Mental State Exam

Question 1

What is the purpose of a mental state exam?

Answer 1

• an assessment of a person’s current state of mind
• sescribes a dnapshot of their presentation during your interaction with them
• also includes relevant negative findings
• used to assess progress during/after treatment

Question 2

What is the format of a mental state exam?

Answer 2

• appearance and behaviour
• speech
• mood and affect
• thought form and content
• perception
• cognition
• insight

Question 3

What aspects of a patients appearance is assessed in a mental state exam?

Answer 3

Description of the person

• ethnicity
• build
• hairl colour
• clothing (appropriate for weather?)
• biological vs chronical age
• well kempt
• evidence of self neglect
• appear physically unwell or intoxicated?
• any distinguishing features

Question 4

What aspects of a patient’s behaviour is assessed in a mental state exam?

Answer 4

how the person acts:

• level of motor activity (agitation or retardation)
• eye contact
• rapport and engagement with interview
• body language and posture
• any unusual or socially inappropriate behaviour

Question 5

What aspects of a patients speech is assessed in a mental state exam?

Answer 5

how the person talks:

• rate and quantity
• rhythm
• volume
• tone
• spontaneity

Question 6

What is the difference between mood and affect?

Answer 6

Mood: a persons emotional state overall

Affect: changes in the persons emotions that you observe moment-to-moment during the interview

Question 7

How is a patients mood assessed in a mental state exam?

Answer 7

• subjectively: how the person tells you they feel in their own words

- objective: your impression of the person's mood during the interview
> euthymic (normal)
> elevated/elated
> low/depressed
> anxious

Question 8

How is a patients affect assessed in a mental state exam?

Answer 8

• reactive: appropriate reaction to the situation or topic being discussed
• flattened: limited emotional reaction
• blunted: no observed emotional reactions (specifically associated with psychosis)
• labile: excessive emotional fluctuations

Question 9

What is thought form?

Answer 9

the pattern of the persons thoughts

• are they logical connections between the things they are saying?

Question 10

How is a patient’s thought form assessed?

Answer 10

include specific quotes if possible

• flight of ideas: rapid flow of speech, moving from topic to topic with logical connections (e.g. mania)
• loosening of associations/Knight’s move thinking: little or no logical connections between thoughts (e.g. schizophrenia)

Question 11

What is thought content?

Answer 11

What the person is saying

any topics that are discussed more than others

Question 12

What are examples of abnormal thought content?

Answer 12

• delusion
• over-valued idea
• obsessions

Question 13

What is a delusion?

Answer 13

a fixed false belief that is out of keeping with the person’s religious and cultural background (e.g. psychosis)

Question 14

Describe different types of delusions

Answer 14

• persecutory: perceived threat from others
• grandiose: considerable overestimate of abilities or possession of special powers
• nihilistic: belie that they are dead or do not exist
• delusions of reference: belief that external events/objects are directly related to them
• thought interference: insertion, withdrawal or broadcast

Question 15

What is an over-valued idea?

Answer 15

a false belief, not totally
fixed but causing great disability (e.g.
anorexia, hypochondriasis)

Question 16

What is an obsession?

Answer 16

recurrent, intrusive, distressing
ideas, impulses or images that the patient
recognises as their own (e.g. OCD)

Question 17

How is a patient’s risk assessed during a mental state exam?

Answer 17

Any thoughts of harm to self or others,
including the degree of planning and intent

Always document, even if negative

Question 18

What is perception?

Answer 18

What the patient tells you and what you observe

Question 19

What are examples of abnormal perception?

Answer 19

• hallucination: perception without external stimulus
  > auditory - associated with psychosis
  > visual, olfactory, gustatory, tactile - more often oganic states
• illusion: false perception of a real stimulus

Question 20

What is cognition in relation to the mental state exam?

Answer 20

• is the person alert and orientated?
• how is their concentration and memory
• can use mini mental state examination if necessary

Question 21

How is cognition assessed in a mental state exam?

Answer 21

• alertness: do they seem fully awake
• orientation: to time, place and person
• attention/concentration: are they able to maintain focus during the interview, are they easily distracted?
• memory: 3 objects, ask to repeat, then spell world backwards and then ask what the objects were

Question 22

What is insight?

Answer 22

The patient’s understanding of their presentation and their need for treatment

Question 23

How is insight assessed in a mental state exam?

Answer 23

Do they believe their experience is unusual?

Is it part of an illness? A mental illness?

Do they require treatment?

What type of treatment?

Do they need to be admitted to hospital?