Psychiatric Interview, MSE

PSYCHIATRIC INTERVIEW
and MENTAL STATUS

EXAM
PSYCHIATRIC
INTERVIEW
GOALS
● Establish a criteria-based diagnosis, prognosis and
treatment decisions
○ Multidimensional understanding of the
biopsychosocial elements of the disorder
○ Information necessary for a patient-centered
treatment plan
● Shapes the nature of patient-physician relationship
Sadock, B.J., Sadock, V. A. & Ruiz, P. (2015), Kaplan and Sadock’s Synopsis of Psychiatry:
Behavioral Sciences/ Clinical Psychiatry 11th Edition. Philadelphia: Wolters Kluwer
GENERAL PRINCIPLES
1. Introduce him/herself and identify the reason for
the consultation
2. Obtain consent to proceed with the interview
3. Ensure patient privacy and confidentiality
4. Treat the patient with respect and consideration
5. Establish rapport
GENERAL PRINCIPLES
6. Have empathy for the patient while maintaining

objectivity
7. Maintain a patient-physician relationship
8. Person-Centered
9. Make the patient feel safe and comfortable
I. THE INTERVIEW
PROCESS
BEFORE THE INTERVIEW
1. Obtain relevant information:
○ Name, age, address, and telephone number(s)
of the patient
○ Who referred the patient
○ Reason for the referral
BEFORE THE INTERVIEW
2. The patient is given relevant information:
○ Length of time for the initial session

○ Fees
○ Whom to call for additional inquiries
3. Previous psychiatric and medical treatments & list of
medications
4. Communication with the referring authority
AT THE WAITING ROOM
● The patient is often given forms to complete
○ Demographic and insurance information
○ List of medications
○ Identification of major medical problems and
allergies
○ Questionnaire or rating scale (PHQ 9, QIDSS)
AT THE INTERVIEW ROOM
● Relatively soundproof
● Chairs of the interviewer and patient should be of relatively
equal height
● The patient and psychiatrist should be seated 4-6 ft. apart
● Interviewer should not be seated behind a desk
● Interviewer should be dressed professionally
● No cellphone interruptions
INITIATION OF THE INTERVIEW
● The psychiatrist introduces him/herself and
extends a hand
● Indicate where the patient will sit
● Inquire how the patient wants to be referred to as
INITIATION OF THE INTERVIEW
● Convey interest and support
● Continue with an open-ended inquiry
○ “What has led to your being here?”
○ “Why don’t we start by you telling me what
has led to your being here?
MENTAL STATUS EXAM
- APPEARANCE AND BEHAVIOR
- General description of how the patient looks and acts during
the interview
- Appearance and whether appropriate for the situation
- Distinguishing features: disfigurations, scars, tattoos
- Grooming and hygiene
- Behavior: Cooperative, agitated, disinhibited, disinterested
MENTAL STATUS EXAM
- MOTOR ACTIVITY
- Bradykinesia, normal, hyperkinesia
- Gait, freedom of movement, postures, restlessness,
lip-smacking, protrusions
II. ELEMENTS OF
INITIAL PSYCHIATRIC
INTERVIEW
Parts of the Initial Psychiatric
Interview
1. Identifying data 9. Developmental and social
2. Source and reliability history
3. Chief complaint 10. Review of systems
4. Present illness 11. Mental status examination
5. Past psychiatric history 12. Physical examination
6. Substance use/abuse 13. Formulation
7. Past medical history 14. DSM-5 diagnosis
8. Family history 15. Treatment plan
IDENTIFYING DATA
1. Name
2. Age
3. Sex
4. Marital Status
5. Race or ethnicity
6. Occupation
7. Referral source
SOURCE AND RELIABILITY
● Clarify where the information has come from

● Assessment of how rerliable the data are
CHIEF COMPLAINT
● Presenting complaint
● Patient’s own words (ideally)
○ Examples: “I’m depressed” or “I have a lot of anxiety.”
● Relative’s own words
HISTORY OF PRESENT ILLNESS
● Chronological description of the evolution of symptoms
● The essential question to be answered in the HP should
include:
○ What (symptoms)
○ How much (severity)
○ How long
○ Associated factors
HISTORY OF PRESENT ILLNESS
● Why is the patient seeking help now? What are the

triggering factors?
● Was there any treatment received? Is that treatment
continuing? If not, why not?
PAST PSYCHIATRIC HISTORY
● Past treatment episodes
a. What was tried, how long, what doses, why was it
stopped
b. Response to medication or modality
c. Side effects
d. Compliance to treatment
PAST PSYCHIATRIC HISTORY
● Past suicidal ideation, intent, plan, attempts

● Violence and homicidality history
● Non-suicidal self-injurious behavior
SUBSTANCE USE, ABUSE AND
ADDICTION
● Includes: alcohol, drugs, medications, tobacco, caffeine use,
gambling, eating behaviors, internet use
● Frequency, route and amount of use should be determined
● Tolerance and any withdrawal symptoms
● Impact of use on social interactions, work, school, legal
consequences, and DWI
SUBSTANCE USE, ABUSE AND
ADDICTION ● RAPS4
● Questionnaires: CAGE
● C : cut down drinking ○ R: Remorse
○ A: Amnesia
● A: annoyed when
criticized about drinking ○ P: Perform
● G: guilty ○ S: Starter
● E: eye-opener to get rid

of hangover Sadock, B.J., Sadock, V. A. & Ruiz, P. (2015), Kaplan and Sadock’s Synopsis of Psychiatry:
Behavioral Sciences/ Clinical Psychiatry 11 Edition. Philadelphia: Wolters Kluwer
th
PAST MEDICAL HISTORY
● History of treatment episodes
● Major medical illnesses and conditions, as well as
treatments
● Past surgeries
● Previous neurologic issues: seizures, head injury, pain
disorder
● Prenatal, perinatal and developmental problems should be
noted
PAST MEDICAL HISTORY
● Reproductive and menstrual history

