Mental State Examination

Question 1

Appearance?

Answer 1

Colour and state of clothes
Facial appearance 
Posture 
Ethnicity 
Physique 
Tattoos 
Kempt or unkempt 
Signs of self-neglect 
Looks older, younger or as expected for age

Question 2

Behaviour?

Answer 2

• General: relaxed, agitated, fidgety, restless, anxious, guarded, suspicious, hostile
• Eye contact: able to make and maintain it
• Posture: open and responsive or closed off
• Unusual mannerisms
• Excessive or inadequate amount of movements
• Comment on how these behaviours impacted on ability to build rapport
• Scanning for danger

Question 3

Speech questions?

Answer 3

Level of articulation 
Spontaneous or not 
Variation in tone
Rate: slow, normal, rapid 
Volume: quiet, adequate or increased 
Quantity: Decreased, adequate, increased 
Clear abnormalities: Stammer, dysarthria

(Flight of ideas, clanging, punning, schizophrenia/word salad)

Question 4

Pressured speech is?

Answer 4

Rapid rate
Increased volume
Difficult to interpret

Question 5

Poverty of speech is?

Answer 5

Lengthy pauses between brief utterances

Question 6

Mood?

Answer 6

Anxious?
Apathetic
Dysphoric 
Depressed 
Euthymic 
Elated 
Euphoric 
Irritable 

Affect:
-Congruent (eg distressing thoughts & laughing)
-Reactive or restricted
-Blunted: expression of emotion is insensitive to situation
-Flattened: outward display of emotion reduced
Labile: Poorly controlled and fluctuating

Question 7

Thought?

Answer 7

Flow:

• Amount and speed
• Pressure: Rapid, abundant, wide ranging
• Poverty: slow, limited range
• Blocking: abrupt end to chain of thought

Form:

• Any formal thought disorder
• Flight of ideas
• Knights move
• Loosening of associations
• Circumstantiality
• Tangenital
• Preservation
• Neogolisms

Question 8

Consider what 2 things when assessing thought?

Answer 8

Content of thought

Thought possession

Question 9

What is involved in possession of thought?

Answer 9

Thought insertion
Broadcasting
Thought withdrawal

Question 10

Knights move?

Answer 10

Jumps from idea to idea with their being no apparent connection between them

Question 11

Loosening of associations?

Answer 11

Thought becomes muddled and difficult to follow- word salad is severe form

Question 12

Circumstantiality?

Answer 12

Questions answered in a very round about way

Question 13

Tangenital?

Answer 13

Wanders off topic and never returns to it

Question 14

Preservation?

Answer 14

Involuntary repetition of ideas and thoughts when subject has been changed

Question 15

Neogolisms?

Answer 15

New words invented for objects with only the patient understanding these

Question 16

Content of thoughts?

Answer 16

Nature: guilt, shame, worthlessness, homicidal
Pre-occupations: thoughts that are in an individuals mind but not fixed, false or intrusive

Over-valued ideas: nature of thought is unreasonable, irrational, intrusive and cannot be suppressed

Delusions: Foxed, firm belief that is inappropriate to background firmly held in the face of logical argument or contrary evidence and of great significance to the patient

Question 17

Types of delusional thoughts?

Answer 17

Congruent or incongruent 
Bizarre 
Grandiose 
Paranoid 
Nilistic 
Control 
Thought control: insertion, broadcast, removal 
Reference: innocuous events held in high significance. Two

Question 18

Perceptions?

Answer 18

• Depersonalization (body is strange or unreal)
• Derealization (feelibg that object in external world are strange/unreal)
• Illusions (normal sensory stimuli are misinterpreted)
• Hallucinations (perception in absence of sensory stimulus)

Question 19

Types of hallucinations?

Answer 19

• Visual
• Auditory
• Olfactory
• Tactile
• Gustatory
• Auditory

Question 20

Questions about auditory hallucinations?

Answer 20

• No of voices
• Do they recognize voices
• Do you hear them inside your head or speaking to you like I am
• Do they talk to you or about you
• What do they say
• Do they tell you to do anything

Question 21

Cognition

Answer 21

Formal assessment: MMSE
Information assessment:
-Orientation in time, place, and person
-Concentration and level of conciousness

Question 22

How can aspects of insight be remembered?

Answer 22

4 As

• Awareness: Recognise they are unwell
• Attribution: Attribute it to mental health problem?
• Appraisal: Understand consequence of symptoms
• Acceptance: Accept need of treatment

Question 23

Questions to ask so patients understand consequences of not getting help?

Answer 23

• Do you think you symptoms are a problem
• What do you think is causing you to think this way/hear these voices
• Would you accept that is due to mental illness
• Do you think you need help
• What do you think would happen if you didn’t get help

Question 24

Flight of ideas?

Answer 24

Words are associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders far from the original theme. The patient jumps from topic to topic but with recognizable links such as rhyming, punning or environmental distractions.

Question 25

Clanging is?

Answer 25

Words put together because of how they sound not what they mean

Question 26

What is punning?

Answer 26

Associating words that sound the same (soul the fish and soulful)

Question 27

What is word salad?

Answer 27

Connection between themes, sentences and even words is lost, resulting in unintelligible speech