Mental State Exam
Appearance and behaviour
How does the patient enter the room?
- quickly? slowly?
What is the patient’s attitude to the interview?
- aggressive? reluctant? Can you build a rapport with them?
- can you engage them?
- Do they make any? Is there too much? None at all?
- Eccentric? Clean? Mismatch – (inability to co-ordinate thoughts)
- Tattoos (on the face high indication to mental illness, sign of past imprisonment, gang involvement) Scars
- Facial expression
- unusual movements
- agitation / retardation
- Elated (overly happy)
- Dysphoric (very low)
- Euthymic (normal)
- Labile (constantly fluctuating)
- Subjective – patient’s opinion of their mood and state
- Objective – our opinion of their mood and state
- Rate / Rhythm / Tone
- Do they answer questions
Ask the patient to describe any preoccupations or worries:
- Can they form construct thoughts? Do they make sense?
- Are there any thoughts they seem to be preoccupied with?
- e.g persecution, health, weight
- Interference: Insertion, withdrawal, broadcasting
- Passivity phenomenon feels as if they’re being taken over.
- Delusions : A false belief, which is firmly held despite contrary evidence and is out of keeping with the patient’s cultural or religious background.
- Obsessions: A recurrent thought, impulse or image that enters the subject’s mind despite resistance.
- The patient may realise that it’s not necessarily true but can’t resist thinking about it.
- May be compulsive in nature
- An overvalued idea: A belief not held quite as strongly as a delusion, and is typically more understandable.
- The content may be normal but the flow (form) may not be : Formal thought disorder
- flight of ideas, connections e.g. rhyming, do the ideas join together?
- Suicide / self harm / harm to others
- Future plans
Have you ever heard anything that other people couldn’t? Do things / people seem diffirent from normal.
- Hallucinations: A perception experienced as real in the absence of a stimulus
- Illusions: A misperception e.g. seeing someone in the shadows when there is no-one there
- Depersonlization: A feeling of detachment from the normal sense of self “ As if i’m acting”
- Mini mental state
- Orientation – time, place, person
- Show patient 3 items and ensure they have registered them – test recall after 2mins
- Spectrum – fluctuates according to mental state
- Are they aware of their behaviour
- Do they believe they need treatment
- Do they believe they have a mental disorder