Mental State Examination Notes

1. Behaviour and Appearance

Physical appearance
Comment on grooming, hygiene, clothing, shoes, hair, nails, build, tattoos, breath, and smell.
Are there any visible physical abnormalities?

Reaction to examiner
Comment on eye contact and degree of rapport.
Is the patient hostile, friendly, withdrawn, guarded, co-operative, seductive or flirtatious? What is the level of hyperarousal? Is the patient hypervigilant?

Motor behaviour
Is the patient psychomotor retarded, restless, fidgety, squirming, still? Does he have tremors, hand wringing, tongue darting, or chorea?
Is there evidence of akathisia or other abnormal motor movements?

2. Orientation and Memory

Is the patient oriented to time, place and person?

How is the patient’s memory? (immediate, short term, long term)

Is a Mini Mental Status examination indicated?

3. Mood and Affect

Mood is the pervasive internal feeling/emotional state of the patient. Is the patient euthymic, euphoric, depressed, dysthymic, angry, irritable, anxious, or apathetic? It can be reported as subjective mood (as reported by the patient) and objective mood (as observed by the examiner).

Affect is the visible expression of mood. Affect is observed predominantly in terms of facial expression but also body language. Aspects of affect commonly described include range, responsiveness, changeability intensity and appropriateness to the content.

4. Speech

How is the speech rate, rhythm, volume and amount?

5. Thought Form

Thought form is assessed by describing the following:

• Amount of thought and its rate of production (e.g. poverty of thought, flight of ideas)
• Logical flow of ideas (e.g. goal directed, thought blocking, tangential, derailment, looseness of associations, circumstantiality, echolalia)
• Language disturbance (e.g. neologism, clanging, word salad)

6. Thought Content

What are the themes in the discussion with the patient? Are there delusions, obsessions, phobias, compulsions, preoccupations, overvalued ideas?

7. Perceptions

Are there hallucinations? (auditory, visual, tactile, olfactory, gustatory)

Are there illusions, derealisation, depersonalizations, heightened perceptions?

8. Insight

Comment on the patient’s cognitive appraisal of their mental functioning and the impact that this has on their life.

Is the patient aware of his situation? What is his concept of what’s happening to him? Does the patient understand his illness, his condition, its impact, treatment options and consequences?

9. Judgment

Judgment is about how someone makes decisions that lead to action. It is assessed by reviewing the recent actions the person has taken and the future actions they plan.

10. Safety

To self: Does the patient have thoughts of wanting to be dead? How strong are these thoughts? Are there specific methods or plans of going about it? What has the patient done to further these thoughts?

To others: Does the patient have thoughts of harming others? How strong are these thoughts? What are the methods or plans of carrying it out? Is the patient neglecting the care of a helpless dependent? (E.g. infant, disabled relative)

Self-care: Is the patient able to take care of himself as regards basic nutrition and hydration? Is the patient engaging in risky behaviours that have serious consequences? (E.g. manic spending sprees, sexual indiscretions as a result of psychotic/manic illness) Are his actions acutely endangering his physical wellbeing? (E.g. driving whilst intoxicated, forgetting to take life sustaining medications like insulin, leaving gas stove on)