Note: Put a check mark in the appropriate box of significant observed descriptor/s.

1. General Description
1.1. Appearance
Descriptors Yes No Remarks
Congruent apparent age
Appropriate dressing
Clean / Hygienic
Good posture
Good gait
Appropriate facial expression
With eye contact
With pupil dilatation
With pupil constriction
Normal state of health & nutrition
1.2. Speech
Descriptors Yes No Remarks
Rapid speech
Slow speech
Loud volume
Soft volume
Minimal speech
Pressured speech
Stuttering
Slurring of words
Unusual accents
1.3. Motor Activity
Descriptors Yes No Remarks
Lethargic
Tensed
Restless
Agitated
With observed tics
Grimaces
Tremors
Compulsive

1.4. Interaction During Interview

Descriptors Yes No Remarks
Hostile
Uncooperative
Irritable
 Guarded
Apathetic
Defensive
Suspicious
Seductive

2. Emotional State
2.1. Mood
Descriptors Yes No Remarks
Sad
Fearful
Hopeless
Euphoric
Anxious
Happy

2.2. Affect
Descriptors Yes No Remarks
Congruent / Appropriate
Flat
Labile

3. Experiences
3.1. Perceptions
Descriptors Yes No Remarks
Hallucinations: Auditory
Visual
Tactile
Gustatory
Olfactory
Illusions

4. Thinking
4.1. Thought content
Descriptors Yes No Remarks
Delusion: Religious
Somatic
Grandiose
Paranoid
 Thought broadcasting
Thought insertion
Depersonalization
Hypochondriasis
Ideas of reference
Magical thinking
Nihilistic ideas
Obsession
Phobia
4.2. Thought process
Descriptors Yes No Remarks
Circumstantial
Flight of ideas
Loose associations
Neologisms
Perseveration
Tangential
Thought blocking
Word salad

5. Sensorium and Cognition

5.1. Level of consciousness
Descriptors Yes No Remarks
Confused
Sedated
Stuporous
Oriented to: Time
Place
Person
5.2. Memory
Descriptors Yes No Remarks
Intact remote memory
Intact recent memory
Intact immediate memory

5.3. Level of concentration and calculation

Descriptors Yes No Remarks
Easily distracted
With difficulty in simple math
5.4. Information and Intelligence
Descriptors Yes No Remarks
With learning disability
With learning difficulty
 Able to interpret simple proverb
5.5. Judgment
Descriptors Yes No Remarks
Appropriate judgment
With good relationship to others
5.6. Insight
Descriptors Yes No Remarks
Accepts presence of problem
Blames the problem on others

Descriptive Analysis: