Can you provide a comprehensive mental health interview template that includes the SIEGECAPS (Sleep change, Interest loss, Energy decrease, Guilt, Appetite change, Concentration problems, Psychomotor changes, Sadness) mnemonic for depression and the DIGFAST (Distractibility, Indiscretion, Grandiosity, Activity increase, Sleep deficit, Flight of ideas, Talkativeness) checklist for mania, and also covers assessment of mood, anxiety, psychosis, substance‑use disorder, ADHD, and a full mental‑status examination?

Comprehensive Mental Health Interview Template

A structured mental health interview should systematically assess depression using SIEGECAPS, mania using DIGFAST, and comprehensively screen for mood, anxiety, psychosis, substance use disorders, and ADHD, followed by a complete mental status examination.

Depression Assessment: SIEGECAPS Mnemonic

When screening for major depressive disorder, systematically evaluate these nine criteria over a 2-week period 1:

• Sleep change: Insomnia or hypersomnia nearly every day
• Interest loss: Markedly diminished interest or pleasure in activities most of the day
• Energy decrease: Fatigue or loss of energy nearly every day
• Guilt: Feelings of worthlessness or inappropriate guilt (may be delusional)
• Emotional state/mood: Depressed mood most of the day (in children/adolescents, can be irritable mood)
• Concentration problems: Diminished ability to think, concentrate, or indecisiveness
• Appetite change: Significant weight loss/gain (>5% body weight in a month) or appetite changes
• Psychomotor changes: Psychomotor agitation or retardation (observable by others)
• Suicidal ideation: Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan

Critical point: At least one symptom must be either depressed mood or loss of interest/pleasure. Five or more symptoms are required for diagnosis 1.

Validated Screening Tools for Depression

Use the PHQ-9 as the first-line screening instrument 2. The PHQ-9 directly maps to DSM criteria and provides both categorical diagnosis and dimensional severity scoring. Alternative validated instruments include 2:

• Beck Depression Inventory (BDI): Scores ≥20 suggest clinical depression
• CES-D: Scores ≥16 suggest moderate to severe depressive symptomatology
• Hamilton Rating Scale for Depression (HAM-D): 7-17 mild, 18-24 moderate, ≥25 severe depression

Mania Assessment: DIGFAST Mnemonic

Screen for manic episodes by assessing these seven criteria:

• Distractibility: Attention easily drawn to unimportant stimuli
• Indiscretion/Impulsivity: Excessive involvement in pleasurable activities with high potential for painful consequences (sexual indiscretions, foolish business investments, reckless driving)
• Grandiosity: Inflated self-esteem or grandiosity
• Flight of ideas: Subjective experience that thoughts are racing
• Activity increase: Increase in goal-directed activity (socially, at work/school, sexually) or psychomotor agitation
• Sleep deficit: Decreased need for sleep (feels rested after only 3 hours)
• Talkativeness: More talkative than usual or pressure to keep talking

Diagnostic threshold: Three or more symptoms (four if mood is only irritable) must be present during a distinct period of abnormally and persistently elevated, expansive, or irritable mood.

Anxiety Assessment

Use the GAD-7 as the primary anxiety screening tool 2. The GAD-7 provides dimensional scoring:

• 0-4: Minimal anxiety
• 5-9: Mild anxiety
• 10-14: Moderate anxiety
• 15-21: Severe anxiety

Key anxiety domains to assess 2:

• Feeling nervous, anxious, or on edge
• Inability to stop or control worrying
• Worrying excessively about different things
• Trouble relaxing
• Restlessness making it hard to sit still
• Becoming easily annoyed or irritable
• Feeling afraid as if something awful might happen

Alternative validated instruments include the Beck Anxiety Inventory (BAI), with scores ≥10 suggesting mild anxiety and ≥19 suggesting moderate anxiety 2.

Psychosis Assessment

Immediate psychiatric referral is required for any patient presenting with psychotic symptoms, severe agitation, or confusion/delirium 2.

