The Psychiatric Interview: A Guide to History Taking and the Mental State Examination

Modern psychiatric practice and research rely heavily on structured pencil-and-paper instruments for diagnosis and for following symptom severity and change. The move to standardized assessment, which gathered momentum in the 1960s, has been enormously important to progress across all facets of our field, from epidemiologic and treatment research, to biological psychiatry, to the training of students and residents. It has also had its maddening aspects, such as the rote application of checklists to determine the need for treatment in managed care settings. This grim example, all too commonly encountered, serves as a reminder that first-rate psychiatric assessment is a complex craft requiring the observation and integration of multiple signs and symptoms with well-honed clinical judgment and that this should not become a lost art.

Enter Saxby Pridmore’s The Psychiatric Interview. The title is something of a misnomer in that the book is not a guide to diagnostic interviewing and DSM-IV diagnosis per se. Rather, it is a thorough treatment of the mental status examination that is clinically sound, understandable, and enlightening. For each domain—appearance, speech, mood, affect, thought, perception, intelligence, cognition, rapport, and insight—a chapter is devoted to description of the many more common as well as less common signs and symptoms that are germane to psychiatric assessment. The signs and symptoms are carefully described, along with suggestions about how to elicit them during the interview. Numerous examples are provided in the form of photographs, sketches, and writing samples of patients, drawn from the author’s wealth of clinical experience. These serve to illustrate several phenomena, particularly disorders of thought and mood, that are difficult to appreciate through text alone. A closing chapter on office assessment of frontal lobe function is brief but highlights an important domain not often considered in the routine clinical examination.

In summary, this is an excellent text for advanced trainees in psychiatry and related fields, as well as for experienced practitioners and teachers who wish to bone up on the fundamentals of the mental status examination. One does sometimes wish that the discussion were more rooted in the contemporary research literature in addition to the author’s rich clinical experience. However, this would surely lengthen the text and maybe dampen its impact as a concise training tool. The text may be too detailed for beginning medical students, but it certainly will be useful in the training of psychiatric residents, neurologists, and primary care physicians with an interest in disturbances of mental status, as well as psychologists and psychiatric nurse practitioners and social workers.