Evaluation of
Psychiatric Disorders
Mark E. Schneiderhan, Leigh Anne Nelson,
and Timothy Dellenbaugh
1
KEY CONCEPTS
Patients with psychiatric conditions are treated in all
healthcare settings. All clinicians need to develop basic skills
in psychiatric assessment to provide the best care for their
patients.
2 The Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, Text Revision (DSM-5) and the Pocket Guide
to the DSM-5 Diagnostic Exam provides clinicians with a
standardized approach for the initial assessment and follow
up of patients with mental disorders.
3 Clinicians should be prepared to gather both the mental
and physical health history from their patients. Obtaining a
release of information (ROI) from patients to communicate
with other healthcare providers or significant others is often
necessary when there are multiple providers.
4 The interview should be conducted in an atmosphere that
ensures the comfort and safety of both the patient and the
clinician. The clinician’s application of open-ended questions
and listening is essential in the interview process and
therapeutic relationship. One technique used is motivational
interviewing in which clinicians can empower patients to
achieve their goals of treatment.
If the patient is in crisis, the clinician may feel some
5
apprehension about asking certain assessment questions.
Knowing what specific questions to ask can help facilitate
inquiry about sensitive areas, such as delusional thinking
and suicidality.
6 A thorough medication history to identify all medications
currently taken, as well as those previously taken, is a
cornerstone of effective patient management. In addition,
it must be determined whether there was an adequate trial
(dose and duration) of current and prior medications for
psychiatric disorders.
7 A baseline mental status examination and psychiatric
rating scales are critical tools in monitoring the severity of
symptoms and response to treatments of mental disorders.
8 Although there are no diagnostic tests for mental disorders,
physical and laboratory assessment of the patient can help
the clinician rule out drug-induced or medical causes that
may produce similar or overlapping symptoms.
9 Psychiatric rating scales, cognitive testing (neuropsychiatric
rating scales), and psychological testing can provide
objective measures of psychiatric symptoms, adverse side
effects, memory, and intellectual capacity and are often used
in research and clinical settings.
Copyright © 2014 McGraw-Hill Education. All rights reserved.
e|CHAPTER 20
1 Patients with mental disorders are treated by clinicians from
many disciplines and in all settings of healthcare. Patients often
receive the majority of their care from nonpsychiatrists, and there
is frequently a lack of coordination of care.1 Hence, the need for
good psychiatric assessment skills must not be limited to mental
health clinicians. Even public education programs are being offered
in some communities to help the public understand and to respond
to signs of mental and substance use disorders.2 Along with tradi-
tional assessments used across all medical specialties (e.g., labo-
ratory tests, medical history, physical examination), mental health
clinicians rely on communication skills and use validated assess-
ments that are perhaps less objective in nature and less familiar to
nonpsychiatric practitioners. This chapter provides a basic overview
of appropriate assessment techniques used by clinicians to develop
individualized treatment plans for psychiatric patients. Readers
needing greater depth than the materials provided in this chapter are
referred to other sources.3–9
OVERVIEW OF THE DIAGNOSTIC
AND STATISTICAL MANUAL OF
MENTAL DISORDERS
2 The Diagnostic and Statistical Manual of Mental Disorders
(DSM) is the most widely accepted and most important diagnostic
reference used in the care of individuals with mental disorders. It
provides a common language for practitioners to describe and diag-
nose psychiatric disorders.7 Common language is essential because
there is considerable overlap of symptoms across many diagnoses.
The Diagnostic and Statistical Manual of Mental Disorders, First
Edition (DSM-I) was introduced in 1952 and was the first manual
on mental disorders to contain a description of diagnostic catego-
ries. In 1980, the DSM-III and subsequent editions (DSM-IV (1994)
and DSM-IV-TR (2000)) suggested formulating psychiatric diagno-
ses in a multiaxial (Axis I primary psychiatric diagnosis, Axis II
personality/developmental, Axis III medical, etc.) system format
that was widely accepted in psychiatry.9,10 eTable 20-1 provides
an example of the former multiaxial system.10 The Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
published in May 2013, includes a greater emphasis on severity as
well as presence of symptoms.11
The DSM-5 takes a dimensional approach to formulating diag-
noses to better account for the heterogeneity and complexities of
mental disorders while still retaining many of the components found
in the former DSM-IV-TR. Of note, the DSM-5 uses the term “disor-
ders” rather than “illness” or “disease” to recognize the complexities
299
300
eTABLE 20-1 Historical example of a DSM-IV-TR
Multiaxial Evaluation
Axis I 300.02 Generalized anxiety disorder
305.10 Nicotine dependence
303.90 Alcohol dependence
Axis II 301.83 Borderline personality disorder
Axis III 250.00 Diabetes mellitus, type II
401.90 Hypertension, essential
SECTION
Axis IV Divorce, threat of job loss
Axis V 43 (Current)
DSM, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision.
2 in formulating diagnoses; likewise, the term “disorder(s)” will be
used throughout this chapter.9 Clinicians are strongly urged to review
Organ-Specific Function Tests and Drug-Induced Diseases
DSM-5 to appreciate the full scope of changes from the previous
DSM-IV-TR. Some of the significant changes in the DSM-5 include
modifying the diagnostic criteria of certain disorders (e.g., age crite-
ria in attention-deficit/hyperactivity disorder [ADHD]), reclassifying
and/or renaming certain diagnoses (e.g., certain childhood disorders
such as mental retardation, autistic disorder, and ADHD are now all
classified under neurodevelopmental disorders and include intellec-
tual disability, autism spectrum disorder, and ADHD, respectively;
dementia is now classified as a major neurocognitive disorder).
Secondly, the International Classification of Diseases (i.e., ICD-10)
system is the current standard to improve global consistency in the
coding of all mental disorder diagnoses. Thirdly, the former multi-
axial system (Axis I–III) was combined into a single diagnosis or a
list of diagnoses (nonaxial assessment system) that describe over-
lapping mental, developmental, and personality disorders, etiolo-
gies, and contributing neurological or medical illnesses (e.g., major
depressive disorder and hypothyroidism).9,11 During the adoption of
DSM-5, mental health clinicians must still remain cognizant of the
former multiaxial assessments (i.e., DSM-IV-TR) that will still be
found in patients’ current and past psychiatric histories. The DSM-5
will continue to distinguish primary diagnoses from “psychosocial
and environmental problems” (formerly Axis IV) and functional sta-
tus (formerly Axis V), but will use already established ICD codes to
classify psychosocial conditions needing clinical attention (i.e., low
income, homelessness, uncomplicated bereavement). In addition,
the Global Assessment of Function (GAF) rating scale (formerly
Axis V) is now replaced with the World Health Organization Dis-
ability Assessment Schedule 2.0 (WHODAS 2.0), which is thought
to provide a clearer and more comprehensive measure of disabil-
ity. For a complete listing of all changes, please refer to the DSM-5
hardcopy or online at “http://www.psychiatry.org/dsm5” (changes
from DSM-IV-TR to DSM-5).
More emphasis is placed in DSM-5 on objective diagnostic and
follow-up assessments, utilization of severity rating scales, screen-
ing tools, and cultural assessments. A complete list of the suggested
patient assessment measures is available for clinical use and can be
found in Section III of the DSM-5 entitled “Emerging Measures and
Models” or online at “http://www.psychiatry.org/dsm5” (Online
Assessment Measures). Other important rating scales are discussed
in the section below on Psychiatric Rating Scales.
The DSM-5 provides general information on all mental disor-
ders recognized by the American Psychiatric Association (APA) and
includes age of onset, clinical course, complications, predisposing
factors, prevalence, and differential diagnoses. The specific diagnos-
tic criteria for each mental disorder, dimensional assessment tools
(i.e., rating scales), and the number of symptoms required to estab-
lish a diagnosis are also listed.
Additional information besides the DSM-5 diagnosis is required
before a comprehensive treatment plan can be developed. For instance
Copyright © 2014 McGraw-Hill Education. All rights reserved.
The pocket guide to the DSM-5 Diagnostic Exam includes examples
of screening and follow-up questions used in a diagnostic interview
for each of the mental disorder categories in DSM-5. It also discusses
building a therapeutic patient alliance, conducting a 30-minute diag-
nostic interview, a stepwise approach to differential diagnosis, and
evaluations in special populations (i.e., cultural assessments).9
In summary, the DSM-5 and the The pocket guide to the DSM-5
Diagnostic Exam provide clinicians with a systematic approach of
evaluating patients, thereby creating better treatment plans and a
more consistent evaluation of treatment outcome.
THE CLINICAL INTERVIEW
The mental health clinical assessment is more than a verbal com-
munication exchange. Although the focus of the interview may be
on mental health, the clinician should be prepared to assess both
the mental and physical health conditions of their patients. Clini-
cians need to be aware that patients with mental disorders often
have a lack coordination of their healthcare.1 These patients often
have multiple medication prescribers, resulting in polypharmacy.
Communication exchanges between psychiatry and primary care
services are often fragmented even if they are co-located because of
underdeveloped shared care practices.12,13 Moreover, patients with
severe and persistent mental illness (SPMI) have a shortened life
span and are less likely to receive the same level of primary medical
care compared with patients without mental disorders.14–18 Barriers
to medical care include patient paranoia, ambivalence, and disorga-
nization, accounting for missed appointments; stigma toward mental
disorders; and poor communication among primary care and psy-
chiatric clinicians.19,20 For example, a significant number of patients
who take antipsychotics are not adequately monitored for diabetes
and dyslipidemia.21–24 Therefore, the interviewer should be aware of
the significant health disparity in this population because best prac-
tices for medical monitoring become the standard of care.18,22,25–27
Clinical Controversy. . .
Stigma and discrimination often negatively affect the lives
(e.g., employment prospects) of individuals labeled mentally
ill. Consumer advocating organizations such as the National
Alliance on Mental Illness (www.nami.org) are committed to
help increase awareness about the issues and perceptions
surrounding mental illness.
Release of Information
3 Because coordination of care is often lacking, permission from
the patient to obtain “collateral information,” such as psychiatric
and medical diagnoses, laboratory test results, medication lists,
and other verbal or written records, should be obtained before the
interview is completed. Collateral information can be obtained by
asking the patient to sign a release of information (ROI), which is
mandatory in order to contact significant others, family members,
and clinicians.28
In summary, the clinician should be prepared to assess the
mental and physical health of the patient, which is discussed in more
detail in the Mental Status Examination and Physical Examination
and Laboratory Assessment sections later in this chapter.
Interview Techniques
4 The interview should be conducted in a quiet, nonstimulating,
and comfortable area where the patient and the interviewer feel at

