Mental state exam Flashcards
Appearance
(6)
Distinguishing features: these may include scars (e.g. self-harm), tattoos and signs of intravenous drug use.
Weight: note if they appear significantly underweight or overweight.
Stigmata of disease: note any stigmata of disease (e.g. jaundice).
Personal hygiene: this can provide insight into the patient’s current ability to care for themselves.
Clothing: note if this is appropriate for the weather/circumstances and if the clothes have been put on correctly.
Objects: look around to see if the patient has brought any objects with them and note what they are.
Behaviour
(5)
Engagement and rapport
Eye contact
Facial Expressions
Body Language
Movements or postures
Speech
Rate of speech
Quantity of speech
Tone of speech
Volume of speech
Fluency and rhythm of speech
Mood
“How are you feeling?”
“What is your current mood?”
“Have you been feeling low/depressed/anxious lately?”
Examples of mood states
- Low mood
- Anxious
- Angry
- Enraged
- Euphoric
- Guilty
- Apathetic
Affect
(4)
Apparent emotion
Congruency of affect
Intensity of affect
- Heightened: associated with mania and some personality disorders.
- Blunted or flat: associated with schizophrenia, depression and post-traumatic stress disorder.
Range and mobility of affect
- Fixed affect: the patient’s affect remains the same throughout the interview, regardless of the topic.
- Restricted affect: the patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.
- Labile affect: characterised by exaggerated changes in emotion which may or may not relate to external triggers. Patients typically feel like they have no control over their emotions.
Thoughts (4)
- “Do you think people can put ideas in your head, without your control?”*
- “Have you ever felt like people have removed memories or thoughts from your mind?”*
- “Do you ever feel like others can hear what you’re thinking?”*
Speed of thoughts
Thought content
- Delusions: a firm, fixed belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with regional and cultural norms. These may include persecutory delusions, in which the patient erroneously believes another individual or group is trying to harm them or ideas of reference, in which the individual incorrectly believes specific events relate to them.
- Obsessions: thoughts, images or impulses that occur repeatedly and feel out of the person’s control. The patient is aware these obsessions are irrational, but the thoughts continue to enter their head.
- Compulsions: repetitive behaviours that the patient feels compelled to perform despite recognising the irrationality of the behaviour.
- Overvalued ideas: a solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer’s life (e.g. the perception of being overweight in a patient with anorexia nervosa).
- Suicidal thoughts
- Homicidal/violent thoughts
Flow and coherence of thoughts
- Loose associations: moving rapidly from one topic to another with no apparent connection between the topics.
- Circumstantial thoughts: these are thoughts which include lots of irrelevant and unnecessary details.
- Tangential thoughts: digressions from the main conversation subject, introducing thoughts that seem unrelated, oblique, and irrelevant.
- Flight of ideas: there is an accelerated tempo of speech often referred to as ‘pressure of speech’. In addition to the increased rate of delivery, the language employed is characterised by a wealth of associations, many of which seem to be evoked by more or less accidental connections… the excited speech wanders off the point following the arbitrary connections, and the coherent progression of ideas tends to become obscured.1
- Thought blocking: sudden cessation of thought, typically mid-sentence, with the patient being unable to recover what was previously said.
- Perseveration: refers to the repetition of a particular response (such as a word, phrase or gesture) despite the absence/removal of the stimulus (e.g. a patient is asked what their name is and they then continue to repeat their name as the answer to all further questions).
Thought possession
- Thought insertion: a belief that thoughts can be inserted into the patient’s mind.
- Thought withdrawal: a belief that thoughts can be removed from the patient’s mind.
- Thought broadcasting: a belief that others can hear the patient’s thoughts.
Perception (5)
- “Do you ever see, hear, smell, feel or taste things that are not really there?”*
- “Did you think this was real at the time?”*
- “Do you still believe it was real?”*
- “Do you ever feel like you’ve changed or that you don’t recognise the person you currently are?”*
- “Do you ever feel like the world around you isn’t real?”*
Hallucinations: a sensory perception without any external stimulation of the relevant sense that the patient believes is real (e.g. the patient hears voices but no sound is present).
Pseudo-hallucinations: the same as a hallucination but the patient is aware that it is not real.
Illusions: the misinterpretation of an external stimulus (e.g. mistaking a shadow for a person).
Depersonalisation: the patient feels that they are no longer their ‘true’ self and are someone different or strange.
Derealisation: a sense that the world around them is not a true reality.
Cognition (3)
whether they are orientated in time, place and person
what their attention span and concentration levels are like
what their short-term memory is like
Insight (3)
“What do you think the cause of the problem is?”
“Do you think you have a problem at the moment?”
“Do you feel you need help with your problem?”
Judgement (2)
Judgement refers to the ability to make considered decisions or come to a sensible conclusion when presented with information. Judgement can become impaired in several mental health conditions leading to poor decision making.
“What would you do if you could smell smoke in your house?”