Systematically screen for:

• Delusions: Fixed false beliefs not amenable to change despite contradictory evidence
• Hallucinations: Perceptual experiences without external stimuli (auditory, visual, tactile, olfactory, gustatory)
• Disorganized thinking: Manifested by disorganized speech (tangentiality, loose associations, incoherence)
• Grossly disorganized or catatonic behavior
• Negative symptoms: Diminished emotional expression, avolition, alogia, anhedonia

Critical caveat: When evaluating adolescents and young adults for ADHD, be aware that amphetamine prescriptions carry increased risk for incident psychosis or mania, particularly at high doses (>30mg dextroamphetamine equivalents), with a 5.28-fold increased odds 3. Regular screening for psychotic symptoms is essential in patients on stimulant medications.

Substance Use Disorder Assessment

All adolescents and adults being evaluated for any psychiatric condition must be screened for substance use 4, 5, 4, 5.

Comprehensive Substance Use History

Assess the following systematically 6:

• Tobacco use: Current and past use patterns
• Alcohol: Quantity, frequency, pattern of use
• Cannabis/marijuana: Particularly important in adolescents as effects can mimic ADHD 4
• Cocaine, heroin, hallucinogens: Current and past use
• Prescription medication misuse: Including stimulants, opioids, benzodiazepines
• Over-the-counter medications and supplements

Key Clinical Considerations

For adolescents: Substance use can mimic ADHD symptoms, and adolescents may feign ADHD symptoms to obtain stimulant medications for performance enhancement 4. Marijuana use specifically can produce effects that mimic inattention and executive dysfunction.

Comorbidity patterns: Individuals with ADHD are at significantly increased risk for substance use disorders, and this comorbidity substantially affects treatment sequencing 5. A multimodal, multi-agency approach is needed when both conditions coexist 7.

Medical causes: Always determine if depressive or anxiety symptoms are substance-induced (e.g., interferon administration, stimulant withdrawal) 2.

ADHD Assessment

For adolescents (age 12-18), establish that symptoms were present before age 12 to meet DSM-5 criteria 4, 5.

Core Symptom Domains

Assess two primary dimensions:

Inattention symptoms:

• Fails to give close attention to details or makes careless mistakes
• Difficulty sustaining attention in tasks or play
• Does not seem to listen when spoken to directly
• Does not follow through on instructions
• Difficulty organizing tasks and activities
• Avoids tasks requiring sustained mental effort
• Loses things necessary for tasks
• Easily distracted by extraneous stimuli
• Forgetful in daily activities

Hyperactivity/Impulsivity symptoms:

• Fidgets with hands or feet or squirms in seat
• Leaves seat when remaining seated is expected
• Runs about or climbs excessively (in adolescents/adults, may be limited to feeling restless)
• Unable to play or engage in leisure activities quietly
• "On the go" or acts as if "driven by a motor"
• Talks excessively
• Blurts out answers before questions completed
• Difficulty waiting turn
• Interrupts or intrudes on others

Mandatory Comorbidity Screening

At minimum, screen all patients being evaluated for ADHD for the following comorbid conditions 5:

Emotional/behavioral conditions:

• Anxiety disorders
• Depression
• Oppositional defiant disorder
• Conduct disorders
• Substance use (particularly critical in adolescents)

Developmental conditions:

• Learning disabilities
• Language disorders
• Autism spectrum disorders

Physical conditions:

• Tic disorders
• Sleep apnea

Special consideration for adolescents: The risks of mood disorders, anxiety disorders, risky sexual behaviors, intentional self-harm, and suicidal behaviors all increase during adolescence 4. Trauma experiences, PTSD, and toxic stress are additional comorbidities requiring assessment.