ease.8 The setting should be appropriate to the patient’s level of acuity
and the potential for risk to the patient and clinician. The interviewer
should introduce him- or herself and explain what is about to happen
in order to establish a trusting relationship (therapeutic alliance).
Generally, open-ended questions come first followed by questions
focused on more specific or personal data. Open-ended questions
allow the patient to provide descriptions and other information in his
or her own words. Even though more specific questions may then
be necessary to fill in the gaps, beginning in this manner minimizes
the risk of “leading” the patient. Patients can respond to specific
questions and “yes” or “no” questions with answers they think the
interviewer wants to hear. The interviewer must listen carefully and
remain nonjudgmental about the information offered by the patient
to develop trust and rapport and to ensure completeness and accu-
racy of the information. Motivational interviewing (MI) is another
technique that can be useful for engaging the patient if conflicting
issues arise such as discussions around tobacco, drugs, or alcohol
use.29 The MI approach to patient interactions is described by the
acronym OARS (open-ended questions, affirmations, reflective lis-
tening, and summary).29–31 More comprehensive descriptions and
training opportunities for MI are available in other sources.29,31,32
Whether a clinician takes notes or just listens during the inter-
view is an individual decision; the primary considerations are accu-
rately recalling the details of the examination and assuring that the
patient is comfortable with the note taking. eTable 20-2 provides
examples of questions useful for gathering mental health informa-
tion toward the completion of the clinical interview. Before any con-
clusions are made during a patient interview, the impact of culture
on the patient’s presentation should be considered. Something that
sounds delusional in one culture can be the norm in another culture.
If a clinician is unclear whether culture of origin accounts for some
of the patient’s symptoms, he or she should obtain an ROI to consult
with a family member or someone else familiar with the patient’s
culture of origin. The Cultural Formulation Interview (CFI) found
in the assessment tools of DSM-5 can also be used to assist the
clinician who suspects that cultural influences may be affecting
the diagnostic assessment.9,11
The Challenging Patient
5 Patient assessments can be challenging when symptoms of the
condition prevent effective engagement with the clinician. Whereas
excited patients may exhibit speech that is rapid and unorganized,
depressed patients may respond with few words. Patients in the
manic phases of bipolar disorder may not pause as they speak (pres-
sured speech), making it difficult for the interviewer to interject. In
all cases, the interviewer can regain control by politely redirecting
the patient back toward the question.
The interviewer should always be prepared to adjust his or
her communication approach based on the responses or reactions
of the patient. Often, as in the disease of schizophrenia, a patient
may demonstrate poor insight and judgment. It can be common for
the clinician to react negatively with anger if the patient seems to
be manipulating and not adherent with treatment. Instead of react-
ing negatively, one principle in MI is to “roll with resistance” in
which the clinician accepts the patient’s perspective and encourages
the patient to explore his or her own solutions.29 In another situa-
tion, patients with psychosis may be paranoid and appear guarded
or frightened by the interviewer’s questions. During any patient
encounter, clinicians should be aware of strong emotions such as
fear, anger, or frustration and be careful not to judge or react to the
patient. Overall, the best approach is to remain calm and respect-
ful, use shorter or closed-ended questions, and seek only essential
information until the patient is less paranoid. Patients can become
agitated and occasionally violent. Often violence is preceded by
increased psychomotor agitation as evidenced by pacing, speaking
Copyright © 2014 McGraw-Hill Education. All rights reserved.
301
eTABLE 20-2 Examples of Interview Questions for
Assessing Patients with Mental Disordersa
Mania
1. Tell me what your typical day is like.
2. Do your thoughts go faster than you can say them?
3. Have you noticed a change in the amount of sleep that you require?
4. Have you spent a lot of money lately, and what did you spend it on?
e|CHAPTER  
5. Do you have a lot of extra energy?
(To assess hallucinations and delusions, see Schizophrenia section below.)
Depression
1. How do you spend your time?
2. Do you cry without any reason?
3. Do you still enjoy the same hobbies or activities that you once did?
4. Has your weight changed recently?
5. Have you had changes in your energy level recently?
20
6. Do you have any guilty feelings?
7. Do you find it difficult to remember phone numbers, names of friends,
appointments, and so on?
(To assess sleep and suicidal potential, see Sleep and Suicide sections
Evaluation of Psychiatric Disorders
below.)
Schizophrenia
Delusions
1. How do people treat you?
2. Do you feel that people plot against you?
3. Do you ever feel that you are watched or spied on?
4. Do you have any special abilities?
5. Does anyone ever try to mess with you or bother you?
6. Do others read your thoughts?
Hallucinations
1. Does the TV or radio ever tell you things?
2. Do you hear voices that other people don’t hear?
3. What do they say? How many voices?
4. How often do they bother you?
5. Do the voices ever tell you to kill yourself or someone else?
6. Have you ever heard your name called when there is no one there?
7. Have you ever seen anything strange that you can’t explain?
8. Do you ever see things that bother you and no one else?
9. Do you want to act on what the voices say?
Thought Broadcasting or Insertion
1. If I stood by you, could I hear your thoughts?
2. Does your head ever act like a radio?
3. Do you feel that others can put thoughts in your head?
Insight
1. What reasons did your family give you for coming here?
2. What brought you here?
3. Do you consider yourself in need of help?
4. What does your medication do for you?
Sleep
1. Tell me about your sleep.
2. How many hours do you sleep each night at present?
3. How many hours do you usually sleep at night?
4. Do you sleep all through the night?
5. Is there a reason for your waking up?
6. Do you have trouble falling asleep?
7. How do you feel when you wake up?
Suicide Potential
1. Do you feel your life is not worth living?
2. Do you ever think of killing yourself? How often?
3. Do you see things improving in the future?
4. Do you think you will try to kill yourself now?
5. How would you do it?
6. Do you have the means to hurt yourself?
For all of these example questions, try to get the patient to expand on their answers.
a
in a loud voice, or gripping the arms of the chair. When there is
concern about safety, the interviewer should avoid any behavior that
could be misconstrued as threatening, such as touching or unnec-
essary staring, and should interview the patient in the presence
of another healthcare provider. Both the patient and interviewer
should have equal access to leave the room if either becomes too
uncomfortable. If a patient becomes threatening to the interviewer,
