• Psychiatric equivalent of the physical

examination
• Observations and impressions of the patient
by the examiner at the time of the interview
• Explores all areas of mental functioning
• Denotes evidence of signs and symptoms of
mental illnesses
 Personal Identification
◦ Brief nontechnical description
◦ Attitude toward examiner can be described

Cooperative, attentive, interested, frank, seductive, defensive, hostile, playful,

ingratiating, evasive, guarded

 Behavior and psychomotor activity

◦ Tics, mannerisms, gestures, twitches

 Attitude towards the examiner

◦ Level of rapport established
 General Description
◦ Posture, bearing, clothes,
grooming, hair, nails
◦ Healthy, sickly, angry, frightened,
apathetic, perplexed, poised,
old/young looking, effeminate,
masculine
◦ Signs of anxiety
 Rate
◦ Slow, average, rapid, or
pressured
 Volume
◦ Soft, average, loud
 Articulation
◦ Well-articulated, lisp,
whisphered, stutter,
slurred, mumbled
 Tone
◦ Angry vs pleading
• Pervasive and sustained emotion that colors the patient’s
perception of the world
• Emotion that
– the patient tells you he feels, or
– conveys nonverbally
• Present emotional responsiveness of the
patient
• Inferred from the facial expression, including
the amount and the range of expressive
behavior
• Assessment of how the mood of the patient
appears to the examiner
 • Quality
– Describes the depth and range of
feelings show
• Motility
– Describes how quickly a person
appears to shift emotional states
• Appropriateness to content
Outward expression of the – Consider appropriateness of
patient’s inner experiences response in the context of the
subject the patient is discussing
• Patient’s form of thinking
• How the patient uses language and puts ideas
together
• Describes whether thoughts are
– Logical
– Meaningful
– Goal-directed
• Formal thought disorders
– Loosening of association (Derailments)
– Flight of ideas
– Neologisms
– Word Salad
– Clang Association
– Thought Blocking
– Tangentiality
– Circumstantiality
– Preservation
– Punning
• Describes the type of ideas expressed by the
patient
• Poverty of thought vs overabundance
– Too few vs too many ideas expressed
• Delusions
– fixed, false beliefs that are not shared by the
culture of the person and cannot be changed by
reasoning
• Suicidal and homicidal thoughts
• Phobias
• Obsessions
• Compulsions
• Ideas of reference
• Ideas of influence
• Hallucination
– Sensory experiences not based in reality
– No stimuli present
• Illusions
– Inaccurate perception of existing sensory stimuli
– Stimuli present
 Alertness
◦ Awareness of environment, attention span, clouding of
consciousness, fluctuations in levels of awareness,
somnolence
 Orientation
◦ Time, place, person
 Concentration and calculation
◦ Subtracting 7 from 100 and keep subtracting 7’s
◦ Whether anxiety or some disturbance of mood or
concentration seems to be responsible for difficulty
 Memory
◦ Remote Memory – Childhood data; important events that
have occurred when patient was younger or free of illness
◦ Recent Past Memory – Past few months
◦ Recent Memory – Few days ago; what did the patient do
yesterday, the day before? What she had for breakfast,
lunch, or dinner
◦ Immediate Retention & Recall
 Fund of Knowledge
◦ Level of formal education, and general knowledge
◦ Questions should have relevance to the patient’s educational and
cultural background
 Abstract Thinking
◦ Disturbances in concept formation
◦ Manner in which the patient conceptualizes or handles his or her ideas
◦ Similarities (e.g., between apples and pears), differences, absurdities
◦ Meanings of simple proverbs
◦ Appropriateness of answers
• Is the patient capable of controlling sexual,
aggressive, and other impulse?
• Critical in ascertaining the patient’s awareness
of socially appropriate behavior
• Measure of the patient’s potential danger to
self and others
• Patient’s degree of awareness and understanding
about being ill
 Awareness Awareness
Awareness of being that illness
Complete True
of being sick, but is caused by Intellectual
denial of emotional
sick, but blaming it something insight
illness insight
denying it on other unknown in
factors the patient
• The psychiatrist should be able to assess many
aspects of the patient’s capability for social
judgment
– Does the patient understand the likely outcome of his
behavior and is he influenced by this understanding?
– Can the patient predict what he would do in imaginary
situations?
• The mental status part of the report concludes
with the psychiatrist’s impressions (thus,
subjective) of the patient’s reliability and
capacity to report his situation accurately