Expansion
Appearance, behaviour, speech, mood, thought, perception, cognition, insight
Expansion
- Appearance and behaviour: self-care, clothing, eye contact, rapport, psychomotor activity, abnormal movements
- Speech: rate, rhythm, volume, quantity, form (flight of ideas, poverty of speech)
- Mood and affect: mood is the subjective, sustained state reported by the patient; affect is the objective, observed and moment-to-moment. Note whether affect is reactive and congruent
- Thought: form (loosening of associations, thought block), content (delusions, obsessions, preoccupations), and possession (thought insertion, withdrawal, broadcasting)
- Perception: hallucinations (specifying modality), illusions, depersonalisation
- Cognition: orientation, attention, memory, using a formal tool if indicated
- Insight: does the patient recognise the experiences as abnormal and as illness, and do they accept the need for treatment
- Risk: to self, to others, from others, and of neglect. Never omitted
The mood and affect distinction is the one most often confused: mood is the climate, affect is the weather.
Risk assessment should be explicit and specific, covering suicidal ideation with plans and intent, self-harm, harm to others including dependants, and safeguarding concerns.