Mental State Examination

Remember – the mental state should take into account not just your observations during the course of the interview but also information obtained on symptoms and signs during the course of this episode of illness.  If there is evidence of disorder of thought form you should give examples of speech to demonstrate this.

Appearance and behaviour

General description

Build

Distinguishing features

Self-care

Rapport and eye contact

Interactions ie. guarded, cooperating etc

Intoxication

Body language ie. posture, psychomotor activity

Facial expressions ie. angry, relaxed

Unusual movements ie. medication side effects, tremors, tics

Mood

Subjective rating

Objective: Euthymic, elated, blunted, flat, labile. 

Congruency

Speech

Rate, rhythm, tone, volume

Disorders of thought form (continuity of thought as reflected in speech/writing)

Form is the processing and organising of thoughts. Do they flow in a logical order?

-      acceleration/retardation

-       circumstantiality/loosening of association

-       perseveration

-       neologisms

-       word salad

-       Tangentiality

-       Flight of ideas

Disorders of thought content

Pre-occupations (including suicidal ideation)

Overvalued ideas (including ideas of reference)

Obsessions/phobias

Delusions (including disorders of the possession of thought)

-       primary, secondary

-       disorders of the possession of thought (thought insertion, thought withdrawal, thought broadcasting

Disorders of perception

Derealisation/depersonalisation

Illusions

Hallucinations

Cognitive assessment

Orientation

Attention and concentration

Memory

Intelligence and general knowledge

Insight/judgement

Insight

What does the patient think is the explanation for their problems? What is their attitude to treatment/ supervision/ staying in hospital?

What do you think is causing the problem?

Is it possible that this could be a mental health problem?

What would help?

Would you be willing to try....?