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OtherSPECIAL ARTICLE

The Mental Status Examination in the Age of the Internet

Patricia R. Recupero
Journal of the American Academy of Psychiatry and the Law Online March 2010, 38 (1) 15-26;
Patricia R. Recupero
JD, MD
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    Table 1

    Suggested Opening Questions for the Interview

    Have you ever Googled yourself?
    Do you use any social networking sites, such as Facebook, MySpace, Friendster, YouTube, or LinkedIn? If yes: How do you use the site(s), or what do you use it/them for?
    Do you tweet? Do you follow anyone or anything on Twitter?
    Do you subscribe to any news feeds?
    Do you have a blog or a personal homepage or Website?
    How many e-mail addresses do you have? If more than one: Do you use the same one for business (or school) and personal contacts?
    Do you chat online? If yes: With whom? About what?
    Do you play computer games or video games? If yes: Alone, or against other players? What are your favorites? What types of characters do you like to play?
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    Table 2

    Screening Tools for Problematic Internet Use

    Aboujaoude et al: proposed diagnostic criteria16
    Beard and Wolf: proposed diagnostic criteria for Internet addiction17
    SIGNS: Mnemonic for pathologic computer use18
    IADQ: Internet Addiction Diagnostic Questionnaire19
    CIAS: Internet Addiction Scale20
    CIAI: Chinese Internet Addiction Inventory21
    OSA-Q: Online Sexual Addiction Questionnaire (OSA-Q)22
    OCS: Online Cognition Scale23
    CIUS: Compulsive Internet Use Scale24
    BTOB: Brief Test of Online Behavior25
    PIUQ: Problematic Internet Use Questionnaire26
    GPIUS: Generalized Problematic Internet Use Scale27
    IRABI: Internet-Related Addictive Behavior Inventory28
    IRPS: Internet-Related Problem Scale29
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    Table 3

    Suggested Questions for an MSE

    Appearance and general behavior
        What's on your _______ (Facebook, MySpace, Other) profile?
        Do you have an avatar? If yes: Can you describe your avatar for me?
        What have you chosen for your e-mail addresses, screen names, or nicknames on the Internet? Can you explain why you chose them?
        I've noticed that a lot of people have phogographs of themselves on their _______ (Facebook, MySpace, Other) profiles. How did you choose the ones that you posted? Or: Why did you decide not to post one of yourself?
        Are you more comfortable expressing yourself in person or online?
    Attitude, rapport, mood, and affect
        Have you ever purchased treatments, such as drugs, medicines, or herbal supplements from an Internet pharmacy or Website?
        Have you ever been involved in a flame war?
        How would you feel if your computer crashed tomorrow and you were unable to log on to the Internet?
        Do you get any support from family, friends, or others online?
    Thought process and content
        Do you use any Websites that you check regularly for updates, such as online auctions, news sites, social networking sites like Twitter, stock trading sites, or others? How often do you check them?
        How long does it take you to write an e-mail (or blog post)? Do you ever find yourself going back and editing your message repeatedly?
        Do you look up medical information online?
        What kinds of information have you read online?
        Have you learned anything interesting on the Web lately?
    Perceptual disturbances
        Do you ever feel that what happens online (or in your favorite game or virtual world) is more real than your life offline?
        Do you ever lose track of time or forget where you are when you are playing a game or chatting online? If yes: Can you tell me a little more about what that's like?
        Have you ever had trouble figuring out what was real and what was not real while online or while playing a game?
    Insight and judgment
        Are you concerned about your privacy online?
        What do you do to protect _________ (your privacy, your identity, your children, other) online?
        Do you ever send e-mails to famous people, or to people you don't know very well? If yes: What kinds of things do you say?
        Do you think your Internet use has caused any problems for you in your ________ (job, marriage, school, social life, other)?
    Impulse control
        Have you ever posted something or done something on the Internet and regretted it later?
        When you ____________ (shop online, gamble online, chat, look at Internet pornography, have cybersex, play games online), do you ever feel like you are doing it too much or can't stop when you want to?
    Do you ever have difficulty controlling an urge to shop online, gamble at Internet casinos, send inappropriate e-mails, engage in cybersex, or view Internet pornography?
    • View popup
    Table 4

    Potential Sources of Digital Evidence for Evaluations

    Internal and external computer hard drives
    Digital archives and/or backup disks and drives
    Media storage devices, such as zip drives, USB flash drives, CD-Rs, and DVD-Rs
    Archives maintained by ISPs or stored on networks
    Cached Web browser files and/or logs of Web browser activity, including search terms used on search engine sites (e.g., how to make MDMA (methamphetamine)); lists of URLs visited with the dates and times of access
    Hidden files or files “deleted but not gone”71,72; any available information on documents that may have been destroyed
    Archived e-mails and chat logs; records of e-mail discussion groups such as Usenet; messages stored or accessed through newsgroup reader software
    Websites, including personal homepages, blogs, profiles on social networking sites, and bulletin boards or other Web-based discussion groups
    Cell phone/smart phone records of calls and text messages, videos, and images
    Personal and work computers; cookies, malware, or applications stored on the evaluee's computer
    Material stored on hand-held personal digital assistants (PDAs) or other portable electronic devices
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Journal of the American Academy of Psychiatry and the Law Online: 38 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 38, Issue 1
March 2010
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The Mental Status Examination in the Age of the Internet
Patricia R. Recupero
Journal of the American Academy of Psychiatry and the Law Online Mar 2010, 38 (1) 15-26;

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Patricia R. Recupero
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    • The Internet in the Forensic Psychiatric Interview
    • Review of Collateral Information
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