The Clinical Interview and the Mental Status Exam

The clinical interview is the core of most clinical work and is used primarily to gather information about past and present behavior, attitudes, emotions, and a history of the person's problem(s) and life circumstances. Other important points to cover include precipitating events, family composition and history, sexual development, religious beliefs, cultural concerns, educational achievement, and social-interpersonal history.

To organize information obtained during an interview, many clinicians will use a mental status exam; an exam that involves the systematic observation of a client’s behavior across five domains:

a. Appearance and behavior
b. Thought processes (e.g., rate and flow of speech, clarity, and content of speech and ideas)
c. Mood and affect (e.g., is affect and mood appropriate of inappropriate?)
d. Intellectual functioning (e.g., does the client have a reasonable vocabulary and memory?)
e. Sensorium (i.e., general awareness of surroundings such as date, place, time, knowledge of self).

Clinical interviews may be structured or semistructured.

Unstructured clinical interviews are not standardized with respect to procedure and content and follow no systematic format.

Semistructured clinical interviews contain questions that have been carefully phrased and tested to elicit useful information in a consistent manner, but also allow room for clinicians to depart from the format with additional questions of interest (e.g., Anxiety Disorders Interview Schedule, 4th ed., or the Structured Clinical Interview for DSM).

Clinicians often recommend a physical examination, particularly if the patient has not been seen by a medical doctor in the past year. The reason for the physical exam is to rule out medical conditions that are associated with psychological disorders and those that may masquerade as psychological disorders. Examples of physical conditions that may lead to psychological problems include toxic states, hyperthyroidism (anxiety), hypothyroidism (depression), brain tumor, and drug ingestion.

There are a variety of ways to conduct a clinical interview. The best way is the one that values your client's input and systematically records your clinical observations for later evaluation. It is important to conduct the clinical interview in a way that elicits the patient’s trust and empathy in order to facilitate communication. Alway remember, information provided by patients to psychologists and psychiatrists is protected by laws of confidentiality.