Mental state examination
Appearance & behaviour
The big three to look out for are self neglect, eye contact and rapport. For more details:
- Motor abnormalities
- Self Care
- Eye contact
- Slow in depression
- Fast in mania
- Sponteneity – do they talk with being asked
- Makes sense
- Volume (loudness) - quiet in depression, loud in mania
- Articulation - dysarthria
- Unusual speech rhythm, melody, pitch - dysprosody
Mood & Affect
Subjective mood - what the patient says, ie. "I feel like death!" Objective mood - how the patient comes across, ie. fidgeting and hesitant speech.
How fast mood changes:
- Labile affect: changes too much - Someone can't have a yoghurt and they scream with rage, and then start crying - think hormonal teenage girl.
- Blunt affect: changes too little - Their dog dies, and they say "Oh. That's a shame". They win the lottery, and they say "Oh. That's great".
- Incongruous: doesn't fit - Their mum dies, and they're incredible happy.
- disorganised thought
- tangential thinking - never reaches point, keeps going off on tangents: "pub, tub [because of rhyming], I like ice cream!" [comes in tubs]
- loosening of association - less severe than tangential thinking: "pub, alcohol, smoking, smoking ban"
- circumstantiality - eventually get to the point but take ages
- flight of ideas
- thought blocking - common schizophrenic symptom
- thought alienation - thought broadcast, insertion and withdrawal "People hear/insert/remove thoughts from my head"
- delusions of control - "I'm not in control of my body"
- persecutory delusions - "The FBI are stealing my biscuits"
- grandiose delusions - "I'm the King of the world"
- religious delusions - "I'm a ninja Jesus"
- Hallucinations - I see a monkey over there (there's nothing over there)
- Illusions - I see a monkey over there (there's a dog over there)
Check they know Time, Place, Person.
- What time is it? What is the date?
- Where are you?
- What is your name?
Do they know they are ill? Be tactful, to avoid scaring them - don't ask "How long have you been mental?"; try "Why are you in hospital?"