahiot nang paa si Ka Nagarding.
→ Sumasaway ng pasaway ang nagsasaway na sanay magsaway
→ Nagparito ng pitumpu’t putong puto ang pumipitong puting pato.
→ Palakang kabkab, kumakalabukab, kakakalabukab pa lamang,
kumakalabukab na naman.
→ WRITTEN EXPRESSION (Writing)
▪ Evaluate the patient’s ability to write by asking the patient
to write his or her name and a sentence on a piece of
paper about anything and read it to the examiner.
6. VISUOSPATIAL ABILITY
● The 6th area of cognition is visuospatial ability.
● Checks the ability to plan, organize, and to actually carry
out an activity.
● To test this, we ask the patient to copy a drawing you make or a
picture you have of the following: flower, house, or an elephant.
or to simply ask the patient to draw a flower, a house or an
elephant.
● Another option is to ask the patient to draw a clock and state a
particular time without showing him a drawing or an actual
clock.
→ Ex. “Would you please draw a clock that indicates the time
as 10:20.”
▪ Done without showing the patient an actual clock.
→ If the patient has difficulty drawing without an image then ask
him to draw the time on his watch or a clock in the room.
● Sometimes writings and drawings can be inserted in the
psychiatric report especially if the results are significant in
diagnosing organic mental disorder
● The examiner can also describe the whole process in detail in
the report.
7. INFORMATION & INTELLIGENCE
● The 7th area of cognition
● Consists of four specific aspects in assessing the patients
level of intelligence.
● Consider the patient’s level of formal or self education and
occupation
● 🚩Make sure the questions are relevant to his culture and
socioeconomic background.
● COUNTING AND CALCULATION
9A, 9B
→ For counting simply ask the patient to count from 1 - 20 or
50, rapidly.
→ For calculation, ask the patient to solve simple math
problems that involve addition, subtraction, multiplication,
and division.
→ This could be evaluated by asking the patient to calculate
change when buying something
▪ “If you had 100 pesos and you had to pay 46 pesos for the
grab delivery, how much change should he give you?”
▪ “What is the cost of a papaya that weighs 2.5kgs if 1 kg is
110 pesos?”
→ Another would be to ask the patient to determine the
distance between two points or other problems that involve
weight or volume.
▪ “What is the distance between Manila and Cavite?”
▪ “If you bought a 16-inch log, you have to divide it into 8
pieces of equal size, how long would each piece be?”
▪ “If you have 10 pieces of 5-peso coins, how much money
do you have?”
▪ “How many minutes are there in an hour?”
▪ “How many meters are there in a kilometer?”
● VOCABULARY
→ You can ask the patient the meaning of one or two words
▪ In English, what does solidarity mean?
▪ In Tagalog, what does bayanihan mean?
▪ “Could you define the word conservation or kapayapaan?”
● GENERAL FUND OF KNOWLEDGE
→ Ask questions about historical events or information one has
learned in school
→ Data that everyone is expected to know
▪ “How many presidents have we had in the Philippines?”
▪ “Where do you find tarsiers?”
▪ “What are the main islands that compose the Philippines?”
● CURRENT EVENTS
→ Ask questions that have been reported in the news or are
circulating in social media.
▪ “Who are the current presidents of China and New
Zealand?”
▪ “Who are the presidential Candidates of the 2022
elections?”
▪ “What are the COVID vaccines given to Filipinos?”
▪ “How many cases of COVID have there been for the past
few weeks?”
8. ABSTRACT THINKING
● The 8th area of cognition is abstract thinking
● Give SIMILARITIES between 2 dissimilar objects
→ 📢 ABSTRACT THINKING is the ability to deal with concepts
and the ability to see the similarity in terms of functions or
purpose as well as categorize or classify the similar objects
under one classification
→ 📢 CONCRETE THINKING is the ability to only see the
physical or material characteristics that are experienced
through the 5 senses like color, shape, smell, texture or taste
● To determine if the patient has the ability for abstract thinking,
you need to assess the patient in 2 ways:
→ Ask them to give similarities between dissimilar objects;
→ Interpret proverbs which you and the patient should be
familiar with
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam

