98 CHAPTER 3
P SNdescribe the problem, its history, and the patient’s functioning in different
areas of life. Other standard questions in the mental status exam probe the
patient’s ability to reason, to perform simple mathematical computations,
and to assess possible problems in memory and judgment. The clinician uses
the patient’s answers to the standard questions to develop hypotheses about
possible diagnoses and diffi culties with functioning, and then asks other ques-
tions to obtain additional information. For instance, as part of the mental
status exam, patients are routinely asked whether they remember their own
name, the date and year, and who is president. If the patient doesn’t remem-
ber correctly who the current president is, the clinician might ask other, more
detailed questions involving different aspects of memory—such as memories
of other languages spoken, of more distant events or important personal
events in the recent past—which may refl ect an underlying neurological prob-
lem. People from other cultures may answer some of the questions in a men-
tal status exam in unconventional ways, and clinicians must take care not to
infer that “different” is “abnormal.”
The mental status exam assesses cognitive, emotional, and behavioral func-
tioning broadly, and the standard questions are not designed to obtain specifi c
information that corresponds to the categories in DSM-IV-TR. The interviewer
can arrive at a diagnosis based on answers to both standard and follow-up
questions, but the goal of the mental status exam is more than diagnosis: It
seeks to create a portrait of the individual’s general psychological functioning.
The mental status exam contrasts with another semistructured interview
format—theStructured Clinical Interview for DSM-IV, Axes I and II (SCID-I
and SCID-II; First et al., 1997, 2002), which is generally used when the interview
is part of a research project and is designed to assist the researcher in diagnosing pa-
tients according to the DSM-IV-TR. The SCID provides modules that correspond
to different categories of disorders. Each module starts off with a question to assess
whether the individual has symptoms related to that category of disorders. If the
patient does not have such symptoms, the rest of the questions in the module are
skipped. If symptoms are present, the SCID lists the questions the interviewer should
ask. The questions correspond to DSM-IV-TR criteria lists, such as that in Table 3.4.
Based on the patient’s responses, the interviewer can readily determine which disor-
der (if any) is the most appropriate diagnosis. Such DSM-related tools generally do
not require the interviewer to interpret patients’ answers.
Clinical interviews provide a wealth of information, about the patient’s symp-
toms and the patient’s general functioning, as well as about the context in which
the symptoms arose and continue. However, a thorough clinical interview can be
time-consuming and may not be as reliable and valid as assessment techniques that
utilize tests.Tests of Psychological Functioning
Many different tests are available to assess different areas of psychological function-
ing. Some tests assess a relatively wide range of abilities and areas of functioning
(such as intelligence or general personality characteristics). Other tests assess a nar-
row range of abilities, particular areas of functioning, or specifi c symptoms (such as
the ability to remember new information or the tendency to avoid social gatherings).Cognitive Assessment
One tool to assess cognitive functioning is an intelligence test. Clinicians typically
use the Wechsler Adult Intelligence Scale, 4th edition (WAIS-IV, revised in 2008)
or the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV, revised in
2003), depending on the age of the patient.Numerical results of these tests yield an
intelligence quotient (IQ); the average intelligence in a population is set at a score
of 100, with normal intelligence ranging from 85 to 115. IQ scores of 70 to 85 are
considered to be in the borderline range, and scores of 70 and below signify men-
tal impairment. However, the single intelligence score is not the only importantAs part of the mental status exam, patients are
asked whether they know their own name, the
date and year, and who is currently president.
Patients who do not know these facts may have
some type of memory impairment. Further tests
will be done to determine the specifi c memory
problems, their cause, and possible treatments.Photo Edit