Clinical Assessment, Interviewing and Psychiatric Examination
Structure of the assessment
A defensible psychiatric assessment follows a fixed sequence: presenting complaint and history of present illness, past psychiatric and medical history, medication, substance use, family and social history, developmental and forensic history, then the Mental State Examination (MSE). The MSE is a cross-sectional snapshot organised in a set order - appearance and behaviour, speech, mood and affect, thought form and content, perception, cognition, insight, and risk.
Interviewing skills
Know the difference between open (facilitative, exploratory) and closed (clarifying) questions, and when to switch. Understand active listening, reflection, summarising and clarification. Examiners test how to handle difficult situations: an agitated patient (safety first, short sentences, offer choices), a guarded patient (build rapport, avoid confrontation), a patient with suspected cognitive impairment (collateral history is mandatory).
Traps
- Confusing mood (sustained subjective state) with affect (observed, fluctuating expression).
- Reporting a diagnosis in the MSE instead of describing findings.
- Missing risk assessment as a discrete, documented step covering self-harm, suicide, harm to others, and safeguarding.
Rule of thumb
When asked what to do first with a distressed or aggressive patient, the answer is almost always ensure safety and establish rapport - not to complete the history.