the interviewer should not hesitate to leave the room and call for
help. If a patient describes suicidal thoughts, he or she should be
302
further assessed using the questions outlined in eTable 20-2. If con-
cerns about the patient’s safety persist, further assessments should
be directed to the appropriate type of care, including either an
emergency department visit or direct hospitalization for patients at
immediate risk of harming themselves. A suicidal patient should
never be left alone. Asking a patient about suicidal thoughts will
not increase the risk. The risk is greater if these questions are never
asked or signs of distress are ignored. In summary, applying MI
skills or just remaining calm, quiet, and respectful may deescalate
SECTION
the agitated patient, preserve the therapeutic alliance, and improve
overall treatment adherence.29
Clinical Controversy. . .
2 Mental health professionals are not immune from stereotyping
people with mental disorders, which can negatively impact
how professionals assess and manage patients. A team
Organ-Specific Function Tests and Drug-Induced Diseases
approach to patient care is one way to help guard against
personal biases influencing clinical decision making.
Psychiatric History
Both the patient’s and the patient’s family history of mental disor-
ders provide important information when formulating a diagnosis and
treatment plan. Information should include the current and previous
psychiatric diagnoses, clinical presentation of each mental disorder,
time frame between episodes, level of functioning between epi-
sodes, length of each episode, total duration of the mental disorder,
and treatment given during each episode as well as response to those
treatments. Baseline functioning or the highest level of functioning
achieved in the last few years is important because it helps to define
a treatment goal. Information on the history of the current episode
and reasons for presenting to the clinician should also be gathered. A
family history should include a medication history of the immediate
relatives because a family member’s response to a given medication
might predict an individual patient’s response to that same medication.
Social History
A social history should include educational and occupational back-
ground; religion; marital status; substance-use patterns, including
tobacco, alcohol, and caffeine; and current living situation. By
understanding a patient’s living environment and social situation,
strategies to foster treatment adherence, reduce stress, and increase
social support can be developed. To probe this area initially, the cli-
nician can ask patients to describe their social support network. This
can be followed by more specific questions such as: “To whom are
you closest?” or “In whom do you confide?”
Medication History
6 A thorough medication history is one of the most important
contributions a clinician can make to treatment planning. The his-
tory should include medications for both psychiatric and medical
conditions and list all medications, including over-the-counter and
herbals, taken by the patient. The history should also report how
each drug was tolerated and describe the responses to a single drug
or combination of drugs. All allergies must be noted. Because most
psychiatric medications have a delayed onset of effect, it is impor-
tant to determine whether an adequate trial (dose and duration) was
provided before the patient is deemed “nonresponsive” to that drug.
If a patient has a history of nonadherence, specific causes should
be investigated. Causes of nonadherence may include, but are not
limited to, drug cost, complicated dosing schedules, lack of insight,
and adverse effects.
Copyright © 2014 McGraw-Hill Education. All rights reserved.
Mental Status Examination
7 The mental status examination (MSE) is a key patient assess-
ment tool in psychiatry and is analogous to the physical examina-
tion in medicine. The MSE is completed through a direct patient
interview and provides a systematic method of organizing and
reporting current behaviors, thoughts, perceptions, and function-
ing. The MSE has several components (e.g., Appearance, Attitude,
Activity, Speech and Language, Mood and Affect) and is combined
with other aspects of the patient workup (history of present illness,
physical examination, appropriate laboratory tests, and medical and
psychiatric history) to give a full picture of the presenting problem
and factors contributing to the mental disorder.7,8,10 The addition
of symptom rating scales incorporated into the MSE can greatly
enhance the clinical assessment. Consistent identification and track-
ing of symptoms with rating scales can even enable both the clini-
cian and patient to mutually construct specific treatment goals and
measure clinical progress such as changes in symptom frequency
or severity over weeks or months.33 Although terminologies can be
misleading, the MSE should not be confused with the Mini Mental
Status Exam (MMSE) ,which is discussed in the Systematic Mea-
surement of Cognitive Function section later. The components of
the MSE include:
Appearance and Attitude Toward the Examiner
The appearance of the patient throughout the interview should be
noted, including age, dress, grooming and hygiene, use of cosmet-
ics, and facial expressions. A description of appearance also should
include unusual physical characteristics and the general state of
physical health. The interviewer should note whether the patient is
cooperative, mute, hostile, paranoid, guarded, or withdrawn.
Activity
Motor activity may be excessive or diminished. Overactivity dur-
ing the interview can range from hand wringing; restless leg move-
ments; and picking at clothing, skin, or hair to severe back and forth
pacing in the room. Underactive patients move less than expected.
Patients with rigid posture, an absence of movement, and failure to
communicate may be catatonic or paranoid or experiencing medica-
tion-induced adverse effects.
Speech and Language
The quantity, flow, and speed of speech and the amount of eye con-
tact should be noted. The appropriateness and degree of eye contact
varies significantly among cultures, and before poor eye contact is
interpreted, the patient’s cultural background should be considered.
Speech should be assessed as to whether it proceeds logically in a
goal-directed manner or whether the content is vague and poorly
organized. Abnormal speech characteristics include thought block-
ing, whereby the person suddenly stops speaking without any obvi-
ous reason. Thought blocking usually occurs when a hallucination
or delusion intrudes into the person’s thinking or when upsetting
issues are discussed. Circumstantial speech lacks a clear direction
because of excess unnecessary information, but the circumstantial
patient eventually will make his or her point. In tangential speech,
however, the ultimate point is never made. Perseveration is repeti-
tion of an original answer to subsequent questions. Flight of ideas is
overproductive, rapid speech during which the patient jumps rapidly
from one idea to the next. Mutism is identified when the patient does
not respond even though he or she is aware of the discussion.
Affect and Mood
Affect describes the patient’s current emotional tone, as expressed
through facial expression, body posture, and tone of voice, all of
which can be objectively observed by the clinician. Mood describes

