Mental State Exam

Contents

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?
Eye contact?
- Do they make any? Is there too much? None at all?
Clothes
- Eccentric? Clean? Mismatch – (inability to co-ordinate thoughts)
Facial
- Tattoos (on the face high indication to mental illness, sign of past imprisonment, gang involvement) Scars
- Facial expression
Psychomotor
- unusual movements
- agitation / retardation
General
- tearful
- anxious
- overactive
- underactive

Description
- 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

Ask the patient to describe any preoccupations or worries:

Content
- 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.
Nature
- 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.
Flow
- 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
- Auditory (psychotic) – 2^nd person (talking to them), 3^rd person (talking about them)
- Visual (acute confusional state)
- Tactile
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