● Current medications, duration of intake, compliance, effect
and side effects
● Allergies to medications
FAMILY HISTORY
● Psychiatric diagnoses, medications, hospitalizations,
substance use disorders, lethality history
● Medical illnesses present in family histories
● Family traditions, beliefs and expectations
● Family’s attitude toward, and insight into, the patient’s illness
● Identify potential support, potential stresses, availability and
adequacy of potential caregivers
DEVELOPMENTAL AND SOCIAL
HISTORY
● Prenatal or birthing history and developmental milestones
● Childhood history
● School history
● Work history
● Nature of relationships with coworkers
● Patient’s income, financial issues, insurance coverage
● Military history
DEVELOPMENTAL AND SOCIAL
HISTORY
● Marriage and relationship history
● Current relationship with family members
● Legal history
● Social history
● Cultural and religious influences on the patient’s life
● Sexual history
REVIEW OF SYSTEMS
● Current physical or psychological symptoms not
already identified in the HPI
● Neurological and systemic symptoms
● Illnesses that might contribute to the presenting
complaints or influence the choice of therapeutic
agents Sadock, B.J., Sadock, V. A. & Ruiz, P. (2015), Kaplan and Sadock’s Synopsis of Psychiatry:
MENTAL STATUS
EXAM
MENTAL STATUS EXAM
● SPEECH
- Fluency
- Full command of the language
- Stuttering / word finding difficulties / paraphasic errors
- Amount
- Normal, increase, decreased
MENTAL STATUS EXAM
- Rate
- Slowed, rapid/pressured
- Tone and volume
- Irritable, anxious, dysphoric, loud, quiet, timid,
angry
● MOOD
- Internal and sustained emotional state
- Subjective = USE PATIENT’S OWN WORDS
MENTAL STATUS EXAM
● AFFECT
- What the patient’s mood appears to be to the clinician
- Quality: dysphoric, happy, euthymic, irritable, angry,
agitated, tearful, sobbng, flat
- Quantity: intensity
- Range: restricted, normal or labile
- Appropriateness: correlation of the affect to the setting
- Congruence
MENTAL STATUS EXAM
● THOUGHT CONTENT
- Spontaneous expression and responses to specific
questions
- Obsessional
- unwelcome and repetitive thoughts
- Resisted by the patient
MENTAL STATUS EXAM
- Compulsions
- repetitive , ritualized behaviors to avoid anxiety
- Delusions
- False, fixed ideas not shared by others
- Bizarre vs nonbizarre
Thought Process
● How thoughts are formulated, organized and expressed

● Ideas should be linear, logical and goal-directed
Thought Process
● Form:
○ Conversational, spontaneous, logical, relevant, pertinent,
concise, verbose, circumstantial, tangential/deranged,
rambling, repetitive, confusing, perseverating, illogical, etc.
● Rate
○ Accelerated, rapid, pressured, normal, slowed, hesitant,
interrupted, blocking
Perceptual Disturbances
● Include hallucinations, illusions, depersonalization and
derealization Perception in the absence of stimuli to account for them
Forms: Auditory (most frequent in psychiatric setting), visual,
Hallucination tactile, olfactory, and gustatory
Sensory experience with some reality basis

(e.g. Hearing the wind rustle through the trees outside one’s
Illusions bedroom and thinking a name is being called)
Depersonalization Feeling that one is not oneself or that something has changed
Feeling that one’s environment has changed in some strange way

Derealization that is difficult to describe
Cognition
● Elements: Alertness, orientation, concentration, memory
(both short and long term), calculation, fund of
knowledge, abstract reasoning, insight and judgment
● Abstract Reasoning
○ Ability to shift back and forth between general
concepts and specific examples
Insight and Judgment
● Insight
○ Refers to the patient’s understanding of how he or
she is feeling, presenting, and functioning as well as
the potential causes of his or her psychiatric
presentation
○ No insight, partial insight or full insight
○ Component: Reality testing in patients with psychosis
Insight and Judgment
● Judgment
○ Refers to the person’s capacity to make good
decisions and act on them
○ Level of judgment may or may not correlate to the
level of insight
○ Better to use real situations from patient’s own
experience to test judgment

Psychiatric Interview, MSE

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PSYCHIATRIC INTERVIEW

and MENTAL STATUS

6. Have empathy for the patient while maintaining

○ Length of time for the initial session

● Clarify where the information has come from

● Why is the patient seeking help now? What are the

● Past suicidal ideation, intent, plan, attempts

● E: eye-opener to get rid

● Reproductive and menstrual history

● How thoughts are formulated, organized and expressed

Sensory experience with some reality basis

Feeling that one’s environment has changed in some strange way

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