Mental Status Exam Psychiatry

To assess appearance, behaviour and speech begin by asking some general open questions:

• Appearance – dress, posture, facial expression, mannerisms
• Activity – sitting still/fidgeting
• Social and emotional behaviour – apathy, irritable, co-operative

Speech

• Rate
• Tone
• Quality
• Content – depressive ideas, delusions

Now ask more specific questions relating to the other parts of the assessment:

• Symptoms of anxiety – e.g. sweating, palpitations
• Current mood state – (both subjective and objective)
• Any biological symptoms – e.g. sleep, appetite, libido, or loss of concentration
• Suicidal ideation

Phobias and obsessions

• Phobias: determine the stimulus, its psychological and physiological effect and the nature of any avoidance behaviour
• Obsessions: determine the underlying thoughts, the nature of the obsession, the effect on daily life and if it’s a senseless obsession?

Abnormal experiences

• Illusions/misperceptions
• Hallucinations: visual, ophthalmic, auditory (second or third person)

Abnormal beliefs

• What do you think is wrong with you?
• Do you think you need any treatment?
• What do you think the treatment will do for you?

Cognition – this should be done by the mini mental state examination, although this is generally not part of the OSCE.