Mental state Examination

Question 1

Appearance

Answer 1

General elements such as attire and sign of self neglect
Facial expression
Tatoos and scars
Evidence of substance misuse
Possibly relevant physical disease

Question 2

Behviour

Answer 2

Cooperation, rapport, eye contact
Social behaviour
Apparent responses to possible hallucination or unobserved stimuli
Over activity
Under activity
Abnormal activirty

Question 3

Agitiation

Answer 3

Combination of pyshic anxiery and excessive, ouorose less motor activity

Question 4

Compulsion

Answer 4

Sterotyped action that the patient cannot resist performing repeatedlt

Question 5

Disinhibiton

Answer 5

Loss of control over normal social behaiour

Question 6

Motor retardation

Answer 6

Decreased motor activity, usually a combination of fewer and slower movements

Question 7

Posturing

Answer 7

Maintainence of bizarre gait or limb positions for no valid reasons

Question 8

Speech

Answer 8

Articulation (stammering, dysarthria)
Quantiity (mutism, garrulosness)
Rate (pressured, slowed)
Volume (whispering, shooting)
Tone and quality (accent emotionality)
Fluency (staccato, monotonous)
Abnormal language (neologism, dysphasia, clanging

Question 9

Clang associations

Answer 9

Thoughts connected by their similar sound rahte than by meaning

Question 10

Echolalia

Answer 10

Sensless repetition of the interviwer’s words

Question 11

Mutism

Answer 11

Absence of speech without impaired conciousness

Question 12

Neologism

Answer 12

Invented word, or a new meaning for an established word

Question 13

Pressure of speech

Answer 13

Rapid, excessive, continious speech

Question 14

Word salad

Answer 14

Meaningless string of words, often with loss of grammatical construction

Question 15

Mood

Answer 15

Variabke iver time

How has your mood been lately

Question 16

Blunting

Answer 16

Loos of normal emothional sensitivty to expierneces

Question 17

Catastrophic reaction

Answer 17

An extreme emotional and behavioural over-reaction to trivial stimulus

Question 18

Flattening

Answer 18

Loss of range of normal emotional responses

Question 19

Incongruity

Answer 19

Mismatch between the emotional expressiona dn the associated thoguh

Question 20

Lability

Answer 20

Superficial, rapidley changing and poorly controlled emotions

Question 21

Thought form

Answer 21

As with speech this is not an assessment of what the patient is thinking about but how they think about it

Question 22

Circumstantiality

Answer 22

Trivia and digressions impairing the flow but not direction of thought

Question 23

Cenrete thinking

Answer 23

Inability to think abstractly

Question 24

Fliught of ideas

Answer 24

rAPID SHIFTS FROM ONE IDEA TO ANOTHER, RETAINING SEQUENCING

Question 25

Loosening of associations

Answer 25

Logical sequence of ideas impaired. Subtypes include knight's move thinking, derailment, thought blocking and in its extreme form word salad

Question 26

Perseveration

Answer 26

Inability to shift from one idea to the next

Question 27

Pressure of thought

Answer 27

Increased rate and quantitiy of thoughts

Question 28

Thought content

Answer 28

Main themens and subjects occupying the patient's mond

Question 29

Hypochondriasis

Answer 29

Unjustified belief in suffering from a particular disease in spite of appropriate examination and reasssurance

Question 30

Morbid thinking

Answer 30

Depressive ideas

Question 31

Phobia

Answer 31

Senslesss avoidance of situation, objecr or activity stemming from a belief that has caused an irrational fear

Question 32

Preoccupation

Answer 32

Beliefs that are not inhertly abdnormal but which have come to dominate the patient's thinking

Question 33

Ruminations

Answer 33

Repeptivie, intrusive, senseless thoughts or preoccupations

Question 34

Obsessions

Answer 34

Ruminations that persist despite resistance

Question 35

Delusion

Answer 35

An abnornal belief held with total conviction which is maintained in spite of proof or ligcal argument to the contrary and is not shared by others from the same culture

Question 36

Delusional perception

Answer 36

Delusion that arises fully formed the false interpretation of a real perception

Question 37

Magical thinking

Answer 37

An irrational belief that certain actions and outcomes are linked, often culturally determined by folklore or custom

Question 38

Overvalued ideas

Answer 38

Beliefs that are held, valued, expressed and acted on beyond the normn fro the culture to which the person belongs

Question 39

Thought broadcastin

Answer 39

Belief that the patients thoughts are heard by others

Question 40

Thoguht insertion

Answer 40

elief that thoughts are being placed in the patients head from outisde

Question 41

Thought withdrawl

Answer 41

Belief that thoughts are being removed from the patients head

Question 42

Depersonalisation

Answer 42

Subjective expeiirence of feeling unreal

Question 43

Derealisation

Answer 43

Subjective experience that the surrounding environent is unreal

Question 44

Hallucination

Answer 44

False perception that is an understandable misinterpreation of a real stimulus in the external world

Question 45

Pseudohallucination

Answer 45

A flase perception that is percieved as part of one's internal expiernce

Question 46

Cognition

Answer 46

``` If the hsitory and observation suggest a cognitive deficit it must be evaluated by standard tests Level of consciousness Orientation Memory Attention and concentration Intelligence ```

Question 47

Level of concioussness

Answer 47

Mental disorders are rarely associared with areduced level of consciousness such as drowsiness stupor or coma. The exception is delerium

Question 48

Oritentation

Answer 48

Key aspect of cognitive function being particular sensivie to impairment Check orientation to time, place and person by evaluating their knowledge of the current time and date, recognition of where they are and identification of familiar people

Question 49

Memory

Answer 49

Divided into 3 elements Registration is tested by asking the patient to repeat after you the names fo 3 unrelated objects Short term memory Long term memory

Question 50

Insight

Answer 50

Degree to which a patient agrees that they are ill Recognition that abnormal mental expiericnes are in fact abnormal Agreement that. these abnormalities amount to a mental illness and acceptance of the need for treatment

Question 51

Risk assessment

Answer 51

Who is at risk Nature of the risk Lieklihood of the risk

Question 52

Collateral hisotry

Answer 52

IMportant whnever assessment is limited by: Physical illness, acute confusional state or dementia Severe learning disability or other mental disorder imparing communication Disturbed, aggressive or otherwise uncooperative behaviour

Question 53

Abberviated mental test

Answer 53

``` Age DOB Time Year Hospital name Recognition of 2 people Recall address Dates of first world war Name of the monarch Count backwards 20-1 ```

Question 54

General morbitidity has

Answer 54

General health questionnaire

Question 55

Mood dirsorders

Answer 55

Hospital anxiety and depression scale | Beck Depression Inventroy

Question 56

Alcohol

Answer 56

CAGE questionnaire

Question 57

CAGE

Answer 57

Cut down: Have you ever felt you should cut down on your drinking Annoyed: Have people annoyed you by criticising your drinking Guilty: Have you ever felt bad or guilty about driving Ever: Do you ever have a drink first thing in the morning to steady you or help your hangover

Question 58

FAST

Answer 58

1- Men: How often do you ahve eight or more drinks on one occasion Women: How often do you have six or more drinks on one occasion 2- How often during the last year have you been unable to remember what happened the night before because you had been drinking 3- How often during the last year have you failed to do what was normally expected of you because of drinking 4- In the last year, has a relative or friend, or a doctor or other heath worker been concerned about you drinking or suggested you cut down