Mental State Exam

Question 1

how would you open the conversation?

Answer 1

working with your doctor today, asked me to have a chat with you about how you’re feeling. Were you expecting that, is that okay with you?
Is there anything I can do to make you feel more comfortable? Would you like a glass of water or anything?

Question 2

What are the key parts of the exam, what would you write in your notes as a structure?

Answer 2

Patient
Appearance
Behaviour
Speech
Emotion
- mood
- affect
Perception
Thoughts
- form 
- content
- suicide
- possession
Insight (and judgement)
Cognition
- basic
- MMSE

Question 3

what are you looking for with regard to the patient’s appearance?

Answer 3

distinctive features 
clothing
posture/gait
grooming/hygiene
evidence of self harm

Question 4

What aspects of behaviour are you watching out for?

Answer 4

eye contact
facial expression
psychomotor activity (two things at once)
body language/ gestures/ mannerisms
arousal
ability to follow requests
rapport/ engagement

Question 5

what things to do with speech could be a tell tale sign of a mental health problem?

Answer 5

rate
quantity
tone
volume
fluency and rhythm

Question 6

what are the components of emotion that you are assessing in the patient and how are they different?

Answer 6

mood and affect

mood - sustained, long-term emotion, the climate, things you ask about
affect - immediately expressed or observed, the weather, given away by their facial expression or demeanour

Question 7

what sort of questions would you ask to assess their mood?

Answer 7

how are you feeling?
what would you say your current mood is?
have you been feeling….recently?

Question 8

what aspects of affect would you be observing?

Answer 8

quality
range
intensity
fluctuations

Question 9

what type of thing is indicative of someone’s altered perception?

Answer 9

hallucinations
pseudohallucinations
illusions

Question 10

what are hallucinations?

Answer 10

false perception - hearing voices

Question 11

what are pseudo hallucinations?

Answer 11

hallucinations that they know aren’t real

Question 12

what are illusions?

Answer 12

misinterpretation

Question 13

what type of questions would you ask to assess the patient’s perception?

Answer 13

do you ever see, hear, smell, taste, feel anything that isn’t there?
did you think it was real at the time?
do you still think it was real?

Question 14

what aspects of thought are you assessing?

Answer 14

form
content
possession

Question 15

what comes under thought form?

Answer 15

speed

flow/coherence - linear, incoherent, not to the point, flight of ideas, repetition

Question 16

what comes under thought content?

Answer 16

abnormal beliefs/delusions
obsessions
overvalued ideas
suicidal
homicidal/violent

Question 17

what the of questions would you ask to assess thought content?

Answer 17

whats been on your mind?
are you worried about anything?
do things seem unreal to you?
are there thoughts that you are having trouble getting out of your head?
do you think anyone is trying to harm you?
do you have beliefs that your loved ones don’t share?
have you ever thought of ending your life? - have you ever acted on it?
have you ever though of harming yourself or others?

Question 18

what is thought possession?

Answer 18

insertion - believe that people can put thoughts in their head
withdrawal - belief that people can remove thoughts from their head
broadcasting - believe others can hear their thoughts

Question 19

what would you ask to see if they suffer from thought possession?

Answer 19

do you think people can put thoughts into your head?
have you ever felt like people have taken away things like memories from your mind?
do you ever feel like people can hear what you’re thinking?

Question 20

what is insight?

Answer 20

whether they know they have a problem, think they know the cause of the problem and recognise that they need help
also includes judgement - their general problem solving ability

Question 21

how do you assess cognition?

Answer 21

basic - orientation, concentration and attention, short-term memory
detailed - MMSE

Question 22

how would you present the MSE?

Answer 22

introduce the patient
explain why they came in, and relevant parts of their history
I was concerned so carried out a mental state exam
ABSEPTIC (dont forget suicide)