Mental State Examination

Appearance + behaviour

  • how they present, how they interact with other people, motor activity, build, dress, self-care, visible features
    • Abnormal involuntary movements?
      • Utilisation behaviour (frontal lobe behaviour)
      • Tardive dyskinesia "like I have a lollipop in my mouth and I move my tongue around"
      • Akathisia
      • Waxy flexibility
      • Stereotyped movements, mannerisms
      • Gait abnormalities

Speech

  • Rate
    • Pressured i.e. cannot interrupt (mania)
  • Poverty of speech (depression/negative symptoms of schizophrenia, “I don’t know what to say”)
  • Perseveration = repeating words/topics
  • Neologisms = using existing words in a different context where the meaning is different

Mood/affect

  • Mood: subjective and objective
  • Affect = what you see i.e. how mood manifests
    • N: reactive
    • euphoric, labile, flattened

Thought form

  • "Are you thinking clearly?"
  • What is the transition between statements?
  • Record some examples
  • Other characteristics: over-inclusive, circumstantial, tangential, loosening of associations, derailment, neologisms, flight of ideas, word salad, perseveration (cognitive impairment)
  • Formal thought disorder?
  • Thought block = subjective experience of thought: being 'stopped' by outside force

Thought content

  • e.g. worries, phobias, obsession
  • Depersonalisation. Often associated with anxiety
  • Delusions – see psychosis

Perception

  • "Do you hear anything or anyone that other people can't hear?"
  • Interacting with hallucinations?
  • Modalities of hallucinations:
    • Auditory/visual most common
    • Tactile (delirium tremens, MDMA)
  • Illusions (misinterpreting normal perceptions) vs hallucinations (no external stimulus)
  • Pseudo hallucinations: with preserved insight; stimuli comes from “within” (EUPD)
  • Hallucinations: false perception in absence of stimulus
    • External/internal?
    • Describe nature and content e.g. 2nd/3rd person, running commentary, thought echo, command hallucination

Cognition

  • Oriented in time/place/person?
  • May require more formal testing

Insight

  • About diagnosis, treatment, what other people think about it
  • What does the patient understand about their condition and the cause and the indication for treatment?
  • Awareness but blaming on others?
  • Pre-morbid personality

abbreviated version copy paste

  • Appearance and behaviour:
  • Speech:
  • Mood/affect:
  • Thought (content/form):
  • Perceptions:
  • Insight:
  • Risk assessment:

MH treatment history:

Previous sections:

MH FHx:

#mental-health