PSYCHIATRY CLERKSHIP - INTERVIEW + MSE + SAFETY

YEAR 3 | PAGE 31A - OBSERVE -> INTERVIEW -> MSE -> MEDICAL RULE-OUT -> RISK ->

DISPOSITION — WHY PSYCHIATRY IS A SEQUENCING CLERKSHIP

The diagnosis is rarely a single symptom. Build each encounter from behavior and context: stabilize urgent medical problems, obtain the patient story and collateral, describe the mental status exam, exclude delirium/substance/medication/medical causes when indicated, assess safety and capacity, then choose a treatment setting and follow-up plan.

A. THE PSYCHIATRIC FIRST-PASS FRAME

Step	Ask yourself	Output
1. Medical / behavioral stability	Is there delirium, intoxication/withdrawal, overdose, severe agitation, catatonia, eating-disorder medical instability, or another condition requiring immediate medical care?	Stabilization and supervised escalation before diagnostic refinement.
2. Reason for encounter + collateral	Why is the patient here, who is concerned, what changed from baseline, and what do family/EMS/chart/medication records add?	Problem representation with reliable timeline and context.
3. Psychiatric history + MSE	Symptoms, duration, function, past episodes, treatment response, substances, trauma, sleep, medical/neurologic history; describe current MSE.	Syndrome defined by observed findings + longitudinal history.
4. Medical / substance rule-out	Could this be delirium, endocrine/neurologic disease, medication effect, intoxication or withdrawal rather than a primary psychiatric disorder?	Focused exam/testing only when it changes the differential or safety plan.
5. Safety + capacity	Suicidal/self-harm thoughts, violence risk, grave disability, access to lethal means, protective factors; can the patient understand/appreciate/reason/communicate a choice?	Explicit risk formulation and decision-making assessment.
6. Treatment + disposition	What level of care is safe: outpatient, urgent follow-up, voluntary/involuntary evaluation per local law, inpatient psychiatry, or medical admission?	Defensible supervised plan + contingency + follow-up.

B. MENTAL STATUS EXAM - DESCRIBE BEFORE YOU LABEL

Domain	High-yield observation / question
Appearance / behavior	Grooming, eye contact, psychomotor activity, cooperation, abnormal movements, response to internal stimuli.
Speech	Rate, volume, fluency, latency, spontaneity, pressure.
Mood / affect	Patient-stated mood; observed range, intensity, stability, congruence and reactivity of affect.
Thought process / content	Linear vs tangential/circumstantial/disorganized; delusions, obsessions, guilt, hopelessness, SI/HI and other safety content.
Perception	Hallucinations/illusions; modality, context, insight and whether symptoms occur with substances, sleep transitions or delirium.
Cognition	Attention first; orientation, memory/language/executive testing as clinically indicated. Fluctuating inattention should trigger delirium reasoning.
Insight / judgment	Recognition of illness/need for care; ability to anticipate consequences and make safe decisions.

B. MENTAL STATUS EXAM - DESCRIBE BEFORE YOU LABEL — Direct video-first foundation

Geeky Medics - Anxiety Mental State Examination (MSE) OSCE Geeky Medics - Mania / Bipolar Mental State Examination (MSE) OSCE ADMSEP - Educational Objectives for a Junior Psychiatry Clerkship 2026/27 clerkship-expanded edition - verify school and official exam updates before testing