Psychiatric assessment, descriptive psychopathology and formulation
A psychiatric assessment begins with a person’s concerns, priorities and account of what has changed. Establish chronology, baseline functioning, sleep, physical symptoms, medicines, substance exposure, relationships and relevant developmental history. Information from another person can be valuable, but its reliability, consent and confidentiality context must be considered. Separate what was observed, what was reported and what the clinician inferred. A diagnostic label without that evidence does not communicate the reasoning.
The mental-state examination describes the present encounter. Appearance and behavior, speech, mood and affect, thought form and content, perception, cognition, insight and judgment are related but distinct observations. Mood is not the same as the emotion the observer perceives in the interview. Derailment describes disrupted associations in speech rather than simply an unusual opinion. An illusion involves a real stimulus that is misperceived; a hallucination is a perception-like experience without a corresponding external stimulus. Internal versus external location alone is not a reliable boundary between genuine and unreal illness.
Assess symptoms within their cultural and interpersonal context. A belief cannot be called delusional merely because it differs from the clinician’s worldview. Ask about the person’s meaning, degree of conviction, alternatives, associated experiences and effects on life. Thought insertion, broadcasting or passivity experiences are useful descriptions, but none alone establishes one specific disorder. Mood episodes, substances, neurological conditions and other medical causes can produce overlapping presentations.
Formulation integrates predisposing, precipitating, maintaining and protective factors into an account that can guide care. It should explain uncertainty and alternative possibilities, rather than turn a list of risk factors into a claim of causation. Screening and severity scales can structure observations or monitor change; they do not replace a clinical assessment or independently decide admission, discharge, capacity or diagnosis. Test interpretation requires the correct instrument, version, language, norms and purpose.
Acute changes in attention, consciousness, orientation or neurological function require particular attention to physical illness, intoxication, withdrawal or medication effects. Safety assessment includes the person’s current situation, intent, access to means, supports and foreseeable changes, not a score alone. Record a collaborative plan and the reasoning for urgent escalation where indicated. This chapter concerns professional assessment principles, without claiming one country’s statutory authority or a universal diagnostic timetable.