mental state exam

Question 1

appearance

Answer 1

distinguishing features - scars, tattoos, iv drug use
weight
stigmata of disease - personal hygiene
clothing - appropriate for weather/circumstances
objects with them

Question 2

behaviour

Answer 2

engagement + rapport - distracted (engaging with hallucination)
eye contact
faicial expression
body language - threatening (standing close), withdrawn
psychomotor - movement + delyed responses to Qs, restlessness
abnormal movements or postures - involuntary movements, tremors, lipsmacking, rocking

Question 3

speech

Answer 3

rate - pressured slow
quantity - minimal or absent speech, excessive
tone - monotonous, tremulous (anxiety)
volume
fluency - stammering or stuttering, slurred

Question 4

mood + affect

Answer 4

mood = what they tell you (low, anxious, angry, euphoric, guilty, apathetic)

affect = what you observe
- apparent emotion - anger, hostility, sadness
- range + mobility of affect - fixed, restricted, labile (exaggerated changes)
- intensity of affect - heightened (mania), blunted/flat (depression, PTSD)
- congruency of affect - a patient sharing distressing thoughts while laughing would be incongruent, incongruent assoc with schizo

fixed, blunted, congruent

Question 5

thoughts

Answer 5

form - speed, flow coherence

content - delusions, suicidal, overvalued idea

posession - inserion, withdrawal etc

Question 6

thought form

Answer 6

speed
flow + coherence
- loose assoc
- circumstantial
- tangential
- flight of ideas
- thought blocking
- neologisms

Question 7

thought content

Answer 7

delusions
obsessions compulsions
overvalued ideas
suicidal thoughts
homicidal thoughts

Question 8

though possession

Answer 8

thought, insertion, withdrawal, broadcasting

• 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?”

Question 9

screening for thought content abnormalities

Answer 9

• “What’s been on your mind recently?”
• “Are you worried about anything?”
• “Do you sometimes have thoughts that others tell you are false?”
• “Do you have any beliefs that aren’t shared by others you know?”
• “Do you ever feel that people are out to do you harm?”
• “Do you ever feel that specific events in the world are related to you in some way?”
• “Are there any thoughts you have a hard time getting out of your head?”
• “Do you sometimes feel the need to perform certain behaviours repetitively, despite understanding these are irrational?”
• “Do you ever think about ending your life?”
• “Have you ever felt your life was not worth living?”
• “Have you ever attempted to end your life?”
• “Do you ever think about harming others?”

Question 10

perception

Answer 10

hallucinations
pseudohallucinations - patient aware its not real
illusions - mistaking shadow for erson

depersonalisation - feels like they are no longer their true self

• “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?”

Question 11

cognition

Answer 11

orientated to place time, person
attention spam, concentration
short term memory

Question 12

insight + judgement

Answer 12

insight - aware what theyre experiencing is abnormal, do you think theres a problem here, do you feel you need help

judgement - what would you do if you could smell smoke in your house