Mental State Examination

** Note: we do not ask these questions specifically, rather the medical professionally deduces these from
the comprehensive psychiatric history taken from the patient + general observations.**

Appearance

• Age
• Build
• Ethnicity
• Dressed appropriately
• Cleanliness – well groomed or unkempt
• Expression – anxious, perplexed, guarded

Behaviour

o Facial expressions = Co-operative? Irritable? Angry?

o Appropriate --- socially or sexually disinhibited
o Motor activity – increased or decreased (retardation)?
o Degree of eye contact
o Rapport with patient
o Aggression – verbal or physical?
o Abnormal posture or movements – tics, tremor, extrapyramidal side effects, repetition?

Speech

 Volume  Rate  Tone

 Quantity – spontaneity?  Fluency – articulate?  Rhythm

▪ Abnormal association – clanging, rhyming, punning

▪ Stuttering
▪ Dysphasia (post stroke or traumatic brain injury)?
▪ Word finding difficulties
▪ Flight of ideas
▪ ++ Tangents or circumstantiality of speech

Mood

➢ Patient’s own description

➢ Your observation of mood – complexity
➢ Euthymic = normal ; dysphoric = sad
➢ Affectation: – reactive – labile – blunted – flat – congruous or incongruous
Thoughts

Degree of linearity: :  speed  flow  coherence

• Association quality
• Poverty of thought?
• Capacity for goal directed thinking? Are responses relevant?
• Loosening of association?
• Thought block?

o Self-harm? ○ Suicide? ○ Harm to others? ○ Delusional beliefs – what and type?

➢ Over-valued ideas
➢ Thought alienation – thought insertion, withdrawal, broadcasting
➢ Obsessive thought – intrusive, repetitive, unpleasant ; recognised by patient as alien?

Perceptions

Disturbances:  auditory  visual  gustatory  olfactory  tactile

▪ Flashbacks – PTSD
▪ Depersonalisation? ▪ Derelisation? ▪ Illusions?

Cognition

❖ Orientated -- time -- place -- person

❖ Attention deficits
❖ Memory deficits – short vs long term

** Mild cognitive impairment or suspected dementia → Montreal Cognitive Assessment (MoCA); or

→ Addenbrooke’s Cognitive Examination – revised (ACE-R)

Insight

 good  partial  poor

= WHY!?

► Patient recognition of psychiatric illness and presenting symptoms

► Do they view themselves as unwell

► Do they think require treatment?