The Physical Examination in Psychiatry

The physical examination is a neglected aspect of the psychiatric assessment. For example, a survey of ninety-eight practicing psychiatrists, conducted by Patterson (1) in 1978, found that none of them routinely performed physical examinations on their patients. More than one-half of these psychiatrists reported that they no longer felt competent to do so. One situation in which psychiatrists do often perform physicals is while admitting patients to hospital. However, the quality of these examinations is often poor (2 ,3). An indifferent attitude toward the physical examination has persisted in psychiatry despite numerous publications emphasizing the importance of medical assessment (2-8). One reason for this may be the predominantly negative emphasis of the existing literature regarding the psychiatric physical examination. In general, the literature is concerned only with the ability of the physical examination to exclude non-psychiatric disease. The physical exam is rarely described in a positive sense as an opportunity to gather useful information.