2. Why interviewing ?
• Commonest procedure
• Skill can be Learned
• Small investment with great potential
3. Goals of Psychiatric interviewing
• Build rapport with the patient
• Gather information
• Know the nature of the disease
• Reach a diagnosis
• Formulate a treatment plan
5. 1.Interviewing for :History taking
Greet the patient and introduce yourself
Personal data including :
Name
Age
Sex
Residence
Education
Occupation
Marital status
7. History of Present Illness
Should include :
Onset -- course --- duration
History of chief complaint
Description in chronological order
Important YES-s and Important No-s
11. Personal History
• A) Prenatal – natal – post natal history
• B) Developmental History
• C) Behavioral problems in childhood
• D) Academic achievements
• E) Occupation
• F) Psychosexual
• G) Marital
• H) Military
• I) Forensic
13. 2. Interviewing for Mental status
examination
• A mental state examination is a systematic
documentation of the quality of mental
functioning at the time of interview.
• It helps both with current diagnosis and
treatment planning, and baseline for future
reference.
14. The Mental State Examination
Attitude, Appearance and behavior
Items to cover Comment on
Attitude towards the
examiner
Rapport, degree of cooperation, hostility, evasiveness.
General appearance
and grooming
General health, build, clothing, injection sites, lacerations (especially on
the forearm), personal hygiene, grooming.
Facial expression Is it appropriate or not, eye contact (avoids gaze, excessive scanning),
hallucinatory behavior if any.
Psychomotor activity Agitation or retardation.
Abnormal movements Antipsychotic side-effects such as: tremor, bradykinesia or other
abnormal movements as: tics, chorea, stereotypy, and mannerism.
Posture Whether relaxed, guarded, sitting at the edge of the chair or in a picture
for prolonged period (catatonic posturing).
Gait Whether it is normal, brisk or slow.
15. The Mental State Examination
Sensorium :
Patient is conscious
Oriented to time place and person
Attentive
Concentrating
With intact memory ( immediate – recent -
remote
16. The Mental State Examination
Mood and affect
• Mood: It is a sustained subjective feeling
state, which can be described by qualities
such as happiness, sadness, worry, anxiety,
irritability, anger, detachment and
indifference.
• Affect: It refers to more transitory and
immediate emotional expressions.
17. The Mental State Examination
Appropriateness
(Quality)
Inappropriate to thought and surrounding environment e.g.
in schizophrenia
Intensity (Quantity) Constricted e.g. in depression. Expanded e.g. in mania.
Type Elated (e.g. in mania), Sad (e.g. in depression), Fear (e.g. in
phobia), Anger (e.g. in schizophrenia), Anxious (e.g. in
anxiety neurosis), Irritable (e.g. in hypomania), Blunting
(affects are diminished in intensity and constricted to a
narrow neutral range), Flat (No affective response at all e.g.
in schizophrenia).
Stability Liability e.g. in organic mental disorders.
18. The Mental State Examination
Speech
• Describe tone (variation in pitch), rate (speed)
and volume (quantity), spontaneity, relevance,
reaction time, vocabulary.
• Normal speech can be described as ‘spontaneous,
logical, relevant and coherent’.
• In pressure of speech, rate and volume are
increased and speech may be uninterruptible.
• In depression, tone, rate and volume are often
decreased.
19. The Mental State Examination
Thinking
Items What to examine How to examine Abnormalities, examples
Stream
(tempo)
Spontaneity and
productivity.
Through assessment of
speech.
Flight of ideas, poverty of
content of speech, and
thought block.
Form
(relevance,
continuity)
Evaluate whether
thoughts are
relevant to the
questions asked.
Through assessment of
speech.
Loosening of associations,
tangentiality,
circumstantiality and
illogical thinking e.g in
schizophrenia.
Control Whether thoughts
can be controlled
by an outside
influence.
Do you feel your thoughts
are being interfered with or
controlled? Are they known
to others, e.g. telepathy?
