Mental State Examination Flashcards
Appearance and Behaviour
A record of the impression of personal hygiene, and description of the clothing,
hairstyle, tattoos etc and body language of the patient (appearance). Also a
description of any obvious mannerisms, body posture, eye contact and motor
functions (tremors, getting up from chair, wringing hands etc.)
What can appearance tell you?
The way we dress reflects our mood - depressed people may wear all black/grey,
and neglect themselves, not combing their hair or shaving, manic patients may
dress in flamboyant, multi-coloured attire or weather/season inappropriate attire
(shorts & sunglasses in winter, multiple jumpers in summer). Paranoid patients
may come to assessments with all of their belongings in many bags
Tattoos, t-shirts with logos can tell you about personal interests and significant people (tattoos are
often of children/partners/parent’s names, favourite football clubs, or indicate gang affiliations or
time in prison. Also depressed people may only wear dark colours. Patients with poor self care
may not change their clothes for days on end.
Self harm scars may indicate chronicity of self harm (multiple healed scars) or severity (scarring
around neck from attempted hanging)
Body language often indicates mood - paranoid people may look around constantly, depressed
people may look down, avoiding eye contact, manic people may stare, fidget/move constantly
How to describe appearance and behaviour
1.Describe the appearance of the patient and their clothing, posture and body
language as above
2.Describe level of eye contact
3.Describe any relevant movement/ mannerisms
Speech
A description of the way a patient speaks/vocalises without reference to what they actually say
Why is speech important
Our mood/arousal level affects our speech. Psychotic people may be mute or
shout. Depressed people may be softly spoken. Anxious people may only make
noises. Manic people may be loud, or sing/rap/rhyme
How to describe speech
Comment on the Amount, Tone, Rate and Volume of speech plus any key
characteristics (accent, stammer, dysarthria, repeated phrases, copious swearing,
repeating words, using made up words (neologisms) sounding childlike etc.
Pressured speech
Uninterruptible speech
Poverty of speech
Hardly any words spoken
Mood
A record of both the patient’s description of how they feel (subjective) and the
assessor’s view of their mood
The way we feel is a product of our thoughts and an indicator of them. It gives an indication of risk and the patient’s view of their ability to cope.
Affect
the observed objective emotional expression or response of the patient
Flattened Affect
reduced range of emotion, not expressing happiness, nor really sorrow (but
may seem sad)
Incongruous Affect
Talking about something normally associated with one emotion, but
expressing a different (usually opposite) emotion - for example, smiling whilst talking about death of a loved one
Hypomania
Elevated mood but not associated with the extremes seen in mania
What areas of thoughts are assessed?
1) Content (what someone thinks/says). This includes delusions, obsessions/compulsions and overvalued ideas)
2) Form (how this is presented to you) and any formal abnormalities in thought (e.g flight of ideas, loosening of associations
and Knights-move thinking)
3) Flow - pace and fluency of thought (e.g pressured thought in mania or thought block in schizophrenia and poverty of thought in depression)
How do you assess thought
Thought content is accessed by simply talking with the patient. To get the most
helpful view on their thought content we usually start with an open question, e.g:
“Can you tell me about why you’ve come to the hospital today?”
What you ask next depends on the setting. For an initial meeting with a patient you
might be completing a full psychiatric history, and ask about previous admissions, their personal history etc. If the patient is being reviewed in a ward round, you might ask them about their progress or plans for discharge, or views about their medication or leave.