Mental Status Examination (MSE)

Conduct a systematic MSE covering these domains 6:

Appearance and Behavior

• General appearance, grooming, hygiene
• Eye contact
• Psychomotor activity (agitation, retardation, restlessness)
• Abnormal movements or mannerisms

Speech

• Rate (pressured, slow)
• Volume
• Tone
• Fluency
• Spontaneity

Mood and Affect

• Mood: Patient's subjective emotional state (ask "How would you describe your mood?")
• Affect: Objective observation of emotional expression
  • Range (full, restricted, blunted, flat)
  • Appropriateness to content
  • Stability (labile vs. stable)

Thought Process

• Organization (logical, tangential, circumstantial, loose associations)
• Flow (goal-directed, flight of ideas, thought blocking)

Thought Content

• Suicidal ideation: "Have you ever thought about killing yourself or wished you were dead?" 8
• Homicidal ideation: Prior or current thoughts of physical or sexual aggression 6
• Delusions
• Obsessions
• Preoccupations

Perceptual Disturbances

• Hallucinations (specify modality)
• Illusions
• Depersonalization/derealization

Cognition

• Orientation (person, place, time, situation)
• Attention and concentration
• Memory (immediate, recent, remote)
• Executive function

Insight and Judgment

• Awareness of illness
• Understanding of need for treatment
• Decision-making capacity

Suicide Risk Assessment

When screening for suicidal ideation, place the question in the middle or toward the end of depression symptom questions to normalize the inquiry 8.

Structured Approach

1. Initial screening question: "Have you ever thought about killing yourself or wished you were dead?" 8

2. Behavioral history: "Have you ever done anything on purpose to hurt or kill yourself?" 8

3. If positive responses, obtain detailed information 6:

   • Context of suicidal thoughts or attempts
   • Method considered or used
   • Damage caused
   • Potential lethality
   • Intent to die
   • Current plan and access to means
   • Protective factors

4. Assess family history: History of suicidal behaviors in biological relatives increases risk 6

5. Screen for risk factors 8:

   • History of bullying victimization (school or cyberbullying)
   • Pathologic internet use (>5 hours daily of video games/internet)
   • Recent psychiatric hospitalization
   • Substance use
   • Access to lethal means

Critical action: Any endorsement of current suicidal ideation with plan or intent requires immediate psychiatric evaluation and safety planning. Self-administered scales may detect suicidality that patients deny in person 8.

Practical Implementation Algorithm

Step 1: Initial Screening (5-10 minutes)

• Administer PHQ-9 for depression
• Administer GAD-7 for anxiety
• Brief substance use screening questions

Step 2: Positive Screen Follow-up (15-30 minutes)

• If PHQ-9 ≥10: Apply SIEGECAPS criteria systematically
• If elevated mood/irritability noted: Apply DIGFAST criteria
• If substance use endorsed: Detailed substance use history
• If adolescent/young adult: Screen for ADHD symptoms and establish age of onset

Step 3: Comorbidity Assessment (10-15 minutes)

• Screen for psychotic symptoms if indicated
• Assess for ADHD if not already done
• Evaluate for trauma/PTSD if relevant history

Step 4: Complete MSE (5-10 minutes)

• Systematic observation and documentation of all MSE domains

Step 5: Risk Assessment (5 minutes)

• Suicide risk assessment for all patients with mood symptoms
• Homicide risk if aggressive ideation present

Total interview time: 40-70 minutes depending on complexity

Key Clinical Pitfalls to Avoid

1. Failing to establish symptom timeline: For ADHD in adolescents, symptoms must have been present before age 12 4, 5

2. Missing substance-induced symptoms: Always consider whether psychiatric symptoms are caused by substance use or withdrawal, particularly in adolescents where marijuana can mimic ADHD 4

3. Overlooking comorbidities: The majority of patients with ADHD meet criteria for another mental disorder 5. Systematic screening is mandatory, not optional.

4. Inadequate suicide screening: Use direct questions and place them appropriately within the interview. Self-report scales may reveal information patients deny verbally 8

5. Ignoring medical causes: Rule out medical conditions (hypothyroidism, sleep apnea, neurological disorders) and medication effects before finalizing psychiatric diagnoses 2, 6

6. Stimulant-induced psychosis risk: When prescribing amphetamines, particularly at doses >30mg dextroamphetamine equivalents, maintain heightened vigilance for emerging psychotic or manic symptoms 3

7. Inadequate functional assessment: Document how symptoms impair work, school, relationships, and daily functioning—this is essential for diagnosis 1