Mental Health Assessment – a starting point


Dress, Grooming and Personal Hygiene:

  • Include style of dress and its appropriateness to the patient’s age and situation
  • Unkempt appearance in depression, chronic organic brain disease
  • meticulous grooming of the compulsive personality.


Facial Expression:

  • observe facial mobility at rest and in interaction with others
  • watch for variations in speech and manner.
  • Depression, anxiety, apathy, anger, facial immobility occurs in Parkinson’s



  • Quality – loudness, clarity, inflection
  • Quantity – pace, volume
  • Organization – coherence, relevance, circumstantiability
  • Slow monotonous tone of depression, pressure of speech, flight of ideas in manic conditions, incoherent circumstantial speech with neologisms (self-coined speech) in schizophrenia.


Manner,Mood and Relation to Person and Things

  • note variations according to the topics under discussion and to other activities or People around him
  • note the patient’s openness and approachability
  • watch for the following:
  1. Uncooperativeness
  2. evasiveness
  3. hostility
  4. anger
  5. resentment
  6. depression
  7. tearfulness
  8. elation
  9. distrustfulness



Assess the patient’s mood, not only by observation, but through line of questioning

This may be accomplished through the interview by asking:

“How did you feel about that”

of generally “How are your spirits”

If you suspect depression, it is essential that you assess its depth and the associated risk of suicide

A series of questions like the following is useful, proceeding as far as the patient’s positive answers warrant.

  • Do you get pretty discouraged, depressed or blue
  • How low do you feel
  • What do you see for yourself in the future
  • Do you ever feel that life isn’t worth living? Or that you had just as soon be dead?
  • Have you ever thought of doing away with yourself?
  • How did, do you think you would do it?
  • What would happen after you were dead?


Thoughts Processes and Perceptions

Coherency and Relevance of Thought Processes

  • observation of the way in which the patient describes his history is most important here
  • incoherent, disorganized thought occurs in schizophrenia


Thought Content

  • much information about the patent’s thought content has probably been revealed in the interview.
  • additional inquires may be necessary to ascertain specific symptoms
  • Phrase your questions in the context of the patient’s history, follow leads provided by the patient’s own words
  • “Sometimes when people are upset like this, they can’t keep certain thoughts out of their minds”


Thoughts associated with neurotic disorders:

  1. Compulsions – repetitive acts that the patient feels driven to do
  2. Obsessions – recurre t, uncontrollable thoughts
  3. Ruminations – repetitive or continuous thinking or speculations, often about everyday decisions
  4. Doubting and indecision – excessive time-consuming uncertainties about everyday decisions
  5. Phobias – irrational fears
  6. Free-floating anxieties – sense of ill-defined or impending doom

Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.


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