Mental State Examination

Question 1

What is the mnemonic?

Answer 1

All Sane Men Think That Pizza Is Italian, Really?

Question 2

What does the mnemonic stand for?

Answer 2

Appearance and behaviour
Speech
Mood
Thought form
Thought content
Perception 
IQ (cognition)
Insight
Risk

Question 3

What are we looking for in Appearance + Behaviour?

Answer 3

Age, ethnicity, gender.
Clothes.
Cleanliness.
Posture and movement.
Any unusual behaviours
Agitation and restlessness or psychomotor retardation.
Any evident physical abnormality.
EYE CONTACT + RAPPORT.

Question 4

What are we looking for in Speech?

Answer 4

Rate, rhythm and volume.
Any pressure of speech.
Flow of speech.
Spontaneous speech or lack thereof.

Question 5

What are we looking for in Mood?

Answer 5

Objective: do they appear low, euthymic, elated? any other emotions?

Subjective: in their own words.

Affect: moment to moment changes in emotional state. Blunted, flat, labile, appropriate.

Question 6

What are we looking for in Thought Form?

Answer 6

Does the conversation make sense? Was their flight of ideas, loosening of associations, perseveration, neologisms, thought blocking etc.

Question 7

What are we looking for in Thought Content?

Answer 7

Predominant ideas or preoccupations, delusions, overvalued ideas, thought interference, obsessions.

Question 8

What are the different types of delusions we should be aware of?

Answer 8

Persecutory, nihilistic, grandiose, infidelity (Othello’s syndrome).

Question 9

What are the different types of thought interference we should be aware of?

Answer 9

Thought insertion, blocking, withdrawal, broadcast.

Question 10

What are we looking for in Perception?

Answer 10

Hallucinations (auditory, visual, olfactory, somatic, tactile), pseudohallucinations, depersonalisation, derealisation.

Question 11

What are we looking for in IQ (cognitive function)?

Answer 11

Formal assessment of cognition (MMSE, AMTS), orientation in time, body and place, memory problems, other tests for frontal lobe function.

Question 12

What are we looking for in Insight?

Answer 12

Patients views on the diagnosis, problems, acceptance of treatment and management.
What do they think the diagnosis is?
Do they think they have a mental illness at all?
Is insight, poor, partial or good?

Question 13

What are we looking for in Risk?

Answer 13

Risk to self (suicide or self-harm)
Risk to others
Other ways they may be at risk (self neglect, reduced oral intake, vulnerability etc.)