| Appearance |
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How does the client look?
Posture – slumped, tense, bizarre.
Grooming – dishevelled, make-up inappropriately applied, poor personal hygiene.
Clothing – bizarre, inappropriate, dirty.
Nutritional status – weight loss, not eating properly.
Evidence of AOD use – intoxicated, flushed, dilated/pinpoint pupils, track marks.
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| Behaviour |
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How is the client behaving?
Motor activity – immobile, pacing, restless, hyperventilating.
Abnormal movements – tremor, jerky or slow movements, abnormal walk.
Bizarre/odd/unpredictable actions.
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How is the client reacting to the current situation and assessor?
Angry/hostile towards assessor/others.
Uncooperative or withdrawn.
Over familiar/inappropriate/seductive.
Fearful, guarded, hypervigilant.
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| Speech and language |
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How is the client talking?
Rate – rapid, uninterruptible, slow, mute.
Tone/volume – loud, angry, quiet, whispering.
Quality – clear, slurred.
Anything unusual about the client’s speech?
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How does the client express himself/herself?
Incoherent/illogical thinking (word salad: communication is disorganised and senseless and the main ideas cannot be understood).
Derailment (unrelated, unconnected, or loosely connected ideas; shifting from one subject to another).
Tangentiality/loosening of associations (replies to questions are irrelevant or may refer to the appropriate topic but fail to give a complete answer).
Absence/retardation of, or excessive thought and rate of production.
Thought blocking (abrupt interruption to flow of thinking so that thoughts are completely absent for a few seconds or irretrievable).
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| Mood and effect |
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How does the client describe his/her emotional state (i.e., mood)?
Down/depressed; angry/irritable; anxious/fearful; high/elevated.
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What do you observe about the client’s emotional state (i.e., affect)?
Depressed – flat, restricted, tearful, downcast.
Anxious – agitated, distressed, fearful.
Irritable, hostile.
Labile – rapidly changing.
Inappropriate – inconsistent with content (e.g., laughs when talking about mother’s death).
High/elevated – excessively happy or animated.
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| Thought content |
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What is the client thinking about?
Delusional thoughts (e.g., bizarre, grandiose, persecutory, self-referential).
Preoccupations: paranoid/depressive/anxious/obsessional thoughts; overvalued ideas.
Thoughts of harm to self or others.
Does the client believe that his/her thoughts are being broadcast to others or that someone/thing is disrupting or inserting his/her own thoughts?
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| Perception |
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Is the client experiencing any misinterpretations of sensory stimuli?
Does the client report auditory, visual, olfactory, or somatic hallucinations? Illusions?
Are they likely to act on these hallucinations?
Do you observe the client responding to unheard sounds/voices or unseen people/objects?
Any other perceptual disturbances, such as derealisation (feeling one is separated from the outside world), depersonalisation (feeling separated from one’s own personal physicality), heightened/dulled perception?
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| Cognition |
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Level of consciousness
Is the client alert and oriented to time, place, person?
Is the client attentive during the interview (drowsy, stuporous, distracted)?
Does the client’s attention fluctuate during the interview?
Does the client present as confused?
Is the client’s concentration impaired? (Can he/she count from 100 or say the months of the year backwards?)
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Orientation
Does the client know:
Who he/she is? Who you are?
Where he/she is?
Why he/she is with you now?
The day of the week, the date, the month, and the year?
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Memory
Can the client remember:
Why he/she is with you? (Immediate) What he/she had for breakfast? (Recent)
What he/she was doing around this time last year? (Remote)
Are they able to recall recent events (memory and simple tasks; e.g., calculation)?
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| Insight and judgement |
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How aware is the client of what others consider to be his/her current difficulty?
Is the client aware of any symptoms that appear weird/bizarre or strange?
Is the client able to make judgements about his/her situation?
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Adapted from NSW Department of Health [277] and Marsh et al. [276].