Saturday, July 8, 2017

The Mental State Examination



This assesses state of mind at the time of interview with the patient. A true description of mental states entails valid knowledge about current emotions plus their reactions to those emotions.

Take notes under the following headings.

• Appearance and behavior: see for signs of self-neglect; slowness, anxiety, or suspiciousness.

• Mode of speech: Speech rate, eg gabbling (pressure of speech), or slow/retarded. Note content.

• Mood: Note thoughts about harming self or others. Gauge your own response to the patient. The
laughter and grand ideas of manic patients are contagious, as to a lesser extent is the expression of thoughts from a depressed person.

• Beliefs: Eg about himself, his own body, about other people and the future. Note abnormal beliefs
(delusions) eg that thoughts are overheard, and ideas (eg persecutory, grandiose).

• Unusual experiences or hallucinations: “Sometimes when people are low they have unusual
experiences; have you heard anything unusual recently?” Note modality, eg visual.

• Orientation: In time, place, and person. What year? What season? What month/day of week? Is
it morning or afternoon? What is your name?

• Short-term memory: Recall a name & address 5 minutes after learning it. Ensure he really has learned it before waiting for the 5 minutes to elapse.

• Concentration: Months of the year backwards.

• Patient’s insight and degree of your rapport.

• Long-term memory: Current affairs recall. Who is the monarch/head of state? This tests other functions, not just memory


Non-verbal behavior look for
Gaze and mutual gaze
• Facial expression
• Smiling, blushing
• Body attitude (eg ‘defensive’).

Look For Signs Of Anxious behavior:
• Fidgeting, trembling
• Nail-biting
• Shuffling feet
• Squirming in the chair
• Sits on edge of chair

Look for Signs of a depressed mood:
•Hunched, self-hugging posture
• Downcast eyes; tears
• Little eye contact
• Slow thought, speech, and movement

Signs of auditory hallucinations:
• Inexplicable laughter
• Silent and distracted while listening to ‘voices’
• Random, meaningless gestures

Direct questions to Ask:
• Any odd thoughts?
• Do you feel anyone is controlling you?
• Is anyone putting thoughts into your head?
• Do other people access or hear your thoughts?
• Is anyone harming you?
• Any plots against you?
• Do you hear voices when there’s no one nearby? What do they say? Echoing you? Telling you off ?
• Do you see things that others cannot see?
• Are you low/depressed?
• Is life worth living?
• Can anything give you pleasure?
• Sleep and appetite ok?
• Energy levels increased  or decreased?
• Can you concentrate ok?
• Are you feeling guilty?
• Is your confi dence low?
• Are you wanting to harm anyone? Yourself?
• Any worries/anxieties?

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