The American Psychiatric Publishing

TEXTBOOK OF PSYCHIATRY
Fifth Edition
Edited by Robert E. Hales, M.D., M.B.A., Stuart C. Yudofsky, M.D., Glen O. Gabbard, M.D.
© 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org

CHAPTER 1

The Psychiatric Interview and

Mental Status Examination
Linda B. Andrews, M.D.

Slide show includes…

Topic Headings
Tables
Key Points

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 1
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 CHAPTER 1 • Topic Headings

REQUISITE PHYSICIAN PREPARATION THE MENTAL STATUS EXAMINATION

General Appearance
CONDUCT OF THE PSYCHIATRIC INTERVIEW
Orientation
Goals and Purpose
Speech
Guidelines for the Interview
Motor Activity
Pre-Interview Contact
Affect
PROCESS OF THE PSYCHIATRIC INTERVIEW Mood
Thought Production
CONTENT OF THE PSYCHIATRIC INTERVIEW Thought Content
Chief Complaint and History of Present Illness Perceptual Disturbances
Past Psychiatric History Suicidal and Homicidal Ideation
Family Psychiatric History Attention, Concentration, and Memory
Medical History Abstract Thinking
Social History Insight/Judgment
Developmental History
Review of Systems DIAGNOSTIC FORMULATION AND TREATMENT
PLANNING
CONCLUSION

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 2
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 CHAPTER 1 • Tables

Table 1–1. Tasks for the therapist conducting a psychiatric interview

Table 1–2. Outline of the psychiatric interview
Table 1–3. Outline of the mental status examination
Table 1–4. Steps in developing a diagnostic formulation and treatment plan
Table 1–5. DSM-IV-TR multiaxial assessment and differential diagnosis
Summary Key Points

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 3
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 The first—and perhaps most important
—task in the psychiatric interview is to
establish rapport with the patient (Table
1–1). Establishing an effective working
relationship will be necessary to
accomplish all of the other objectives of
the interview.

TABLE 1–1. Tasks for the therapist

conducting a psychiatric interview

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 4
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
Once the introductions, instructions, and consents have been completed, the psychiatrist may
focus on obtaining information from the patient (Table 1–2). If time allows, the interviewer should
cover all key elements of the psychiatric history and mental status examination.

TABLE 1–2. Outline of the psychiatric interview

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 5
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
The psychiatric interviewer completes the mental status examination by combining a series of
observations with a series of formal questions (Table 1–3). The purpose of the mental status
examination is to provide as clear a picture as possible of the patient’s actual mental state at the
time of the psychiatric interview or evaluation.

TABLE 1–3. Outline

of the mental status
examination

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 6
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
The steps involved in consolidating a diagnostic formulation and developing a treatment plan are
listed in Table 1–4.

TABLE 1–4. Steps in developing

a diagnostic formulation and
treatment plan

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 7
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
The psychiatrist must develop a working diagnosis using the five-axis classification system
delineated in DSM-IV-TR (Table 1–5).

TABLE 1–5. DSM-IV-TR

multiaxial assessment and
differential diagnosis

Source. Adapted from American Psychiatric

Association 2000, pp. 27–33.

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 8
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 CHAPTER 1 • Key Points

 Establish rapport and communicate respect. Introduce yourself, use patient’s

name, make eye contact, and limit interruptions.

 Use empathic connection to guide and adjust interview to match the particular
patient and situation.
- Follow the patient’s leads or cues whenever possible and use open-
ended questions to increase depth of understanding and information
gathered (fewer topics covered, greater depth).
- Use focused questions to increase breadth of understanding and
information gathered (more topics covered, less depth).
- Increase focus of questions for patients with disturbances of thought
content or production, perceptual disturbances, or cognitive deficits.
- Abbreviate the interview for acutely agitated, dangerous, or medically
compromised patients.
- Use words that the patient can understand-avoid medical jargon; assess
the patient’s education, language, and cultural needs; and use a
translator when necessary.
- Clarify and verify that the patient understands you and that you
understand the patient. (continued)

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 9
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 CHAPTER 1 • Key Points (continued)

 Assess the patient’s safety, including assessment of suicide risk in every

patient.
- Assess dangerousness early and often during an interview with a
potentially dangerous patient.

 Take notes to record necessary data, but do not let note taking interfere with
your ability to establish and maintain rapport with the patient.
- Review available medical records and test results before completing your
assessment and developing your treatment plan.
- Interview other relevant persons in the patient’s life.

 Cover all key elements of the psychiatric history and mental status
examination.
- Psychiatric history includes chief complaint, history of present illness,
past psychiatric history, past medical history, social history,
developmental history, family psychiatric and medical history, and review
of systems.

(continued)

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 10
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org
 CHAPTER 1 • Key Points (continued)

- For the mental status examination, observe or assess the following

aspects of behavior and thought: general appearance; orientation;
speech; motor activity; affect and mood; thought production; thought
content; perceptual disturbances; suicidal or homicidal ideation;
attention, concentration, and memory; abstract thinking; and
insight/judgment.

 Formulate the data gathered during psychiatric interview and develop a

biopsychosocial formulation and a thorough differential diagnosis, including
information for all five DSM-IV-TR axes.
- Develop a treatment plan that includes appropriate biological,
psychological, and social interventions and considers the patient’s
overall prognosis.
- Ensure that the patient understands the treatment goals and plan, and
verify that the patient can afford the treatment recommendations.
- Document if the patient refuses treatment.
- Establish follow-up plans (e.g., next appointment, tests to complete).

The American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition. Edited by Hales RE, Yudofsky SC, 11
Gabbard GO. © 2008 American Psychiatric Publishing, Inc. All rights reserved. www.appi.org