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Mental state examination


  • Wash hands; Introduce self; ask Patient’s name, DOB and what they like to be called; Explain examination and obtain consent

Appearance and behaviour

You don’t need to ask this!

  • Appearance: dress, physical appearance, neglect
  • Behaviour: suspicious, paranoid, irritable, aggressive, eye contact
  • Distractions: preoccupied, distractible, withdrawn, quiet


You don’t need to ask this!

  • Rate: pressure of speech, slow
  • Volume/tone: monotonous
  • Fluency and rhythm

Mood and affect

Ask about their mood (e.g. β€˜How are you feeling?’, β€˜What is your mood like?’, β€˜Have you felt low/anxious recently?’)

  • Mood (sustained emotion over prolonged period of time)
    • Subjective: low, high, anxious
    • Objective: depressed, elated, euthymic, labile
  • Affect (immediately expressed emotion): facial expressions, overall demeanour 


Ask about delusions (e.g. β€˜Have you noticed any strange thoughts, or thoughts that others find strange?’, β€˜Can anyone interfere with or hear your thoughts?’, β€˜Do you feel you are in control of your actions?’, β€˜Do you ever get thoughts which keep going round and round in your head?’, β€˜Are there any actions you feel you need to do repeatedly?’)

Ask about risk to self and others (e.g. β€˜Some people in your situation feel like harming themselves or taking their own life, have you had such thoughts?’)

  • Form:Β coherence, muddled, flight of ideas, knight’s move thinking, preoccupations
  • Content: harm to self/others, suicidal ideas, delusions, over-valued ideas, thought insertion/withdrawal/broadcasting, control of thoughts

Never forget to ask about risk to self/others

e.g. Have the voices ever told them to harm themself/others? Have they taken any measures to protect themself? Do they feel like taking their own life?


Ask about hallucinations (e.g. β€˜Have you ever heard or seen anything you can’t explain?’, β€˜Have you ever heard people commenting on what you do?’, β€˜Do you ever feel events have a special meaning for you?’, β€˜Have the voices ever told you to harm yourself or anyone else?’)

  • Hallucination (sensory perceptions without stimulus)
  • Illusion (misinterpreted stimulus)
  • Pseudohallucination (a hallucination that the patient is aware is not real)


Assess cognition

  • Concentration and attention
  • Short-term memory
  • Orientation to time/person/place and cognition test, e.g. mini mental state examination


Assess insight

  • Awareness of illness
  • Understanding of the need for medications and willingness to take them

To complete

  • Other parts of psychiatric history; summarise 

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