Interview Techniques and Mental State Examination

Question 1

Describe the domains of the mental state examination

Answer 1

• Appearance
• Posture and movement
• Behaviour
• Speech and language
• Mood and affect
• Thought stream and form
• Perception
• Cognition
• Insight

Question 2

What aspects might you cover in the mental state examination when thinking about appearance?

Answer 2

• Pen portrait - age, gender, grooming, clothing, distinguishing features

Question 3

What aspects might you cover in the mental state examination when thinking about posture and movement?

Answer 3

• Tension, hypervigilance, excessive sweating
• Mannerisms, stereotypies, echopraxia, flexibilitas cerea, negativism or excitement
• Parkinsonism, akathisia, tardive dyskinesia, tics
• Responding to auditory hallucinations

Question 4

What aspects might you cover in the mental state examination when thinking about behaviour?

Answer 4

• Irritability, distractibility and apathy
• Overfamiliarity, importunateness, sexual inappropriateness
• Social withdrawal, no eye contact, little conversation
• Perplexity
• Aggression and violence

Question 5

What aspects might you cover in the mental state examination when thinking about speech?

Answer 5

• Quantity of speech
• Rate of speech
• Volume of speech
• Neologisms, thought disorders, punning, clang associations, flight of ideas, poverty of the content of speech
• Perseveration, dysphasia or dysarthria

Question 6

What aspects might you cover in the mental state examination when thinking about mood and affect?

Answer 6

• Quality, duration
• Reactivity (response to emotional stimuli)
• Congruence (between words and expression)
• Depression (enquire about suicide)
• Elation
• Anxiety
• Depersonalization or derealization
• Affect (appropriateness of mood, rate of change of mood - the range expressed during the interview)

Question 7

What aspects might you cover in the mental state examination when thinking about thought stream and form?

Answer 7

• Stream (pace of generation e.g. slow, fast, pressured, increased latency)
• Form (idea connectivity) e.g. logic/understandability of connections between thoughts
• Flight of ideas, circumstantiality (detour), retarded thinking, tangentiality, derailment, blocking, word salad, neologisms, echolalia

Question 8

What aspects might you cover in the mental state examination related to thought content?

Answer 8

• Themes, emphasis of ideas (strongly held but amenable to reason), delusions (fixed, unshakeable, acted on)
• Delusions
  
  • Primary delusions - de novo, un-understandable
    
    • Atmosphere (something is happening)
  • Secondary delusions - tend to arise from other delusions or experiences
• Obsessions
  
  • Recurrent, intrusive phenomena, resisted by the patient but recognised as own
  • Often lead to compulsions

Question 9

What aspects might you cover in the mental state examination with respect to cognition?

Answer 9

• Consider an MMSE
  
  • Orientation
  • Serial sevens
  • Repeat and later recall (short term memory)
  • Recount recent news events (recent memory)
  • Dates of distant events, birth dates of close relatives (long-term)

Question 10

What aspects might you cover in the mental state examination with respect to insight?

Answer 10

• Insight into illness
• Insight into nature of illness
• Insight into treatment

Question 11

What are the 5 domains of affect?

Answer 11

• Appropriateness - to situation and thought content
• Intensity - normal, blunted, heightened
• Range
• Reactivity
• Mobility - lability or fixed