After reviewing the history, this examination is based on the psychiatrist's observations and impressions of the patient.

It is the most essential component of the psychiatric examination and therefore requires a thorough understanding of the patient's psychological life. It has various components and subcomponents that can provide important information leading to a clear diagnosis.

General appearance o Overall appearance o Gait o Grooming o Posture o Gestures o Facial expression o Emotional appearance Anxious Tense Panicky Sad Unhappy o Voice Faint or loud Hoarse o Eye contact Motoric Behaviour o Level of activity Psychomotor agitation or retardation o Tics or tremours o Automatisms o Mannerisms o Grimacing o Stereotypes o Negativism o Apraxia Attitude o Irritable o Aggressive o Seductive o Guarded o Defensive o Indifferent o Cooperative o Sarcastic Mood (should be in patient's own words) o Gloomy o Tense

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Hopeless Ecstatic Resentful Happy

Affect Labile o Blunted o Constricted o Flat o Mood congruity and appropriateness o Range and intensity Speech o Rate Slow or fast Pressured Interruptable o Spontaneous o Stammering o Stuttering o Slurring o Pitch o Articulation o Aphasia o Echolalia o Incoherent o Mute Perceptual Disorders o Hallucinations Olfactory Auditory Tactile Gustatory Visual o Illusions o Hypnopompic or hypnagogic experiences o Feelings of unreality o Deja vu Thought Process o Logical o Goal directed o Loosening of associations o Flight of ideas o Tangential o Relevant
o

Circumstantial Rambling o Clang association o Perseveration Thought Content o Suicidal or homicidal ideation o Delusions Persecution Grandiose Infidelity Somatic Sensory o Thought broadcasting or insertion o Ideas of reference o Phobias o Obsessions o Compulsions o Thought blocking o Depersonalization o Magical thinking Sensorium o Level of consciousness Alert Clear Confused Clouded Comatose Stuporous o Orientation to person, place, time, situation o Cognition Memory o Remote o Recent o Immediate Concentration and Calculations o Ability to pay attention o Distractibility Information and Intelligence o Use of vocabulary o Level of education o Fund of knowledge Judgement o Ability to understand facts o Draw conclusions
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Insight Level o Poor o Limited o Fair o Good

MSE defined? Appearance Body weight obese, overweight, underweight, emaciated (bony, very thin) Hair Bizzare style, unnatural colours, un shaven, alopecia (balding), Patchy, Phenyl ketonurea ( dermatitis- dandruff etc), Other features wounds, scars, tattoos, jewellery, glasses, dental braces Grooming dishevelled, soiled, body odour, halitosis (bad breath), undressed, underdressed, overdressed, bizarre, militaristic Behaviour Walk- gait/march, limp shuffle, assisted, dancing, Repetition gestures, twitches, stereotypical, automatism, mimicry, echopraxia(involuntary imitation of action of others) , tic Over activity - psychomotor agitation , hyperactivity, excitement, agitation, restlessness, akathesia (cant stay still) Catatonia- catalepsy (), stupor (), excitement, rigidity, posturing, cerea flexibilitas (), negativism () Speech rate & volume rapid, slow, pressured, accented, loud, whispered, voluble, Speech form slurred, mumbled, stutters, poverty of speech, poverty of content, dysprosody, dysarthia Speech quality hesitant, emotional , monotonus, stereotypical, unspontaneous, echolalia, verbigerative, aphasia-motor, aphasia-sensory, aphasia-transcortical, aphasia-syntactical, aphasiajargon, aphasia-global Speech quantity garrulous, talkative, responsive, taciturn, mutism,

Attitude towards examiner seductive, playful, ingratiating, friendly, cooperative, interested, attentive, frank, indifferent, evasive, defensive, hostile