All aspects of the person, including facial appearance, clothing, grooming, and self-care, are observed for a proper diagnosis and the person’s composure and distractibility during the interview.
The patient’s posture and activity level 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 (prolonged 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 speech rate 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, the address may be impossible to redirect the person from their topic of choice in mania.
The form of speech may indicate a disorder of thought-form. This may not be the case in persons with a neurological or specific speech disorder (e.g., stuttering).
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 thinking occurs in depression, dementia, or schizophrenia. The rate of thought is affected similarly to the speed of speech for the most part: many people with mania have the 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 disorders, 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 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 vital in determining risk.
Continued Suicidal and homicidal ideas and the presence and nature of any obsessions are also considered in thought content.
Hallucinations (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 acoustic.
It is crucial to enquire about command hallucinations, where individuals hear and sometimes obey voices that command them to perform certain acts – significantly if that may influence them to engage in dangerous behavior.
Illusions are similar to hallucinations but involve misperception of an actual stimulus.
Depersonalization and derealization are odd experiences where the person feels as though they or the world around them are unreal. Both are often associated with anxiety.
Substance use disorders are common coping mechanisms for mental health symptoms. At Refresh Recovery, mental health treatment centers in San Diego offer attention to co-occurring, including alcohol abuse, heroin, and benzodiazepines, among other drugs and substances.