Thought insertion/
withdrawal/ broadcast occur
in schizophrenia.
20. The Mental State Examination
Thinking
Items What to examine How to examine Abnormalities, examples
Content
Negative thoughts
Ruminations
Record guilt, hopelessness.
Record any persistent, disabling
preoccupations.
e.g. in depression.
e.g. worrying about illness or
death.
Obsessions Record any recurrent, irrational,
intrusive, egodystonic, ideas.
e.g. obsessions about checking,
cleaning, religion,
contamination.
Phobias Record any irrational fears. e.g. excessive fear from height
Overvalued ideas Record acceptable and
comprehensible ideas pursued by the
patient. Beyond the bounds of reason,
causing distress.
e.g. an intense, non-delusional
feeling of responsibility for a
bereavement.
Ideas of reference Ask for thoughts that other people are
looking at or talking about them, not
held with delusional intensity.
Delusions: Record false, fixed, beliefs, out of
keeping with the patient’s culture,
unaltered by contrary evidence.
e.g. delusions of persecution,
grandiosity, of reference,
passivity.
21. The Mental State Examination
Thinking
TYPES OF DELUSIONS
Delusion type Content How to ask
Persecutory Someone or something is interfering
with the person in a
malicious/destructive way.
Do you worry that people are
against you or trying to harm
you?
Grandiose Being famous, having supernatural
power or enormous wealth.
Do you have any exceptional
abilities or talents?
of reference Actions of other people, events
media are referring to the person or
communicating a message.
Have you heard people talking
about you? Have you heard
things on the TV or radio you
think are about you?
Passivity Actions, feelings or impulses can be
controlled or interfered with by
outside influence
Do you feel another person can
control what you do directly?
22. The Mental State Examination
Perception
• Perception is the process of being aware of a
sensory experience and being able to
recognize it by comparing it with previous
experiences.
• Perception is assessed under the following
headings:
23. The Mental State Examination
2. Perception
Abnormalities Definition How to examine
Illusions Misinterpretations of normal perceptions
(e.g. interpreting a curtain cord as a
snake). They can occur in healthy people.
Ask whether visual,
auditory, or in other sensory
fields; occur in clear
consciousness or not.
Hallucinations Perceptions, in the absence of an external
stimulus, that are experienced as true and
as coming from the outside world. They
can occur in any sensory modality,
although auditory and visual are the most
common. Some auditory hallucinations
occur in normal individuals when falling
asleep (hypnagogic) or on waking
(hypnopompic).
Ask ‘Have you seen or
heard things that other
people can’t see or hear?
Can you tell me more about
that?’
24. The Mental State Examination
Perception
Abnormalities Definition How to examine
Pseudo-
hallucinations
Internal perceptions with preserved
insight (e.g. ‘A voice inside my head
tells me I’m no good.’)
25. The Mental State Examination
Thinking : Abstraction
Items to cover What to
examine
How to examine
Abstract thinking Reasoning Asking the meaning of common proverbs (in the
patient’s culture) and similarities and differences
between objects in the same class, e.g. similarities
and differences between “ball and orange” “fly and
aeroplane”
The answers may be overly concrete or abstract.
The appropriateness of answers is judged.
Concrete responses or inappropriate answers may
occur in schizophrenia.
26. The Mental State Examination
Judgment
• Judgment is the ability to assess a situation
correctly and act appropriately within that
situation.
• Both social and test judgment are assessed.
• Judgment is rated as Intact or Poor/ Impaired
27. The Mental State Examination
Insight
• Insight is the degree of awareness and
understanding that the patient has regarding
his illness.
28. The Mental State Examination
Physical and neurological examination
• Assessment of the general medical or
neurologic condition of the patient is
sometimes necessary.
• An examination should be conducted if there
is concern that an undiagnosed medical illness
is contributing to or causing psychiatric
symptoms.
