All aspects of the person, including facial appearance, clothing, grooming and self-care are observed for a proper diagnosis, as well as the person’s composure and distractibility during the interview.
The patient’s posture and level of activity may give clues about their mood, for instance psychomotor retardation in depression.
Some disorders and side effects are also associated with particular movement disorders, e.g. tremor and bradykinesia (unusually slow movement) with Parkinson’s disease or the extrapyramidal side-effects of antipsychotic medication.
Specific movement patterns such as echopraxia (involuntary imitation of the movements of others) may indicate catatonia.
Some people with depression or the negative symptoms of schizophrenia display little or no spontaneity of speech, and a lack may also be observable in catatonia.
The volume of voice and rate of speech may be raised in anxiety, mania or anger, and lowered in depression. Similarly, these conditions may affect the quantity of speech.
The flow of speech may also be affected, for instance in mania the speech may be impossible to redirect the person from their topic of choice.
The form of speech may indicate a disorder of thought form. In persons who have a neurological or specific speech disorder (e.g. stuttering) this may not be the case.
The overarching and characteristic themes of the person’s conversation, including the positivity or negativity of such topics, the normality of content and any evident preoccupations are noteworthy.
A person may have a predominantly elevated mood and a highly reactive and labile affect, veering rapidly from enthusiasm to anxiety to irritability to laughter.
If the person’s mood appears depressed, questions probing suicidal ideation should be asked.
Thought can be inferred from observing speech and behavior. Its quantity should be noted: poverty of thought occurs in depression, dementia or schizophrenia. The rate of thought is affected in a similar manner to the rate of speech for the most part: many people with mania have pressure of thought and some people with depression have bradyphrenia (slowed thought stream).
The form of thought may indicate specific problems. Several types of thought disorder, such as tangentiality, derailment and neologisms are signs of psychosis. Clanging or punning associations are often indicative of mania and thought blocking and echolalia (automatic repetition of another’s words) may indicate the presence of catatonia. Thought disorder (“word salad”) may be so severe that no sense can be made of the person’s conversation.
The content of thought may include delusional thinking: a fixed false belief that is not normal for the person’s background. The nature of the delusion and the degree of conviction with which it is held is important in determining risk.
Continued Suicidal and homicidal ideas, and the presence and nature of any obsessions, are also considered in thought content.
Hallucinations (a perception in the absence of sensory stimulus) may affect any sense (auditory, tactile, olfactory, visual and gustatory). The most common type of hallucination in mental illness is auditory.
It is particularly important to enquire about command hallucinations, where individuals hear and sometimes obey voices that command them to perform certain acts – especially if that may influence them to engage in dangerous behavior.
Illusions are similar to hallucinations, but involving misperception of a real stimulus.
Depersonalization and derealization are odd experiences where the person feels as though either they themselves or the world around them are unreal. Both are often associated with anxiety.
Substance use disorders are common coping mechanisms for symptoms of mental health and at Refresh Recovery mental health treatment centers San Diego offer the attention to co-occurring including alcohol, heroin and benzodiazepines among other drugs and substances.