PART C – Psychological evaluations for the investigations of torture ... and the nature of treatment should be inquired upon. (See § 282 in the Istanbul Protocol.) 7. SUBSTANCE USE AND ABUSE HISTORY (See § 283 in the Istanbul Protocol.) 8. MENTAL STATUS EXAMINATION The following components should be evaluated and reported (Sadock, 2005): • Appearance (personal identification, behaviour and psychomotor activity, general description such as posture, bearing, etc) • Speech; mood and affect; thought and perception (process and content of thinking, thought disturbances, perceptual disturbances such as hallucinations and illusions, depersonalization and derealization; dreams and fantasies) • Sensorium and cognition (alertness, orientation; concentration and calculation; memory impairment – long term memory, intermediate recall and immediate recall; knowledge; abstract thinking; insight; judgement). Patients’ responses to specific mental status items are affected by their culture of origin, educational level, literacy, language proficiency, and level of acculturation (Trujillo, 1999). The mental status examination of torture survivors requires flexibility on the part of the examiner, who must have a good understanding of the client’s cultural, linguistic, and educational background before attempting any formal assessment (Jacobs et al., 2001) (See § 284 in the Istanbul Protocol.) 21 9. ASSESSMENT OF SOCIAL FUNCTIONING Trauma and torture can directly and indirectly affect a person’s ability to function. The clinician should assess the individual’s current level of functioning by inquiring about daily activities, social role (as housewife, student, worker), social and recreational activities, and perception of health status. The interviewer should ask the individual to assess his or her own health condition, to state the presence or absence of feelings of chronic fatigue, and to report potential changes in overall functioning. The impact of symptoms on daily life can be highly relevant in forensic procedures or questions of recompensation of torture cases. (See § 285 in the Istanbul Protocol.) 10. PSYCHOLOGICAL TESTING AND THE USE OF CHECKLISTS AND QUESTIONNAIRES Indications and limitations of psychological testing “Little published data exist on the use of psychological testing (projective and objective personality tests) in the assessment of torture survivors. Also, psychological tests of personality lack cross-cultural validity. These factors combine to limit severely the utility of psychological testing in the evaluation of torture victims. Neuro-psychological testing may, however, be helpful in assessing cases of brain injury resulting from torture (see chapter VI, section C.4: ‘Neuropsychological as-