CHAPTER 1 The psychiatric interview and mental state examination
The key to psychiatric assessment is a comprehensive history and mental state examination. The history needs to cover the history of the presenting complaint, past psychiatric history and a longitudinal perspective of the patient, with important ‘milestones’ and events highlighted. A family history is also important.
Any relevant physical examination and laboratory tests need to be performed to cover treatable ‘organic’ causes and contributors to the psychiatric presentation. This is covered in Chapter 2 of this book.
The framework presented here is taken largely from the so-called ‘Maudsley’ approach, named after the famous London psychiatric hospital. For a more detailed expostulation of the Maudsley approach, see the ‘References and further reading’ at the end of this chapter. This schema is for use in adults: adaptations for children and adolescents, and the elderly, are provided in Chapters 16 and 17, respectively. Special considerations pertinent to people with an intellectual disability are given in Chapter 19.
The history
The main areas covered in the history are shown in Box 1.1. Of course, there is some flexibility about the sequence of questions, but ensure you cover the major areas. Generally, starting with non-directive, ‘open’ questions is recommended, later honing in on specific issues with more focused questioning. Certain issues such as suicidality must always be assessed thoroughly (see Ch 15 for a suggested approach).
Past psychiatric history
Full details are needed of past psychiatric illnesses, including first manifestation of psychiatric symptoms, first contact with a health professional for a mental health problem, and longitudinal course of psychiatric problems, including any hospitalisations; self-harm and suicide attempts should be asked about specifically. An overview is required of treatments received (psychological, medication and electroconvulsive therapy (ECT)); engagement with and adherence to such treatments; and treatment response and any adverse effects experienced. A list of current medications should be obtained.
