TABLE 126.3 CHILDHOOD/ADOLESCENT PSYCHIATRIC EMERGENCIES: CHILD MENTAL STATUS EXAMINATION Orientation Appearance Memory Cognition Behavior Speech Mood and affect Thought process Thought content (including suicidal ideation, homicidal ideation, obsessions, delusions, hallucinations) Insight and judgment Mental Status of the Child Evaluation of the child’s mental status takes place throughout the entire ED visit The mental status examination provides a psychological profile of the child and contributes to the assessment of psychiatric diagnoses Frequently much of the relevant data often emerge during the history, physical examination, and interactions with the child and family members The emergency physician should have a systematic and thorough understanding of the mental status examination and should follow up any areas of concern with more specific questions Table 126.3 lists the major categories of the mental status examination, with a focus on the aspects most relevant to emergency psychiatric assessment Family Evaluation The mental status of the family can be assessed while observing the presentation of the history and the interactions of caregivers with the patient during the ED visit The presentation of caregivers should be coherent and logical and should follow a temporal sequence Family members under the influence of drugs or alcohol may not be fully alert and oriented Depressed parents may appear withdrawn and downcast and may be so preoccupied