History and Mental Status Examination Psychiatry

From 1991-2006, the suicide rate was consistently higher among males. Suicide rates declined among both sexes from 1991-2000; the rate among males decreased from 24.64 to 20.67 suicides per 100, 000 and 5.48 to 4.62 suicides per 100, 000 among females. From 2000-2006, however, the suicide rates gradually increased among females. Note: All rates are age-adjusted to the standard 2000 population. Rates based on less than 20 deaths are statistically unreliable. Source: Centers for Disease Control and Prevention. National suicide statistics at a glance: Trends in suicide rates among persons ages 10 years and older, by sex, United States, 1991-2006. Available at: Accessed: May 5, 2010.

Then, the patient's sensorium and cognition are examined, most commonly using the Mini-Mental State Examination. The interviewer should ask patients if they know the current date and their current location to determine their level of orientation. Patients' concentration is tested by spelling the word "world" forward and backward. Reading and writing are evaluated, as is visuospatial ability. To examine patients' abstract thought process, have them identify similarities between 2 objects and give the meaning of proverbs, such as "Don't cry over spilled milk." Once this is completed, perform the physical examination and needed laboratory tests to help exclude medical causes of presenting symptoms.

A compilation of all information gathered throughout the interview and MSE leads to the differential diagnosis of the patient. Once this diagnosis is established, a treatment plan is formulated. At this point, involving the treatment team (eg, social workers, nurses, others) is important to help carefully explain to patients what their treatment will entail. Be sure to ask patients if they have any questions regarding their treatment plans. Discuss the details of the medications chosen, including adverse effects. Give details of the hospital stay if patients are to receive inpatient treatment, such as estimated length of stay, visiting hours, and other aspects. Inform patients that even though the interviewer is the treating physician, their input and concerns are valuable and necessary in order to fulfill treatment goals.