Joge Los Baños, MD


Interview of Psychiatric Patient
Time management Arrangement of Seating Arrangement of Office Taking of Notes Follow-up Interviews Interviewing Variations Depressed and Potentially Suicidal patients Aggressive Patients


Outline of the Psychiatric History

Identifying Data Chief Complaint History of Present Illness Past Illness Personal History (Anamnesis)

Outline of the Psychiatric History

Personal History (Anamnesis) x Prenatal and Perinatal History x Early Childhood (Birth through Age 3 Years x Middle Childhood (Ages 3 to 11 Years) x Late Childhood (Puberty Through Adolescence) x Adulthood
 (Marital,

Education, Religion, Social, Current, Legal)

x x x

Sexual History Family History Fantasies and Dreams


The Mental Status Examination describes the sum total of the examiner’s observations and impressions of the psychiatric patient at the time of the interview
The MSE can change from day to day or hour to hour It is the description of the patient’s appearance, speech, actions, and thoughts during the interview

Outline of the Mental Status Examination
    

   

General description Mood and affectivity Speech characteristics Perception Thought content and mental trends Sensorium and cognition Impulsivity Judgment and insight Reliability

I. General Description

A. Appearance
     

   

Age Height Nutritional status Body type, Healthy, sickly, Old looking, young looking Disheveled Childlike, bizarre Hairstyle Complexion

Posture Poise  At ease Clothing Grooming, jewelry, makeup, nails Signs of anxiety (moist hands, perspiring forehead, tense posture, wide eyes)

B. Overt Behaviour and Psychomotor Activity
         

Mannerisms, tics, gestures, twitches Stereotyped behaviour Echopraxia Hyperactivity Agitation Combativeness Flexibility, rigidity Gait Agility Restlessness, wringing of hands, pacing Psychomotor retardation, generalized slowing down, aimless, purposeless activity

C. Attitude towards examiner

Cooperative, friendly, attentive, interested, seductive, frank, defensive, contemptuous, perplexed, apathetic, hostile, playful, ingratiating, evasive, guarded Level of rapport established

II. Mood and Affectivity

A. Mood

    

Does the patient remark voluntarily about feelings or is it necessary to ask the patient how he/she feels Depth Intensity Duration Fluctuations Depressed, despairing, irritable, anxious, angry, expansive, euphoric, empty, guilty, awed, futile, selfcontemptuous, frightened, perplexed, labile

B. Affect
 

Range: within normal (Broad), constricted, blunted or flat Difficulty in initiating, sustaining or terminating emotional response Mood congruent of incongruent

C. Appropriateness of affect

III. Speech Characteristics

 

Amount Talkative, garrulous, voluble, taciturn, unspontaneous, normally responsive to cues from the interviewer Tone, monotone, rhythmic Rate of production Rapid or slow, pressured, hesitant, staccato Quality Emotional, dramatic, loud, whispered, slurred, mumbled, accent Speech impairment stuttering, dysprosody

IV. Perception
Hallucinations Sensory system involved Auditory Visual Tactile Gustatory Olfactory Command Content of hallucinatory experience Time of occurrence Circumstances Hypnogogic Hypnopompic

Illusions Déjà vu Jamais vu Hypersensitivity to light, sound, smell Distorted perceptions of time Misconception of movement, perspective and size Changes in body perceptions Depersonalization and derealization

V. Thought content and mental trends
A. Thought process Loosening of associations Flight of ideas Racing thoughts Tangentiality Circumstantiality Word salad or incoherence Neologisms Clang associations Punning Thought blocking Vague thought

    B.  Thought content Delusions Persecution Reference Influence Thought broadcasting Grandiose delusions Somatic delusions Delusional love Nihilism Capgras syndrome (belief that people have been taken away & replaced by duplicates

Preoccupations Obsessions Compulsions Phobias Plans Intentions Suicide/homicidal ideas Hypochondriacal symptoms Specific antisocial urges Ideas of reference Poverty of content

VI. Cognition and sensorium

A. Consciousness

Clouded Somnolence Stupor Coma Lethargy Alertness fugue state obtunded

B. Orientation and memory
Orientation to time, place & person Do they know how long they have been in the hospital? Do they know the people around them and their relationship with them? Do they know who the examiner is?

Remote (childhood memories) Recent past (news events from past few months) Recent (What did you have for breakfast? What did you do these past few days) Recall & immediate retention (the interviewer’s name? 6 digits forward and back)

C. Concentration and attention
Concentration Subtracting serial 7’s, 3’s Attention Spell “world” backward span, name 5 things that start with a particular letter

D. Reading and writing

Read a sentence (ex. “Close your eyes.”) and then do what the sentence says Write a simple but complete sentence

E.      Visuospatial ability
Copy a clock face or interlocking pentagons

F.      Abstract Thought
Concrete or overly abstract (Explain similarities of an apple and a pear, between truth and beauty, meaning of simple proverbs)

G.  Information and intelligence
Counting change, how many 25 centavos in 1.25 pesos, vocabulary, general fund of knowledge (relative to educational background, socioeconomic status), past presidents

VII. Impulsivity
Is the patient capable of controlling sexual, aggressive and other impulses?

VII. Judgement and Insight
Judgement Social Judgement – can the patient understand the likely outcome of his behaviour Test Judgement - imaginary situation, smell smoke in a crowded movie theater; better still, situation pertinent to patient’s case

Insight complete denial slight awareness of being sick blaming others for the illness illness is caused by something unknown Intellectual insight (no application to future experiences) True emotional insight

  

IX. Reliability
In percent, poor, good