Mental State Examination

Question 1

What are the eight areas that should be assessed in a mental state examination?

Answer 1

Appearance and behaviour 
Speech 
Mood and affect 
Thoughts
Perception 
Cognition 
Insight 
Risk

Question 2

What are the aspects of appearance and behaviour that need to be assessed?

Answer 2

Clothing 
Body build
Hygiene 
Posture/gait
- festonant gait indicates side effects of anti-psychotics 
Evidence of self harm
Eye contact 
Facial expression 
Psychomotor activities 
Gestures and mannerisms 
Level of arousal - fluctuation indicates delirium 
Rapport and engagement

Question 3

What are the aspects of speech that need to be assessed?

Answer 3

Rate 
Quantity
Tone
Volume 
Fluency and rhythm

Question 4

What does mood and affect mean?

Answer 4

Mood - sustained inner feeling

Affect - observed expression of inner feeling

Question 5

What are the aspects of mood and affect that need to be assessed?

Answer 5

Appropriateness, consistence with mood (incongruence)
Fluctuations
Intensity - blunted or flat
Quality - happy, sad, labile, angry

Question 6

What are three things need to be considered as part of the thought assessment?

Answer 6

Thought form
Thought content
Thought perception

Question 7

What are the aspects of thought form that need to be assessed?

Answer 7

Speed - racing, retarded
Flow - linear, incoherent, circumstantial, tangential (off-topic answer), perseveration (constant repetition of the same thing), loosening of associations (disjointed jumbled answer) or neologisms (new words)
Many of these are signs of psychosis

Question 8

What are the aspects of thought content that need to be assessed?

Answer 8

Abnormal beliefs/delusions - false beliefs held with conviction
Primary and secondary delusions
Content
- persecutory delusions
- delusions of infidelity (Othello syndrome)
- grandiose delusions
- delusions of love
- nihilistic delusions (worthless, death and guilt)
- obsessions (know thoughts are not normal, but can’t push them away)
- overvalued ideas (e.g. anorexia)
- thoughts of self-harm

Question 9

What are primary vs secondary delusions?

Answer 9

Primary delusion
- attaching significance to a normal perception (light from red to green makes a person is an angel sent from god)
Secondary delusion
- occurs secondary to some other psychopatholgical condition
- e.g. voice telling him that no-one likes him makes a person think someone is out to get him

Question 10

What are the aspects of thought form that need to be assessed?

Answer 10

Thought insertion
- feeling of thoughts not being one’s own
Thought withdrawal
- thoughts are being taken out of the patients mind
Thought broadcasting
- belief that others can hear the patient’s thoughts
All signs of schizophrenia

Question 11

What are the aspects of perception that need to be assessed?

Answer 11

Hallucinations (abnormal sensory perception without external stimulus)
- auditory
- visual
- tactile
- olfactory
Illusions (misinterpreted perception)
- e.g. hearing wind when someone is crying

Question 12

What are the aspects of cognition that need to be assessed?

Answer 12

Orientation 
- time, place, person and who you are 
Attention and concentration 
- poor in depressed patients 
- attention fluctuation 
Memory

Question 13

What are the aspects of insight that need to be assessed?

Answer 13

Awareness of own symptoms and experiences
Patients opinion on the symptoms
Do they believe they are ill
What they think the cause of the illness is
Willingness to accept treatment

Question 14

What are the aspects of risk that need to be assessed?

Answer 14

Thoughts of self-harm or suicide
Thoughts to harm others
Alcohol and/or substance misuse