● Abstract thinking is of a higher order than concrete thinking actual responses and that you describe the process how the
→ Ask the patient to GIVE SIMILARITIES BETWEEN TWO patient was able to respond
OBJECTS → So even if the reader of your report was not present during
▪ You should ask at least 2-3 sets with increasing the interview, the reader could still imagine what you are
difficulty describing both in the process and the content of the
● If the patient was able to answer something as simple as the interview
similarity between fruits and animals, you may ask another set → Make sure it is as detailed and as clear as possible
of objects. 🚩
→ Don’t just write in the report “Patient has abstract thinking.”
→ “Can you tell me the similarity between the desk and a as that would not be acceptable at all, you have to be more
pencil?” descriptive and use the patient’s verbatim responses
→ “What is the similarity between a fork and a spoon?”
I. JUDGEMENT
▪ These are simple examples that even children could
● The patient’s capacity to make sound decisions and act on
answer so you need to ask a more difficult set of
them accordingly
dissimilar objects to test for the abstract thinking.
● We can base this on what we gathered from the history that is
▪ Ask the similarity between a movie and a book, or religion
assessed from the patient’s:
and psychology
→ REAL LIFE SITUATION
− These 2 sets have no physical similarities whatsoever,
▪ Behaviour harmful to patient & contrary to culture
and religion and psychology have no physical
description ▪ Was the patient able to live independently?
− A person with concrete thinking will not find any ▪ Has he done anything to endanger himself or others?
similarity ▪ Has he gotten himself in any legal, moral, or ethical
Table 3. Sample questions for abstract thinking trouble?
Scenario Concrete Abstract ▪ If yes, then he might not have very good judgement or is
“What is the similarity “They are both sweet “They are both fruits.” considered to have poor judgement
between an apple and a or colorful.” ▪ How effectively can a patient participate in their own
pear?” medical psychiatric care?
− If the patient is compliant with doctor’s orders and
“What is the similarity “They are both made “They are both used for
between a desk and a of wood.” or “They studying/writing.” medications given to them by the psychiatrist, you
chair?” are both brown.” might consider them to have good judgement.
Otherwise, you would consider him as having poor
“What is the similarity “They are both silver.” “They are both used for
between a fork and or “They are both eating.” judgement
spoon?” made up of metal.” → HYPOTHETICAL SITUATION
“What is the similarity “Both are works of art” ▪ Can the patient predict own behaviour in an imaginary
between a movie and a A person with or “both tell stories.” situation?
book?” concrete thinking will ▪ What would you do if someone gave you money to vote
“What is the similarity not find any similarity. “Both deal with how to for him?
between religion and live life.” ▪ What would you do if you found a bag of money on a park
psychology?” bench?
− If the patient says he would just keep the money or
→ Another way to test for abstract thinking is ask the patient to
give it to the police, his judgement may not be that
INTERPRET PROVERBS
▪ 🚩
Ask for at least 2 because the patient might’ve just good, considering that some local police are not known
guessed the first one to be that honest.
▪ Make sure it is not just a translation from tagalog to − Better judgement might be for the patient to give the
english money to a radio station or television station, and have
Table 4. Sample proverbs for abstract thinking it announced for the owner to come forward and claim
Proverbs Concrete Abstract it.
− If no one claims it, they could give it to the poor or a
“Walang ligaya sa lupa Related it to plants or ● Able to apply the
na di dinilig ng luha.” rain charitable institution directly.
proverb to their life or
● Notice that there is a lot of leeway as to what is poor, fair,
situation
good, or excellent judgement.
● “Hardships in life are
→ Thus, the need to report the patient’s response in
worth it because they
verbatim, in quotation marks, rather than just indicate poor,
are necessary in
fair, or good
achieving success
and happiness.”’ or
● 🚩 What is good for you may not be good for others
● It is imperative, therefore, to write exactly what the patient said,
● “Nothing in life is
so the reader of your report can decide for themselves how poor
attained without
or good is the patient’s judgement
difficulty.”
● Others can ask about future plans
● 📢 This is another part of the MSE that requires you to write the
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam
→ If these are consistent with the patient’s educational
background and resources, he may be considered to have
good judgement.
→ If not, either the patient is very grandiose or gives less
than what he is capable of, this might indicate that the
patient is either manic or depressive.
J. IMPULSE CONTROL
● Based on history and observation
→ Based on history of present illness and on your observation
during the interview
● Aggressive and sexual Drives
→ Take note of how the patient is able to control or not control
his aggressive and sexual drives
→ Is he able to control his anger and frustration?
→ Is the patient able to control his impulse to hurt himself or
others?
● Capable of social appropriate behavior
→ Is his behavior socially appropriate or not? Socially
acceptable or not?
K. INSIGHT
● Refers to the degree of a patient's awareness and
understanding about being ill; its cause, his role in causing or
preventing the illness, and what he can do to improve his
condition.
● 5 Levels of Insight:
→ COMPLETE DENIAL
→ SLIGHT AWARENESS YET DENY
▪ Slight awareness of being sick and needing help but
denying at the same time
→ AWARENESS BUT BLAME, EXTERNAL
▪ Aware of being sick but blame others, or blame other
external, medical, or unknown factors
→ INTELLECTUAL INSIGHT
▪ Patient is aware of being sick and admits that it is caused
by his own irrational feelings or his own doing but fails to
apply this knowledge to future experiences and therefore,
there is no behavioral change.
▪ In other words, his symptoms continue or his illness
persists due to his inability to change.
→ TRUE EMOTIONAL INSIGHT
▪ Highest level
▪ The patient is aware of his own motives and feelings as
well as the meaning of symptoms or the psychological
purpose that his illness serves in his life and eventually
leads to a change in attitude, personality, or behavior.
▪ This would mean that the patient has actively changed his
diet, and lifestyle, for those who are medically ill, not just
compliance to medications or doctor’s orders.
▪ Patient must have done and continues to find the means
of preventing his or her illness from worsening.
▪ Patient has an openness to new ideas/concepts about
himself and those who are important in his life. ( 📌 of present illness gathered as well as salient results of the
Handout from Dra. Vazquez-Genuino)
● Some of the questions we can ask when eliciting what level of
insight does the patient have:
→ Mayroon ka bang sakit? (“Do you have an illness?”)
9A, 9B
→ Ano sa palagay mo ang sakit o problema mo? (“What do you
think is your illness?”)
→ Ano kaya ang sanhi ng sakit o problema mo? (“What do you
think is the cause of your illness?”)
→ Ano ba ang pwede o kailangan mong gawin para gumaling
ka? O kaya para ‘di maulit ang sakit o problema mo? (“What
do you think are the things you need to do in order to feel
better? Or the things you need to do to prevent getting sick
again?”)
● If the patient uses technical or diagnostic terms such as
depression, manic, bipolar, dementia, schizophrenia, phobia, or
panic, ask them what do those terms actually mean for them?
→ And how does he know what the symptoms or disorders
entail according to the patient? Does he have those
symptoms?
→ Don’t just take it for granted that his definition of
schizophrenia is actually according to the DSM 5 criteria.
L. RELIABILITY
● Reliability is your subjective assessment of the accuracy or
veracity of your informants when giving you information and
describing what really happened to the patient
● For the MSE part, it refers to how truthful and reliable you think
the patient was in responding to your questions during the entire
interview. Was the patient consistent with his responses?
III. ENDING THE INTERVIEW
● Last 5-10 mins
● It is important to give a few minutes for the patient to ask the
interviewer questions, or add anything they may have forgotten
earlier but may be important for the interviewer to know.
→ “We have to stop in about 10 mins. Do you have any
questions you would like to ask me at this point?”
→ “Medyo patapos na po tayo, pero baka may gusto po kayong
sabihin o itanong sa akin?”
▪ Address the patient’s questions and issues before ending
the interview.
▪ If it is something you cannot answer, you may tell the
patient you will refer this to your consultant and promise to
get back to him. Which of course you should get back to
him and actually refer him to whomever you think can
address his concerns.
▪ If the patient has no other questions, you may thank the
patient for sharing his experiences with you and wish him
well if he has no more questions and issues to add for the
interview.
● As students, it is not your role to make any promises, give false
hope, or instill fear and anxiety about the patient’s illness. It
would be better for you to encourage the patient to talk to his
doctor about any concerns or worries he may have since his
doctor-in-charge may be in a better position to address and
manage them accordingly.
● At the end of the interview, we usually summarize the history
MSE that led you to a tentative diagnosis before giving the
treatment plan.
→ There is a need to explain the short term and long term
plans, possible and expected outcomes from the treatment,
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PSYCHIATRY III Psychiatric Interview: Mental Status Exam

