Mental state examination

Question 1

What are the main points to cover in a mental state exam?

Answer 1

ASEPTIC

1. Appearance and behaviour
2. Speech
3. Emotions - mood and affect
4. Perceptions
5. Thoughts
6. Insight
7. Cognition

Question 2

What do you look for in appearance and behaviour?

Answer 2

Build and distinctive features
Clothing
Hygiene
Gait and posture
Facial expression
Body language
Gestures
Eye contact and rapport
Unusual features

Question 3

What do you look for in speech?

Answer 3

Rate - rapid/pressured
Rhyme
Tone
Volume

Question 4

What is mood?

Answer 4

Subjective emotion over a prolonged period of time

Described using the patients own words

Question 5

What is affect?

Answer 5

Immediate observed/objective emotion

Described by how they convey their emotion and non-verbal cues

Question 6

What should you pick up when thinking about their thoughts?

Answer 6

Stream - abnormality of the amount and speed of though
- Pressure/poverty/thought blocking
Form - abnormality in the way thoughts are linked
- Flight of ideas/loosening of associations/preservation
Delusions - false unshakeable idea of belief firmly held despite evidence to contrary
- Persecutory/delusions of reference/grandiose/guilt/worthlessness/delusions of control/delusions concerning possession of thoughts/over valued ideas/obsessive
Thoughts of self harm/suicide

Question 7

What should you pick up when thinking about their perception?

Answer 7

Dissociative symptoms 
- De-realisation
- De-personalisation
Illusions
Hallucinations

Question 8

What do you look for in cognition?

Answer 8

Capacity to process information

Question 9

What do you look for in insight?

Answer 9

Awareness and understanding of illness, treatment options and ability to comply