Mental State Examination Notes

Mental State Examination

• Introduction

  • Position chairs

  • Open/closed questions

  • Encouragement to talk

  • Feelings AND facts

  • Clarifying

  • Focusing

• Appearance & Behaviour

  • Physical appearance

    • Body build (NUTRITIONAL)

    • Distinguishing features

    • Personal hygiene (hair, teeth, nails)

    • Quality, style & state of clothing

      • Appropriate for time of year and situation?

    • Facial expressions?

  • General attitude

    • Relaxed, worried, stressed, etc.?

    • Rapport

      • Interactions appropriate?

    • Attitude towards interview

    • Eye contact

    • Affect?

      • How the patient acts according to their emotions

  • Motor behaviours

    • Drug effects?

    • ANS

      • Hyperventilation?

      • Tremor?

      • Sweaty?

    • Restless

    • Fidgety

    • Apathy

    • Retarded

• Speech

  • Volume & speed

    • Pressure of talk

      • Tumbling words=Manic

    • Retardation

      • Slow

      • Not many

  • Construction/Form

    • Rate

      • Fast=Manic (tumbling)

    • Rhythm

    • Fluency

    • Descriptions

      • Flight of ideas

      • Rhyming (manic)

      • Punning

      • Incoherence

  • Enunciation

    • Dysarthria

    • Stammer

  • Content

    • Relates to their thoughts

    • Patient may return to same themes

    • Unusual language

    • Neologisms=made up words

• Mood

  • Types

    • Subjective

      • In their own words

    • Objective

      • Body language, behaviour, facial expressions

      • Empathic understanding

  • SUICIDAL FEELINGS AND SUCIDAL IDEAS

    • Life not worth living?

    • Contemplated?

    • Method?

    • Current intentions?

    • "When people feel bad, sometimes they think of ending it all. Have you ever had thoughts of this kind?"

  • Biological symptoms

    • Poor appetite

    • Weight loss

    • Early morning wakening

    • Diurnal mood variation?

    • Reduced memory and concentration

    • Profound anhedonia (no joy from previously enjoyable)

    • Increased anxiety/panic attacks

• Thoughts

  • DIVIDED

    • Form (Subjective experience of thought disorder)

      • Thought broadcast

        • Thought process disrupt

        • Inner thought aspect lost

        • Psychosis

      • Thought block

        • Break in the flow

        • Outside force removing=Thought withdrawal

      • Thought insertion

        • Thoughts not own

        • Dictated by others

      • Knight's move thinking (derailment)

      • Flight of ideas

    • Content

      • Preoccupations?

      • Ideas of reference?

      • Recurring, pervasive theme

      • Depressive ruminations

      • Grandiose ideas

      • Self-referential ideation

      • Delusions

        • "Have you had the feeling that something odd is going on that you can't explain?"

        • "Do you feel puzzled by strange happenings that are difficult to account for?

        • "Do Familiar surrounding seem strange?"

      • Obsessional thoughts (+Compulsive rituals)

        • “Some people find they have unpleasant and unwanted thoughts or images coming into their mind, which can’t be resisted. Has that been a problem?”

        • “There are other difficulties of a similar kind where people have to keep on checking things that they know they have done; like gas taps, switches, whether the front door is locked, and so on. Do you have problems like that?"

  • Objective signs of thought disorder

• Perceptions (Hallucinations)

  • Auditory hallucinations

    • "We routinely ask, as stress can cause some people to hear noises or voices even when completely alone, and not ordinary explanation is possible. Has this ever happened to you?"

    • Types

      • LOUD THOUGHTS (GEDANKENLAUTWERDEN)

        • "Thoughts loud in your head, almost as if somebody standing near could hear them?"

      • THOUGHT ECHO (ECHO DE LA...

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