feelings, which are subjectively reported by the patient. Changes
in facial expression and the presence of tears, flushing, sweating,
or tremors should be noted. Affect can be described further by its
range, appropriateness, intensity, and stability. For example, in
individuals with schizophrenia or depression, the affect can be flat,
whereby no change in expression occurs throughout the interview.
In contrast, during a manic episode, the affect is very intense and
often excited. Blunted affect denotes that the range of emotional
expression is reduced but not absent. An example of inappropriate
or incongruent affect is when a patient laughs in a situation that
would be expected to produce sadness. A rapidly shifting affect
from one extreme to the other is described as labile.
Thought and Perceptual Disturbances
A variety of thought disturbances can occur in mental disorders.
Many of these disturbances generally indicate the presence of psy-
chosis or impaired reality testing. Delusions are fixed, false beliefs
that are not based in reality or consistent with the patient’s religion
or culture. Delusions can be paranoid, somatic, or grandiose in
nature. Delusions are often unshakable, and although the clinician
can challenge the delusional thinking, one should not attempt to
talk a patient out of a delusion. The lack of awareness of a men-
tal disorder (anosognosia) can often accompany delusions. Thought
broadcasting is the belief that one’s thoughts are audible to oth-
ers. Hallucinations are false sensory impressions or perceptions
that occur in the absence of an external stimulus. Hallucinations can
be auditory, visual, olfactory, tactile, or gustatory and can be con-
tinuous or intermittent. In contrast, illusions are visual mispercep-
tions involving a misinterpretation of a real sensory stimulus. For
example, a person experiencing an illusion may react in fear if he or
she momentarily misperceives the wind moving a curtain to be an
intruder. This phenomenon does not always indicate a psychiatric
disorder and can be seen in persons without mental disorders. Not
all thought disturbances are indicative of psychosis. For example,
the couplet of obsessions and compulsions can indicate the presence
of obsessive-compulsive disorder, which is not considered to be a
psychotic disorder. Obsessions are unwanted thoughts or ideas that
intrude into a person’s thinking. Compulsions are actions performed
in response to the obsessions or to control anxiety associated with
the obsession.
Evaluation of Cognition
The MSE assesses sensorium, attention, concentration, memory,
and higher cognitive functions such as orientation and abstraction.
If deficits in memory and concentration are primary or secondary
complaints of the patient or these deficits are apparent during the
interview, more formal or standardized mental status testing (e.g.,
MMSE) may be required. The clinician should document whether
the patient has received medications with sedative properties
because the outcome of the examination can be altered if central
nervous system depressants were recently taken.
Sensorium, or level of consciousness, refers to the alertness of
the patient, and if he or she is not fully alert, the amount of stimula-
tion needed to awaken the patient. Attention and concentration can
be further assessed using serial subtraction by 7s (“serial 7s”) or 3s
or by having the patient spell a five-letter word backward (e.g., d-l-r-
o-w). General intelligence can be assessed loosely by asking factual
information about current news items, recent presidents, or popular
television shows or sporting events. Memory is the ability to recall
prior information and experiences. There are many descriptors
referring to specific types of memory such as working memory (i.e.,
the capacity to hold information such as a phone number in mind
for a few seconds), short-term memory (i.e., the ability to recall
newly acquired information after several minutes), and long-term
or remote memory (historical facts) that are commonly assessed as
part of the MSE. Orientation to time, place, person, and situation
Copyright © 2014 McGraw-Hill Education. All rights reserved.
303
assesses short-term memory. Asking a patient to recall three objects
5 minutes after they are learned is the definitive test for short-term
memory. Deficits in short-term memory may be seen in depression
and anxiety, but this finding is the hallmark feature of dementia.
Asking the patient to do a certain task (e.g., pick up a pen with his
or her right hand and then fold a piece of paper and pass it to the
examiner) or spelling a five-letter word in reverse are examples of
e|CHAPTER  
testing working memory. Patients with cognitive deficits, such as
those seen in dementias and schizophrenia, can exhibit deficits in
working memory. Remote memory is assessed by asking patients
to recall old facts about their lives, such as where they were born
or where they went to school. Whereas remote memory usually
remains intact the longest in patients with intellectual decline, the
ability to create new memories is generally the first sign of a mem-
ory deficit. Abstraction is the ability to interpret information such as
a proverb (e.g., “People in glass houses shouldn’t throw stones”) or
20
identify similarities or differences between words (e.g., apple and
Evaluation of Psychiatric Disorders
orange). Abstraction is influenced by education, cultures, and lin-
guistic fluency; thus, an inability to abstract is not always a sign
of a psychiatric disorder. Persons with schizophrenia often provide
concrete (literal or superficial interpretations) or bizarre responses
to probes of abstraction.
Insight and Judgment
Insight refers to patient awareness that he or she has a mental disor-
der and the impact of that disorder on his or her life. Anosognosia
is a term used to define the complete lack of insight or awareness
of a mental disorder. Because lack of insight is associated with high
morbidity and mortality rates among patients with mental disorders,
there is much interest in this area as a focus of research.34 For exam-
ple, the symptom of poor insight is thought to be the main cause
of poor judgment such as nonadherence with prescribed medica-
tions.29,34,35 Levels of insight may be variable based on the level of
acuity of the mental disorder.
Judgment is the ability to make decisions appropriate to the
situation and can be impaired in people with a variety of mental
disorders. Judgment can be assessed by asking patients how they
would handle either their current or a hypothetical situation. As
with insight, judgment also can be fluid. For example, intoxicated
patients can demonstrate poor insight and judgment only to improve
over several hours as their blood alcohol concentration decreases.
In summary, the MSE is the clinician’s observations and expert
opinion based on the patient’s history, verbal responses, nonverbal
reactions, appearance, and behaviors. The MSE is primarily used
to establish the patient’s diagnosis, target symptoms, response, and
treatment plan. In addition to the MSE and based on the discretion
of the clinician, a physical examination, laboratory assessments,
objective rating scales, and psychological testing may be needed
for a comprehensive mental health assessment and follow up. These
assessment tools are described in the following sections.
PHYSICAL EXAMINATION AND
LABORATORY ASSESSMENT
8 There is no consensus about specific laboratory tests for diagnos-
ing or evaluating mental disorders.4,7 The identification of biologic
markers (e.g., pharmacogenomics) as diagnostic tools, predictors, or
indicators of drug response is of great interest. Recent developments in
brain imaging (functional magnetic resonance imaging [fMRI]) using
computer algorithms are being studied and show promise in diagnos-
tics. For example, a recent meta-analysis found evidence for diagnos-
tic specificity for emotional processing in schizophrenia and bipolar
disorder.36 Although there are no diagnostic tests to definitively indi-
cate that a patient has a specific mental disorder (e.g., schizophrenia
304
