The psychiatric interview

Question 1

COMPREHENSIVE Mental Status Exam guidelines

Answer 1

Pt in a psychiatric emergency seen in
ER, crisis clinic, non-psychiatric ward
for referral, or psychiatric admit
* New patient patient that is > 40 years
old
* Forensic (legal proceedings) referral
to determine mental competence (legal sanity)
* Physical Exam suggests cognitive
impairment or brain dysfunction
* Pt has a history of psychiatric
disorder, substance abuse, organic
brain disorder (damage or brain tissue deterioration), or physical disorder altering brain function
* Pt’s personal habits, memory,
concentration, or grasp have deteriorated recently
* Pt presents with symptoms of mood
disorder, psychosis, or organic brain
disorder

Question 2

BRIEF Mental Status Exam guidelines

Answer 2

• Pt is referred to an ambulatory clinic for situational or personality problem & none of the comprehensive examination criteria apply
• Pt’s appearance, motor behavior, quality of speech, affect & mood are assessed
• Abnormal thought content typically not investigated unless clinical clues arise
• Eg. hallucinations, obsessions, depersonalization
• Pt’s consciousness, orientation, attention, grasp, memory, fund of information, general intelligence, language competence & thoughts process are inferred from the process
• Physiological functions like sleep, appetite, libido, menstrual cycle, energy level & insight are always assessed

Question 3

Psychiatric Interview - HPI

Answer 3

• Presenting complaint
• “Tell me your story”…
• Lots of follow-up questions
• Chronology of events & development of symptoms
• Precipitation of illness & relevant stressors
• Concerns of the patient & their family, friends, neighbors, employers
• Insight, judgement, & motivation for treatment

Question 4

Level of consciousness

Answer 4

How aware the person is of his or her environment
* Is the patient awake and alert?
* Does the patient respond appropriately and reasonably quickly or lose track
of the topic and fall silent or even asleep?
* Does the patient understand your questions?

Question 5

Review personal history for psychiatric status exam

Answer 5

:)

Question 6

Posture and Motor Behavior questions

Answer 6

• Does the patient lie in bed or prefer to
  walk around?
• Is the patient sitting or lying
  comfortably?
• Is the patient agitated with repetitive
  movements?

Question 7

lack of facial movement

Answer 7

flat affect

Question 8

_____: Observable mood of a person expressed through facial expression, body movements, and voice

Answer 8

Affect

Question 9

____: words or phrases are substituted for
the word a person cannot remember

Answer 9

Circumlocutions

Question 10

_____: malformed words (“I write with a den”),
wrong words (“I write with a branch”),
invented words (“I write with a dar”)

Answer 10

Paraphasias

Question 11

Thought Process Abnormalities

Answer 11

Circumstantiality
Tangentiality
Derailment
Flight of ideas
Loose associations
Incoherence
Blocking
Confabulation
Perseveration
Echolalia
Clanging
Neologisms

Question 12

Thought content abnormalities

Answer 12

Obsessions
Compulsions
phobias
general anxiety
paranoia
delusions

Question 13

Thought perception abnormalities

Answer 13

Illusions
Hallucinations