Mental Status Exam Psychiatry

- Start by introducing yourself to the patient, clarify their identity and explain that you would like to talk to them about their thoughts.
- There are 8 components to this assessment.
To assess appearance, behaviour and speech begin by asking some general open questions:
- Appearance and behaviour
- 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:
- Mood
- 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
- Insight – to determine this you should ask a few directed questions.
- 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.
- Thank the patient for speaking to you.
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