or bipolar disorder), physical assessments and laboratory tests are
important to clarify the etiology of presenting symptoms.
Physical Assessment
Patients who present with psychiatric symptoms need a careful
medical assessment because of overlapping symptoms from dif-
fering causes.3–5,8 A complete physical examination, along with a
detailed medical and medication history, vital signs, body weight
SECTION
and body mass index, a pregnancy test when indicated, and routine
blood chemistry are commonly part of the workup of persons with
a mental disorder. In most cases, a physical examination should be
chaperoned in the mental health setting.
Presenting symptoms can have multiple etiologies (i.e., medi-
2 cal, medications, and mental disorders). Medical and psychiatric
disorders and medications can cause symptoms that are often indis-
tinguishable. Patients with psychiatric disorders, especially depres-
Organ-Specific Function Tests and Drug-Induced Diseases
sion and anxiety disorders, may present to primary care providers
with only nonpsychiatric physical or somatic complaints and thus
receive unnecessary medication or medical treatment, while the root
psychiatric cause is overlooked.
In contrast, psychiatric disorders may cause or lead to medical
complications. For example, patients with SPMI have a high preva-
lence of modifiable risk factors such as poor nutrition and obesity,
substance abuse or dependence (e.g., smoking, alcohol consump-
tion), and sedentary lifestyles, leading to increased morbidity and
mortality.14,16 As a result, these patients die on average 25 years ear-
lier than the general population, with 60% of these premature deaths
caused by comorbid medical conditions, including cardiovascular
disease, diabetes, respiratory disease (influenza, pneumonia), and
infectious disease (HIV/AIDS).17,37
Psychiatric medications can also cause or exacerbate medical
conditions, such as diabetes mellitus, hyperlipidemia, or cardiac
arrhythmias, necessitating an initial assessment and ongoing mon-
itoring for these conditions while continuing treatment.38,39 Psy-
chiatric medications, especially antipsychotic agents, have many
Federal Drug Administration black box warnings and precautions,
requiring baseline and ongoing assessment. Baseline informa-
tion is often needed to help document future adverse effects from
medications (e.g., lithium-induced hypothyroidism, clozapine-
induced leukopenia, antipsychotic-induced diabetes mellitus). For
example, the 2004 expert consensus recommends that patients
taking antipsychotic agents should be screened for symptoms of
metabolic syndrome, including body weight, waist measurements,
blood pressures, and fasting serum lipids and glucose.38–41 For
more in-depth information, refer to the chapter on schizophrenia.
The rapidity of onset of psychiatric symptoms is an important
clue that a medical cause (e.g., delirium from an encephalopathy)
may be present. Whereas most chronic mental disorders have a pro-
dromal period, medically based psychiatric symptoms generally
have a more rapid onset of symptoms. Patients older than 40 years
at first presentation are more likely to have a medical cause for
their psychiatric symptoms because major mental disorders, such
as schizophrenia and bipolar disorder, usually first present in ado-
lescence or early adulthood. Family history can provide additional
clues. Patients with fluctuating levels of consciousness, disorienta-
tion; memory impairment; or visual, tactile, or olfactory hallucina-
tions are more likely to have a medical basis for their presentation
that can be diagnosed by medical diagnostics (e.g., laboratory tests,
computed tomography [CT], magnetic resonance imaging [MRI]).
Laboratory Assessment
General laboratory screenings are useful for medication monitor-
ing and ruling out medical causes of mental disorders. Urine drug
Copyright © 2014 McGraw-Hill Education. All rights reserved.
screens and blood alcohol tests play an important role in identifying
the contribution of illicit substances to the presenting symptoms.
Additional testing can include an electroencephalogram to evaluate
for the presence of seizure activity and other neurologic conditions,
CT scans or MRIs to detect structural abnormalities, sedimentation
rate and antinuclear antibodies for autoimmune disorders, an HIV
test, thyroid function tests, and vitamin B12 and folate concentra-
tions for anemias.4 Laboratory tests should be individualized to the
patient’s age, medical and medication history, cooperativeness, and
physical health, but extensive testing is usually unnecessary and not
cost effective.
Clinicians also use diagnostic tests to evaluate the relative
safety of specific medications, such as pregnancy monitoring with
divalproex, renal status when using lithium, or an electrocardiogram
when using medications that prolong QT interval (e.g., tricyclic
antidepressants such as amitriptyline). Serum concentration moni-
toring is recommended for medications with a narrow therapeutic
index (e.g., lithium, divalproex, carbamazepine). Serum concentra-
tion monitoring can also be useful for assessing medication adher-
ence when there is an inadequate response. With the exceptions of
lithium, divalproex, and clozapine, there are minimal data to support
obtaining serum concentrations for optimizing medication efficacy
in patients with psychiatric disorders. Finally, clinicians must also
be aware of pharmacokinetic and pharmacodynamic drug–drug and
drug–food interactions that occur with many medications, which
raise the probability of adverse effects, toxicity, or loss of efficacy.
Pharmacogenomics may help future clinicians predict and minimize
drug and disease interaction risks and adverse drug reactions (e.g.,
cardiovascular disease and hyperprolactinemia with antipsychotic
agents).42,43
In summary, a range of assessments aid clinicians in conduct-
ing problem-focused workups to verify diagnoses and identify
underlying or potential drug-related problems.44 Although the MSE
remains the cornerstone of the psychiatric workup, experts in the
field recommend selective medical tests; a good medical, psychiat-
ric, and medication history; and a thorough physical examination or
referral to primary care. Awareness of overlapping chronic medical
diseases, mental disorders, and psychiatric medications requires a
more collaborative care approach to both the mental and physical
health needs of the patient.
MEASUREMENTS OF PSYCHIATRIC
SYMPTOMS AND COGNITIVE
FUNCTION
9 In addition to the MSE, symptom-based rating scales are use-
ful tools to provide an objective way to measure subjective data
(e.g., feelings, thoughts, and perceptions) and to screen or diag-
nose specific disorders. Because there are many types of scales
from which to choose, the clinician rater needs training and expe-
rience to select and effectively use the most appropriate scale.
Rating scales are used in a variety of settings, including research
and patient care, and can serve an administrative purpose, such as
quality control.6
Some rating scales are self-administered (“patient rated”) and
do not require a staff member to collect the data; thus, they require
minimal resources to administer and can provide valuable informa-
tion, although some patients may be unable to self-administer a
questionnaire for a variety of reasons, including limited literacy and
severity of symptoms.
In contrast, “clinician-rated” scales may provide a more
consistent measure of target symptoms or behaviors. However,
a major drawback includes the substantial time commitment for
 305
eTABLE 20-3 Adverse Effects Measuring Instruments
Rating Scale Type Scoring Comments
Systematic Assessment Structured interview Summary scores of number of events, 5–10 minutes to complete. Baseline and weekly
for Treatment Emergent and global average severity, and impairment evaluations. Easy to administer. The specific reported
Events–General Inquiry assessment information might be more useful than an overall
(SAFTEE-GI) summary score.
MED Watch Global assessment No scoring involved Minutes to complete. The one-page form requires

