On the one hand, because mental status testing can be threatening to the patient and requires much cooperation on the part of the patient, it is desirable to leave the mental status testing to the end of the overall evaluation when the patient can be placed most at ease and when some degree of rapport has been established between the examiner and the patient. The mental status examination, in many respects, lends itself less well to a systematic and structured approach than other portions of the examination of the patient. Nevertheless, the observational skills and subtle discriminations that constitute "great discernment," and the traits of professional and scientific integrity that are likewise required, must be cultivated afresh in each generation of physicians. The knowledge that the modern physician can bring to bear on this task is certainly much more extensive than in 1801. One could scarcely improve on this advice in the present-day approach to mental status evaluation. To seize the true character of mental derangement in a given case, and to pronounce an infallible prognosis of the event, is often a task of particular delicacy, and requires the united exertion of great discernment, of extensive knowledge and of incorruptible integrity. In his Treatise on Insanity, published in 1801, Pinel, one of the fathers of modern psychiatry, gave some advice to his contemporary colleagues.
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