Use screening tools
Standardised screening tools can greatly assist reliability in identifying mental
illness and/or substance abuse problems. Many are self-completion. They can take
from 2 to 15 minutes to complete.
If the client has case notes, review previous assessments, issues and summaries.
The presenting issue
Listening and listing the presenting issue/complaint(s) may unfold symptomatology
surrounding the issue and social context. e.g.
"What brings you here?"
"How has that affected you?"
"What did this make you think/feel?"
"How long has this been going on - when were you last your normal self?"
"How has this affected the rest of your life - work, interests. sleep?"
"When was the last time you enjoyed yourself?"
"Is this affecting the other members of the family? How are your children going
"Have you had this problem before? What did you do? What worked?" Are you
getting help from anyone else?
Assessment of suicidality and dangerousness
"Does it ever seem that life is not worth living?"
"Have you ever thought of ever harming or even killing yourself?"
"Have you ever had any previous suicide attempts or tried to hurt yourself?"
Investigate further if there is any indication of suicidal or self-harm thoughts or
Past psychiatric history
- Time and nature of previous presentations
- Past and current treatments and their effectiveness
- Names of previous therapists
- Past admissions
Past medical history
Alcohol and other substance use
- The amount consumed and the period and pattern of use
- Tolerance: increasing amounts required to acheive the same effect
- Withdrawal symptoms
- Previous attempts to cut down - were they successful
- Salience of drug use: ie how central is drug us to the person's life - time spent at the
expense of other life areas
- Complications: physical (eg. alcohol associated liver disease, peptic ulcer)
psychological (eg. amphetamine induced depression)
- Disability and handicap: loss of job, legal (eg. driving under the influence), social
(eg. neglect of children, marital breakdown)
Family psychiatric history
Childhood, Schooling, Work history, Marital/relationship history, Current interests, Goals
- "What sort of person are you when you are well?"
- Some underlying personality disorders may predispose to the development of mental
disorder: eg. antisocial personality leading to drug addiction leading to depression.
Mental State Examination
General appearance, grooming, etc. Caution regarding cultural norms. For example the
'grunge' look is appropriate for some youth culture
Slow or accelerated movements, anxious looking, etc.
Note volume and rate of speech. For example, pressure of speech (speaking very fast) may
indicate amphetamine use, mania or both.
Mood refers to the sustained emotional tone as reported by the individual. For example
depressed, angry, elated,irritable or anxious.
Affect refers to the varying emotional response witnessed during the interview. For
example, appropriate, flat, labile, fatuous.
While those with schizophrenia may experience hallucinations in any sensory area (visual,
gustatory, olfactory, auditory), the most common hallucinations are auditory.
Psychotic symptoms which are organic in origin may have hallucinations arising in any
sensory area (eg. alcoholic hallucinosis tend to feel things crawling over their skin and
Loose associations to incoherence (eg schizophrenia). Concrete thinking without the
ability to abstract (eg alcoholic brain disease or schizophrenia)
Delusions are a psychotic symptom. They may be persecutory, grandiose, nihilistic,
bizarre. Delusions are different from people with overvalued ideas (eg those with
hypochondriasis). Those with anxiety disorders may exhibit phobias, obsessions or
A person with schizophrenia may experience thought insertion, thought withdrawal, thought
broadcast, or thought block. Some of these symptoms (eg thought block) can be
associated with chronic drug use and depression.
From flight of ideas to psychomotor retardation.
for the mini-mental status examination commonly used to determine cognitive functioning.
If using this click here
for norms against age and educational status - USA)
- Level of consciousness
- Orientation to person, place and time
- General knowledge, abstract thinking and judgement