Interview assessment methods and applications

Mental status examination involves an evaluation of the client's self-presentation, manner with others, orientation towards the world, general level of alertness, thought processes, and his or her mood. The therapist conducts an observation and evaluation of external and internal aspects of the client's functioning, such as the client's hygiene and the ability to rationally speak to the interviewer, as well tests the client's recall and memory, and the ability to use expressive language (Niolin 2000).

The mental status examination is not superficial: it is important to note the client's ability to engage in basic social functioning. Someone who cannot engage in basic self-care or answer simple questions about him or herself will raise a diagnostic red flag, although it is important that the therapist does not arrive at over-hasty diagnosis.

General appearance and behavior

The therapist should note observable aspects of the client's appearance, including basic demographic data such as sex, weight, age, basic hygiene, if the client is wearing weather-appropriate attire, and if the client exhibits normal motor coordination. Deficits in these areas can indicate mood disorders, eating disorders, or other complications. Behavioral attitudes such as speech, receptiveness to treatment, and other modes of self-presentation should also be evaluated.

General appearance and behavior can provide clues about the client's problem, given the prevalence of certain mental illnesses in specific population groups, and must also influence the therapist's approach to the client. A resistant adolescent with depression may manifest the illness differently (with irritability rather than lethargy) than a depressed adult and require different intervention strategies.

Feeling (affect and mood)

The client's general demeanor or 'feeling' should also be assessed. Is the client visibly anxious? Does he or she speak slowly or quickly, and show signs of depression or mania? Asking the client how he or she feels on most days, if he or she has trouble sleeping or eating, and assessing the client's risk of self-directed violence or violence directed at others is essential (Niolin 2000).

Aspects of this assessment are to some degree subjective on the part of the initial assessor, as some illnesses, such as schizophrenia and the manic phase of bipolar disorder, can resemble one another in the client's presentation of his or her feelings. Additionally, the questioner should know that some mood disorders can present themselves somatically: someone who is anxious may have a racing pulse, and someone who is depressed may have difficulty sleeping, eating, or engaging in basic self-care.

Perception

Aspects of the client's presentation to consider when evaluating his or her perception may include orientation (knowing where he or she is), alertness, coherence and ability to concentrate. Recall can be tested by asking questions about the date, who is president, etcetera; concentration can be tested by using a Digit Span test -- asking the client to count backwards from 100 to 50 by 7s or 3s (Niolin 2000). Noting the presence of delusions or hallucinations, gaining a rough estimate of the client's intellectual ability, thought processes, and judgment (ability to understand why he or she is being assessed), and assessing his or her ability to engage in abstraction (such as understanding proverbs) must be part of evaluation (Niolin 2000).

This assessment must be culturally specific: someone from another country might have difficulty understanding the U.S. mental health system or abstraction, and may be more difficult to assess for intellectual ability because of language barriers.