Mental State Exam

Question 1

What are the 7 domains of the mental state exam?

Answer 1

1. Appearance and behaviour
2. Speech
3. Mood and Affect
4. Perceptions
5. Thought
6. Cognition
7. Insight

Question 2

Define Pressured speech?

Answer 2

rapid rate, increased volume, difficult to interpret

Question 3

Define poverty of speech?

Answer 3

lengthy pauses between brief utterances

Question 4

Define flight of ideas?

Answer 4

thoughts in speech jump rapidly from one to another

Question 5

Define clanging?

Answer 5

words put together because of how they sound not how they mean

Question 6

Define punning?

Answer 6

associating words that sound the same e.g. sole the fish and soulful

Question 7

Define schizophasia/ word salad?

Answer 7

the connection between themes, sentences and even words is lost, resulting in unintelligible speech, although words are still identifiable

Question 8

What is the difference between mood and affect?

Answer 8

• Mood is subjective and this is how the patient says they are feeling that day and should be recorded in their own words
• Affect is objective and is your observation of how the patient appears through the interview

Question 9

What are the two categories considered under thought?

Answer 9

thought content and thought possession

Question 10

What may you look for under appearance and behaviour?

Answer 10

• Do they look and act their chronological age
• Colour and state of clothes
• Facial appearance
• Eye contact
• Posture
• Movement
• Agitation
• Startle response
• Tremor
• Restlessness
• Scanning for danger
• Distractibility

Question 11

What may you look for under speech?

Answer 11

• Rate (is it abnormally slow or fast)
• Pressured speech
• Poverty of speech
• Variation in tone
• Volume of speech
• Flight of ideas
• Clanging
• Punning
• Schizophasia/ word salad

Question 12

What may you look for under mood and affect?

Answer 12

what patient says their mood is
how they appear today (affect)
intensity of affect (can be heightened or bluttened/ flattened)
Congruency

Question 13

What is meant by congruency of affect?

Answer 13

Congruency of affect refers to whether the patient’s affect appears to be in keeping with the content of their thoughts e.g. a patient sharing distressing thoughts and laughing would be described as showing incongruent affect

Question 14

What are some abnormalities of perception?

Answer 14

hallucinations, pseudohallucinations, illusions, depersonalization and derealization

Question 15

What may you look for under cognition?

Answer 15

• Orientation to time, place and person
• Concentration
• Confusion

Question 16

What may you look for under insight?

Answer 16

• Aspects of insight can be remembered with the 4As
• Awareness: Does the patient recognise that they are unwell?
• Attribution: Do they attribute it to a mental health problem?
• Appraisal: Do they understand the consequences of their symptoms
• Acceptance: Do they accept the need for treatment?