Abnormal Involuntary
Movement Scale (AIMS)
Dyskinesia Identification
System: Condensed User
Scale (DISCUS)
Tardive dyskinesia
(TD) assessment
Tardive dyskinesia
assessment
12-item, 5-point severity scale. Items
1–4 orofacial movement; 5–7 extremity
and truncal movement; 8–10 global
severity; 11 and 12 problems with teeth
or dentures (yes or no)
15-item, 5-point severity scale. Items 1,
2 face; 3 eyes; 4, 5 oral; 6–9 lingual; 10,
11 head, neck, or trunk; 12, 13 upper
limb; 14, 15 lower limb
e|CHAPTER  
a narrative description of the problem or adverse
reaction. Online submission: www.fda.gov/medwatch.
5–10 minutes to complete. Most commonly used.
Diagnostic criteria: at least 3 months of antipsychotic
treatment. Mild severity score (2) in two discrete areas
or moderate severity (3) in one area (e.g., orofacial)
indicates TD. Tremor is not counted.
5–10 minutes to complete. More descriptive criteria for
scoring severity than the AIMS. Scoring based on three
dimensions: frequency, detectability, and intensity.
20
Tremor is not counted.

Evaluation of Psychiatric Disorders

Rating Scale for Drug-induced 10-item, 5-point anchored severity 5–10 minutes to complete. Item domains include
Extrapyramidal Side Parkinson’s scale. Mean score is obtained by adding gait, arm dropping, shoulder shaking, elbow rigidity,
Effects (Simpson–Angus and dystonia all scores and dividing by 10. A mean wrist rigidity, leg pendulousness, head dropping, eye
EPS Scale) assessments score of 0.3 is the upper limit for no EPS blinking, tremor, and salivation.
Barnes Akathisia Scale Drug-induced Four items, including three 4-point 10 minutes to complete. Items 1–3: objective
(BAS) akathisia anchored severity scored items and a observation of restlessness, subjective awareness
5-point global rating score item. Total of restlessness, and subjective distress related to
score of 12 possible restlessness. Diagnostic criteria: require both objective
and subjective ratings of at least one in either two
subjective items.

EPS, extrapyramidal symptoms.