as well as possible adverse effects, if any of REVIEW QUESTIONS (2022)

pharmacotherapy, and how to handle such if they arise. 1. At what point in time do we start the History of Present
● Before the patient leaves, make sure they are clear about their Illness in a 29 y/o patient who came in for difficulty in
medications and follow-up date of consultations aside from falling asleep?
giving instruction to the companion or relative on how to give a. From onset of stressor
the medications and how to handle the patients at home. b. From the first time
● There is also a need to give clear instructions to the patient’s c. From the last episode
companion as to what are the warning signs of an impending d. From childhood
exacerbation and indications for an ER consult:
→ Suicidal or violent tendencies 2. What is a fixed false belief?
→ Refusal of medications a. Unrealistic fear
→ The inability to handle the patient at home b. Hallucination
c. Delusion
d. Fantasy

3. What type of insight does a patient have if he knows his

symptoms are due to his own irrational feelings yet there is
no change in behavior?
a. Emotional
b. Intellectual
c. Denial
d. Aware

4. When a doctor asks a patient “How are you?” and the

patient answers: “Oh how do you do.. how how de carabao,
Figure 2. Parts of the MSE that should be reported in detail according to
this sequence batuten.. pen pen desarapan.. doc meron ba kayong
ballpen?” This is a disturbance in__________ and
IV. SUMMARY specifically called __________.
a. Speech, flight of ideas
b. Perception, punning
c. Thought content, looseness of association
d. Thought process, clang association

5. When patient claims that he believes people are talking

about him behind his back whenever he passes by; this is
an example of:
a. Auditory hallucinations
b. Delusion of reference
c. Ideas of reference
Figure 3. Summary of a complete psychiatric report d. Delusions of persecution
● A complete psychiatric report includes:
Answers: b, c, b, d, b
→ Psychiatric history
→ Mental status exam REFERENCES
→ Diagnosis ● Vazquez-Genuino, A. (2021). Psychiatric Interview. Moodle
→ Plan of management online video lecture.

9A, 9B Page 24 of 24