Mental state examination

Aim: To describe patient’s current state of mind under dormains of appearance, attitude, behaviour, mood, affect,
speech, thought process, thought content, perception, cognition and insight.

Domain Describe & comment

Appearance • Distinctive features
• Body built – thin, muscular, obese
• Clothing
• Posture / gait
• Grooming / hygiene
• Nail & hair kept in short ?
• Evidence of self harm – bruises, scar
Behavior • Eye contact
• Facial expression
• Psychomotor activity -  or 
• Body language
• Level of arousal – calm / agitated / aggression
• Ability to follow request
• Rapport / engagement
Speech • Language: He was speaking in __(Language)__
• Content was relevant, coherent & rational ?
• Rate of speech – Pressured / slowed
• Quantity of speech – Minimal / excesive / Absent
• Tone of speech – Monotonous / Tremulous
• Volume of speech – Loud / quiet
• Fluency & rhythm of speech – Articulate / Clear / Slurred
Mood & Mood (What Dr observe) Affect (What Dr conclude)
Affect Def: Immediate expressed & observe Def: Sustained emotion for prolong period of time that can
emotion (facial expression) change patient perception of the world
Questions Quality • Sad / Agitated / Hostile
• How are you feeling ? • Euphoric / Animated
• What is your current mood ? Range • Restricted
• Have you been feeling low, depressed, • Normal
anxious lately ? • Expansive
Intensity • Normal
Example of mood states: • Blunted
• Low / depressed • Anxious • Angry / • Flat
Irritable • Apathetic (No interest) • Elated Fluctuations • Labile – easily changed
(Overjoyed)
Thought Thought • Speed – accelerated / racing / retarded
form • Flow
» Linear – In logic order
» Incoherence – No logic
» Circumstantial – Irrelevant
» Tangential – Flight of ideas
» Perservation – Repetition of particular response despite absence of stimulus
Thought Content Questions
content • Delusions • What been on your mind recently ?
• • Are you worried about anything ? (Obsessions / Overvalued ideas)
Obsessions • Do things seem unreal to you ? (Delusions)
• Are there any thoughts you have hard time getting out of your head ?
 • • Do you think anyone is trying to harm your ? (Delusions)
Overvalued • Do you have any beliefs that aren’st share by others ? (Delusions)
ideas – ex • Do you ever think about ending your life ? (Suicidal thoughts)
anorexia • Have you ever felt your life was not worth saving ? (Suicidal thought)
nervosa • Have you ever attempt to end your life (Suicidal thought)
• Suicidal • Do you ever think of harming other people ? (Violent thought)
thoughts
• Violent
thought
Thought Thought About Question
possesions Insertion Belieft that thoughts can Do you think people can put ideas in your
be insert into patients mind ?
mind
Withdrawal Belieft that thoughts can Do you think people have erased
be remove from patients memory from your mind
mind
Broadcasting Belieft that thoughts can Do you think others can hear what you’re
be heard by others thinking ?
Perception Peception About Questions
Hallucination Sensory perception without external Do you ever see, hear, smell, feel or taste
stimulation that patient believe is real things that are not really there ?
Pseudo- Sensory perception without external Do you think this was real at the time ?
hallucination stimulation that patient believe is NOT real
Illusion Misinterpreted perception Do you still believe is real ?
Congnition • Orientation – Well orientated to place, person & time
• Attention & concentration – Serial subtraction test, Tell days of a week & months forward & back ward
• Memory
» Immediate memory – Digit span test
» Recent memory – What was your last meal ? Able to recall 3 things given to memorized ?
» Remote memory – When was your birthday ?
• Intelligence
» General knowledge – What is capital city in Kelantan ? Kota bharu
» Arithmetic – I have RM10, I bought an apple for RM2 & orange for RM3, how much money I left ?
• Vocabulary » What is mean by library ? A place to study
• Abstract thinking
» Proverb – What is the meaning of “Bagai kacang lupakan kulit” ?
» Similarity – What is the similarity between apple & orange ?
» Differences – What is differences between bird & aeroplane ?
Insight & Insight Judgement
Judgement • Do you think you have a disease ? What is it ? • Social judgement – Do you think scolding mom is a
• Do you think you need to eat medication ? good thing ?
• Test judgement – If you see fire inside your
neighbor home, what do you do ?
• Personal judgement – What is your plan after
getting out from this hospital ?