Mental state examination

Question 1

What are the 8 parts of mental state examination?

Answer 1

1. Appearance and behaviour
2. Speech
3. Mood
4. Thoughts: form and content
5. Perceptions
6. Cognition
7. Insight
8. Risk (self, others, from others)

Question 2

Under appearance what should be commented on?

Answer 2

Appearance:

• Ethnicity
• gender
• age
• build
• dress
• personal care (kempt, unkempt),

Question 3

Under Behaviour what should be commented on?

Answer 3

Behaviour:

• Rapport
• eye contact
• agitation or retardation
• appropriateness
• Intoxication
• Aggression
• Distractability
• Abnormal movements or postures (e.g. tics, dystonia)
• Personal space
• Incongruous e.g. saying sad but laughing (vs. congruous)
• Catatonic e.g. waxy flexibility, mute

Question 4

Under speech what should be commented on?

Answer 4

• Rate
• Volume
• Coherence
• Tone
• Quantity
• Articulate
• Rhythm
• Spontaneity
• Fluency
• Reciprocity
• Cryptolia = Invent own language
• Phonemic paraphasia = things sound like
• Semantic paraphasia = wrong category
• Obsessional e.g. slower conversation
• Echolalia = repeating everything
• Coprolalia = tourettes
• Neologisms = making up new words
• Stock phrases = using same phrase over and over again
• Paragrammatism = disjointed grammar

Question 5

Under Mood what should be commented on?

Answer 5

Subjective assessment: own patients views
Objective assessment: clinical view of emotions
Somantic symptoms/biological: Sleep, appetite, energy, libido, anhedonia
Cognitive symptoms: concentration, self-esteem, guilt
Affect: congruent/incongruent and reactive/blunted/flattened

Question 6

Under Thoughts FORM what should be commented on?

Answer 6

• Tempo: Flight of ideas, physic retardation
• Word salad
• Perseveration (stuck at the end of sentence)
• Thought block
• Obsessional slowness
• Linearity e.g tangentiality, derailment
• Associations e.g. loosening, clanging, punning, responding to environmental cues

Question 7

Under Thoughts CONTENT what should be commented on?

Answer 7

• Delusions - persecutory, grandiose, nihilistic, delusions of control, delusions of thought interference, delusions of reference (ideas of reference)
• Overvalued ideas
• Obsessional thought
• passivity phenomenon
• delusional perception
• Paucity of content

Question 8

Under perceptions what should be commented on?

Answer 8

• Hallucinations: auditory, visual, somatic, oflactory, gustatory, hypnagogic/hypnopompic
• Thought interference: insertion, blocking, broadcasting
• pareidolia (interpreting vague stimulus as something else or hearing hidden messages in music)

Question 9

Under cognition what should be commented on?

Answer 9

• Orientated in time, place and person
• Report any difficulties with memory or attention
• Able to recall recent events or past events
• Mini-mental state examination - 30 point Questionnaire

Question 10

Under insight what should be commented on?

Answer 10

• Ability to recognise your difficulties or limits

- Attitude about hospitalisation/medication/psychological therapy

Question 11

Under risk what should be commented on?

Answer 11

• Risk to self: self-harm, self-neglect, suicide, sexual disinhibition, employment jeopardised
• Risk to others: deliberate harm to others, inadvertent harm to others
• Risk from others: harm, exploitation, confronting others

Question 12

If there is no perception or delusional symptoms, what could be said?

Answer 12

Nil delusional beliefs or overvalued ideas elicited
Nil perceptual abnormalities reported/elicited
Nil reported; not observed to be responding to non-apparent stimuli.