Data from Guy,49 Schooler et al, 51 and Sajatovic and Ramiriz.52

staff to administer the tests and the inability of some patients to

tolerate these interviews, especially patients who are severely
paranoid or agitated. In addition, repeated ratings are usually nec-
essary to objectively describe longitudinal changes over a defined
treatment period as opposed to a snapshot of a complex clinical
situation.
Sensitivity, specificity, reliability, and validity are important
considerations when selecting a rating scale. Sensitivity refers to a
test’s ability to detect a symptom or illness given that the symptom
or illness is present. Specificity refers to a test’s ability to correctly
determine that a symptom or illness is absent when the person does
not have the illness.45
Reliability is the extent to which the score on the scale reflects
the hypothetical “true” score and how much interference occurs
from outside influences.46,47 Reliability is reported by the correla-
tion coefficient, which represents a chance correlation (0.00) or per-
fect correlation (1.00). Rating scales with correlation coefficients of
less than 0.7 are usually considered unreliable for clinical studies.
­Interrater reliability—agreement in rating scores among clinician
raters—is important to achieve when multiple clinicians rate the
same patient or population. Interrater reliability is established by
having all raters independently rate individual patients at the same
time to determine the correlation of their scores.
Validity, in contrast, is the ability of a scale to measure what
it was designed to measure. Various validity tests are performed
on a rating scale to ensure that the scale assesses the appropri-
ate aspects of the illness (content validity), the correlation with
diagnoses or clinical change (criterion-related validity), and the
extent to which the scale measures symptom traits in contrast to
a specific symptom (construct validity).47 Before administering
any rating scale, the clinician should be trained or observed using
the rating scale and have thorough knowledge of the rating scale’s
strengths and limitations.
Psychiatric Rating Scales
Psychiatric rating scales provide the clinician or researcher with
a consistent measure of medication side effects and symptoms
that are present in psychiatric disorders (e.g., tardive dyskinesia
[eTable 20-3], psychosis [eTable 20-4], depression and bipolar dis-
orders [eTable 20-5], anxiety [eTable 20-6]). Symptom-based rat-
ing scales (e.g., Positive and Negative Syndrome Scale, Hamilton
Depression scale, Abnormal Involuntary Movement Scale [AIMS])
are used to measure the presence or severity of symptoms and
assist in the diagnostic formulation.48–52 In contrast, global assess-
ment scales can be used to identify any adverse medication side
effects (eTable 20-3) and the overall severity of mental disorders
(eTable 20-7) based on a rater’s clinical experience (e.g., Clinical
Global Impressions Scale [CGI]).51,53
In summary, patient-and clinician-rated scales are widely
used in psychiatric research and recommended in clinical settings
to monitor schizophrenia, depression, bipolar disorder, and anxiety
disorders.9,11,48–50,54–57
Neuropsychiatric Rating Scales
Neuropsychiatric rating scales provide specific information, such
as the rate of change and severity of cognitive decline or improve-
ment. They are useful when repeated measurements of a patient’s
mental status are needed because they allow the clinician to deter-
mine response to an intervention (e.g., medication) in a more sys-
tematic manner. In addition, some cognitive function measures are
useful screens for Alzheimer’s disease and other causes of cognitive
decline. A number of cognitive rating scales are available, the most
common being the MMSE.
The MMSE is a structured interview that globally assesses
many cognitive domains, including orientation, visuospatial orga-
nization, memory, and reasoning, to determine an overall score of

Copyright © 2014 McGraw-Hill Education. All rights reserved.

306
eTABLE 20-4 Psychosis Rating Scales
Rating Scale Type Scoring Comments
Brief Psychiatric Clinician rated 18 items, 7-point severity scale: mildly ill 32, The anchored BPRS provides descriptions of each severity
Rating Scale (BPRS) moderately ill 44, markedly ill 55, and severely rating to increase the interrater reliability. The BPRS has
ill 70 when correlated to the CGI (Clinical Global four clusters of symptoms: thinking disturbance, anxious
Impressions Scale; see eTable 20-7) depression, withdrawal-retardation, and hostility-
suspiciousness.
Positive and Clinician rated 30-item scale, 7-point severity scale: mildly ill Based on the 18-item BPRS for assessing the presence
Negative Syndrome 57, moderately ill 75, markedly ill 95, and or absence of positive and negative symptoms, and
SECTION

Scale (PANSS) severely ill 116 when correlated to the CGI psychopathology of schizophrenia.

Data from Leucht et.al.48,50 and Sajatovic and Ramiriz.52

  

eTABLE 20-5 Depression and Bipolar Disorder Rating Scales

2 Rating Scale Type Scoring Comments
Hamilton Depression Scale Clinician 17-item scale; <6 = normal mood; 17–25 = Used to screen patients for drug studies and to
(HAMD or HDRS) rated moderate depression; >25 = severe depression determine severity of symptoms and treatment
Organ-Specific Function Tests and Drug-Induced Diseases

outcome. HDRS is the standard to compare other

Montgomery–Asberg
Depression Rating Scale
(MADRS)
Beck Depression Inventory
(BDI)
Zung Self-Rating Depression
Scale (ZSDS)
Patient Health Questionnaire
(PHQ-9)
Quick Inventory of Depressive
Symptomatology (QIDS-C
[Clinician] and QIDS-SR
[Patient])
Young Mania Rating Scale
(YMRS)
Mood Disorder Questionnaire
(MDQ)
depression rating scales against.
Clinician 10-item, 7-point scale. For each item: 0 = no Differentiates among all the intermediate grades of
rated symptoms; 6 = severe symptoms depression. Decreases bias in patients with other
medical illnesses and increased somatization (varied
unexplained physical symptoms).
Patient 21-item scale; 0–9 = normal; 10–15 = mild The standard for depression self-rating scales and an
rated depression; 16–19 = mild-moderate; 20–29 = objective measure of change in symptoms as a result
moderate-severe; 30–63 = severe depression of treatment.
Patient 20-item scale, 4-point severity; <50 = normal; Severity rated by frequency of occurrence of
rated 50–59 = minimal-mild; 60–69 = moderate- symptoms. May not be as sensitive in measuring
marked; ≥70 severe depression changes in severity of symptoms.
Patient 9-item, 4-point scale. For each DSM-IV Commonly used in primary care to establish a
rated depression criteria item: 0 = not at all; diagnosis of depression and assess severity of
3 = nearly every day. Score <10 = minimal depressive symptoms.
depression symptoms.
Clinician 16-item scale; scores range from 0–27; 0–5 = Used to assess symptom severity and symptomatic
and patient none; 6–10 = mild; 11–15 = moderate; 16–20 = change. QIDS-SR found to be as sensitive to symptom
rated severe; 21–27 = very severe change as the HDRS. Has usefulness in both clinical
and research settings.
Clinician 11-item scale; 5-point severity; 13 = minimal; Used to screen patients for drug studies and to
rated 20 = mild; 26 = moderate; 38 = severe determine severity of symptoms and treatment
outcome. YMRS is the standard to compare other
mania rating scales against.
Patient 15-item scale; score of ≥7 suggestive of bipolar Screens for a lifetime history of mania or hypomania.
rated spectrum disorder Does not assess severity of illness.

DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Data from Sajatovic and Ramiriz LF,52 Fankhauser and German ML,54 and Montgomery and Asberg.55

eTABLE 20-6 Anxiety Rating Scales

Rating Scale Type Scoring Comments
Hamilton Anxiety Scale (HAM-A Clinician rated 14 items, 5-point scales; scores Consists of subscales to measure somatic and psychic anxiety
or HAM-AS or HAMRS) of ≥18–20 for moderate anxiety
Self-Rating Anxiety Scale (Zung Patient rated 20-item scale; 4-point intensity Correlates to the clinician-rated Anxiety Status Inventory (ASI);
SAS) ratings however, there is little information on the validity of either test
Sheehan Panic and Anticipatory Patient and Three-part scale Measures panic attacks, anticipatory anxiety, and limited
Anxiety Scale (SPAAS) clinician rated symptom attacks
Yale–Brown Obsessive- Clinician rated Semi-structured interview Consists of several clusters of obsessions and compulsions; used
Compulsive Scale (YBOCS) to assess baseline severity and change in treatment studies

Data from Sajatovic and Ramiriz LF,52 Sheehan,5 and Goodman et al.57

eTABLE 20-7 Global Illness Assessment Scales

Clinical Global Impressions (CGI) Scale
CGI (S): Severity of Illness
CGI (I): Global Improvement
CGI: Efficacy Index
Clinician rated Severity of illness and global
improvement on 7-point rating scales.
Efficacy index: 1–4 marked improvement;
5–8 moderate; 9–12 minimal; 13–16
unchanged or worse
Observational and nonsymptom-specific
for assessing three global subsets: severity
of illness, global improvement, and efficacy
index measures both therapeutic and side
effects

Data from Sajatovic and Ramiriz52 and Busner and Targum.53

Copyright © 2014 McGraw-Hill Education. All rights reserved.


cognitive function. The maximum score is 30, and a score of 23 or
less is indicative of significant cognitive impairment. The MMSE
takes 5 to 10 minutes to administer and is used routinely in the
clinical setting.58 Other examples of cognitive rating scales include
the Blessed Information Memory Concentration test (BIMC), the
Dementia Rating Scale (DRS-2), the Clock Drawing test (CDT),
and Alzheimer’s Disease Assessment Scale (ADAS).59–62
Most of the rating scales involve a structured interview that
requires clinician training to ensure accurate administration. Noise
and distraction can affect the patient’s performance ability; there-
fore, the interview should be conducted in a quiet area with adequate
lighting. The interviewer should speak slowly and clearly to the
patient when providing instructions and asking questions.
PSYCHOLOGICAL TESTING
Although most clinicians do not administer psychological testing,
they can use the results to evaluate the role of medication in relation-
ship to the diagnosis. Psychological testing alone cannot establish
a firm diagnosis but can be a useful diagnostic tool when coupled
with clinical judgment. Types of psychological testing include per-
sonality tests (e.g., Minnesota Multiphasic Personality Inventory-2),
intelligence tests (e.g., Wechsler Adult Intelligence Scale—Revised,
Wechsler Intelligence Scale for Children—Revised), projective
tests (e.g., Rorschach), and neuropsychologic tests (e.g., Bender
Visual Motor Gestalt Test).3 Neuropsychological and intellectual
assessments generally require special training or a patient referral to
a specialist, such as a licensed psychologist or neuropsychologist,
and should not be confused with psychiatric rating scales, which can
be administered by most clinicians. As with physical examinations,
laboratory results, and rating scale scores, psychological test results
are best used as only one part of a comprehensive diagnostic plan.
ACKNOWLEDGMENTS
The authors are grateful to Patricia A. Marken, PharmD, FCCP,
BCPP, Professor of Pharmacy Practice at the University of
­Missouri–Kansas City, School of Pharmacy and Stuart Munro, MD,
Professor and Chair, Department of Psychiatry, School of Medi-
cine at the ­University of Missouri-Kansas City for their significant
­contributions to this chapter in previous editions.
ABBREVIATIONS
ADAS Alzheimer’s Disease Assessment Scale
AIMS Abnormal Involuntary Movement Scale
APA American Psychiatric Association
BAS Barnes Akathisia Scale
BDI Beck Depression Inventory
BIMC Blessed Information Memory Concentration (test)
BPRS Brief Psychiatric Rating Scale
CDT clock drawing test
CGI (S) Clinical Global Impression Severity of Illness scale
CGI (I) Clinical Global Impression Global
Improvement Scale
CT computed tomography
DISCUS Dyskinesia Identification System: Condensed
User Scale
DRS-2 Dementia Rating Scale
DSM-IV-TR Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision
DSM-5 Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition
EPS extrapyramidal symptoms
Copyright © 2014 McGraw-Hill Education. All rights reserved.
307
fMRI functional magnetic resonance imaging
GAF global assessment of functioning
HDRS Hamilton Depression Rating Scale
MADRS Montgomery-Asberg Rating Scale
MDQ Mood Disorder Questionnaire
MI motivational interviewing
MMPI-2 Minnesota Multiphasic Personality Inventory-2
e|CHAPTER  
MMSE Mini-Mental Status Examination
MSE mental status examination
NAMI National Alliance on Mental Illness
OARS open-ended questions, affirmations, reflective
listening, and summary
PANSS Positive and Negative Syndrome Scale
PHQ-9 Patient Health Questionnaire for assessment of
QIDS-C
depression
Quick Inventory of Depressive Symptomatology-
20
Clinician rating scale
Evaluation of Psychiatric Disorders
QIDS-SR Quick Inventory of Depressive Symptomatology-
Subject rating scale
ROI release of information
SAFTEE-GI Systematic Assessment for Treatment Emergent
Events-General Inquiry
SPAAS Sheehan Panic and Anticipatory Anxiety Scale
SPMI severe and persistent mental illness
TD tardive dyskinesia
YBOCS Yale–Brown Obsessive-Compulsive Scale
YMRS Young Mania Rating Scale
ZSDS Zung Self-Rating Depression Scale
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