Overview
This lecture explains how to take a psychiatric history and conduct a Mental Status Exam (MSE), highlighting key differences from general medical interviews and detailing the components of the MSE.
Structure of the Psychiatric Interview
- Psychiatric interviews use the SOAP format:
- S: Subjective
- O: Objective
- A: Assessment
- P: Plan
- In psychiatry, the Subjective section covers the patient’s history, while the Objective section is mainly the Mental Status Exam.
- Key history components: chief complaint, history of present illness (HPI), past medical and surgical history, allergies, medications, family and social history.
- For psychiatric patients, also include past psychiatric history, detailed substance abuse history, and family psychiatric history.
History of Present Illness (HPI) in Psychiatry
- HPI focuses on both symptoms and social impact.
- Assess support systems, living situation, and how the problem affects daily life.
- Look for symptoms affecting sleep, appetite, energy, and concentration (use the "SIG E CAPS" mnemonic for depression).
- Always ask about suicidal ideation, homicidal ideation, and psychotic symptoms (such as hallucinations and delusions).
Mental Status Exam (MSE)
- The MSE replaces the physical exam in psychiatry and includes:
- Appearance and behavior: clothing, hygiene, notable features, motor movements, eye contact, cooperativeness.
- Speech: rate, volume, articulation, fluency, and grammar.
- Mood and affect: Mood is the patient’s stated feeling; affect is the observed emotion (intensity, appropriateness, congruence, mobility).
- Thought process and content: Includes hallucinations, delusions, racing thoughts, phobias, and obsessions.
- Cognition: Orientation (person, place, time), memory (immediate and short-term), language, abstract thinking, and visual-spatial skills (can be assessed with the Mini-Mental State Exam, MMSE).
- Insight and judgment: Insight is awareness of illness; judgment is understanding the consequences of actions.
Key Terms & Definitions
- Mental Status Exam (MSE) — structured assessment of a patient's current mental functioning.
- Mood — patient’s self-reported emotional state.
- Affect — clinician’s observation of patient’s emotional expression.
- Insight — patient’s awareness of their mental illness.
- Judgment — patient’s ability to anticipate consequences of actions.
- HPI (History of Present Illness) — detailed narrative of current issues and their impact.
- SOAP — Subjective, Objective, Assessment, Plan.
Action Items / Next Steps
- Review and practice the components of the psychiatric history and the Mental Status Exam.
- Learn the SIG E CAPS mnemonic for depression symptoms.
- Become familiar with MMSE questions for cognitive assessment.