Mental State Examination

By Roberts Klotins | August 23, 2018


1. Appearance and Behaviour

Appearance e.g. grooming, hygiene, clothing, physical health. Eye contact and facial expression. Attitude to situation and examiner e.g. hostile, withdrawn, seductive. Motor behaviour e.g. slowed down, restless, tremors, posture Any bizarre behaviour e.g. appearing to respond to hallucinations

  • Assess the patient’s level of self- care (note any self neglect which may be associated with depression and dementia).
  • Note any weight loss or signs of physical illness e.g. as may be seen in depression, eating disorders.
  • Note any oddity of dress (e.g. occasionally manic patients may wear very bright or incongruous clothes; hats or sunglasses may be worn for reasons relating to patient’s elation or delusions).
  • Assess eye contact (may be reduced in depression; avoidant in a suspicious patient or staring with Parkinsonism and following use of some drugs.
  • Note facial appearance (may reflect mood as depressed, elated, anxious or angry). Also note if the patient shows little variation in facial expression (may be seen in depression and Parkinson’s).
  • Describe carefully any unusual behaviours that you observe such as appearing to respond to auditory hallucinations.
  • Note posture and movement, this will include psychomotor agitation or retardation. Abnormal motor movements may be observed:
    • Tardive dyskinesia (may be secondary to psychotropic medication)
    • Tremors and tics
    • Stereotypies and Mannerisms
    • Stupor and signs of catatonia

2. Speech

Assessing speech also involves assessing the type and quality of speech and not the thought content.

Note its rate, volume, quantity and flow: Rate e.g. slow, pressured (very rapid), able to interrupt; tone e.g. monotonous; volume e.g. loud, quiet, slurred; quantity of information e.g. restricted amount of spontaneous speech; neologisms, echolalia, perseveration, dysathria

Also make a note of any articulation difficulties (Dysarthria). Some patients may use new words constructed by them or attach personal meaning to existing words (Neologism). Echolalia (repeating same words phrases as examiner) should also be noted.

3. Mood and affect

Mood e.g. depressed, euphoric, suspicious, irritable, anxious Lability; Affect e.g. restricted, flattened (absence of emotional expression) and incongruity

4. Form of thought

Amount of thought and rate of production e.g. hesitant thinking, vague, flight of ideas Continuity of ideas - refers to logical order of the flow of ideas Disturbance in language or meaning

5. Content of thought

Delusions and overvalued ideas Suicidal thoughts, plans or intent Other – e.g. obsessions, compulsions, hypochondriacal preoccupations

6. Perception

Hallucinations relating to sounds heard, visions, smells, tastes, tactile or somatic sensations. Note in particular any command hallucinations. Does the patient think that he or she may act upon these? Other perceptual disturbances

7. Cognition

Level of consciousness Memory: immediate, recent, remote Orientation: time, place, person Concentration: ask the individual to subtract serial 7s from 100 Abstract thinking

8. Insight

Extent of individual’s awareness of problem. Compliance with treatment.

Form to sign off the Competency

Note: You can either fill this PDF form on a computer (preferably together with your assessor) and print it out for the assessor to sign, or you can just print the page and fill it out by hand together with the assessor. In any case after the form is signed, you will need to scan it to upload to your portfolio, just like you would with any paper-based evidence form. If you fill the form on your computer you need to SAVE it with a different name - so that the text you typed into the form gets preserved. A form filled on a computer probably, will be easier to read.

If the form opens directly in your browser you probably will not be able to type in the form fields - for that you need to open the form with your system PDF viewer - which likely will be Adobe Reader.

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