Mental State Examination

Mental State Examination

1. Appearance and Behaviour
It include the physique, clothes, cleanliness, hair, makeup and whether it is appropriate for the age, sex, cultural group and social class of the patient. It is important to pick up signs of self-neglect (poor hygiene, body odour, stained clothes)
Look at the manner the patient act towards the interviewer (anxiety, friendly, cooperative, complaining, suspicious, or critical)
Take note of the psychomotor activity which includes facial expression, posture and gait. (Too little movement; too much movement; involuntary movement)

2. Speech
Look at the rate, rhythm, volume and tone of speech. Also note the quantity and quality of the speech.
Retardation is a delay in starting to speak and rate of speech. Mutism is total absence of speech. Pressure of speech describes rapid outpouring ideas that are often difficult to interrupt. Flight of ideas describes the speech of manic patient move rapidly from one subject to another, usually with some discernible association.

3. Mood and Affect
Mood is the overall impression of mood over the duration of interview while affect is moment to moment variability and responsiveness.

Subjective mood – How have you been feeling recently?
Objective mood – sadness, anxiety, or happiness conveyed through facial expression, posture and motility (weeping, euphoria, irritability)
Autonomic activity – Sweating, palpitation, dry mouth, hyperventilation, and increased frequency of micturition associated with anxiety, acute or chronic schizophrenia

4. Cognition
Orientation – Time, place, person
Attention
Concentration
Short and long term Memory
*basically use MMSE and MSQ

5. Thoughts
Suicidal ideas or self harm – ask about plans, attempts, preparation, perception of the event and perceived fatality
Flow – flight of ideas, word salad, circumstantial
Content – unusual beliefs/ overvalued ideas/ delusions
Alienation – Insertion, broadcast, withdrawal, blocking

6. Insight
Describing patient’s beliefs regarding their symptoms and treatment. It is an understanding of the presence, nature of mental illness and its causes.
*What does the patient believe is the problem? What does the patient believe will help?

7. Perception
*Have you heard voices of people that you couldn’t see? have you noticed any changes in yourself or your surroundings that you can’t account for?
Illusions – misinterpretation of external stimuli
Hallucination – perceptions that are not based on external stimuli; perceived as real
Pseudohallucination – lack the quality of vividness and reality that are possed by normal perceptions and hallucination; often have an ‘as if’ quality

Reference:
1. Mental State Examination Tutorial by Dr. Sharon Butler
2. Oxford Handbook of Clinical Specialties 8th Edition
3. Psychiatry in Medical Practice 3rd Edition