Expansion
ASEPTIC: Appearance, Speech, Emotion, Perception, Thought, Insight, Cognition
Expansion
ASEPTIC:
- A - Appearance and behaviour: dress, self-care, build, marks and scars, eye contact, rapport, psychomotor activity, abnormal movements, agitation, cooperation
- S - Speech: rate, rhythm, volume, tone, quantity, spontaneity, and coherence. Pressured in mania, poverty of speech in depression and negative symptoms
- E - Emotion: mood as the patient describes it (subjective), and affect as observed (objective). Affect may be reactive, blunted, flat, labile or incongruent
- P - Perception: hallucinations (auditory, visual, olfactory, tactile), illusions, depersonalisation and derealisation. Ask about second and third person auditory hallucinations
- T - Thought: form (flight of ideas, tangentiality, thought block, loosening of associations), content (delusions, obsessions, overvalued ideas, preoccupations) and possession (insertion, withdrawal, broadcasting)
- I - Insight: does the patient believe they are unwell, that the symptoms are due to illness, and that treatment may help. Insight is a spectrum rather than present or absent
- C - Cognition: orientation, attention, memory, and formal testing where indicated
Risk is assessed alongside and must always be documented: risk to self (suicidal ideation, plans, intent, means, protective factors), risk to others, risk from others, and risk of self-neglect.
The distinction between mood and affect is the one most often confused: mood is the climate, affect is the weather.