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Mental State Examination

From Mediwikis

The Mental State Examination is a misnomer- it isn't something that is performed separately from the mental health history, but rather should be performed simultaneously to assess the patient's appearance and behaviour. The Mental State Examination gives important clues regarding psychiatric illness, and is a popular station for OSCEs.

Performed simultaneously with history- does the patient ACT MAD !


Just some things to look out for:

  • Dress (weather, sex, colour, age appropriate)
  • Hygiene,
  • Posture
  • Gait
  • Self-care
  • Scars (self-inflicted?)
  • Eye contact.
  • Movement and speech
    • Increased or decreased
    • Voluntary or involuntary
    • Verbal and non-verbal communication
  • Appropriate behaviour
    • Agitation, fidgeting
    • Appropriate conduct for the setting
    • Confusion

(anything medical should be put in here, e.g. on oxygen)


Rate and rhythm, quantity, tone, volume, intonation


  • Content
    • Delusions or beliefs
    • Obsession
  • Stream of thought
  • Form of thought
    • Speed
    • Flow- tangential thought, good flow from one topic to another?
  • Possession of thought


  • Objective: your impression
  • Subjective: what they tell you
  • Affect- reaction tone to topic of conversation- is this congruent with the topic?
  • Suicidal ideation

Abnormal perceptions

  • Illusions
  • Hallucinations: auditory, visual olfactory, tactile

Dementia (cognitive function)

  • Orientation
  • Concentration and memory


  • Awareness of problem
  • Cause of problem
  • Do they want treatment
  • Do they think that it will work
  • ICE


This is performed to find the aetiology of the patient's condition, and therefore provide holistic therapy of the condition.

Biological Psychological Social
Predisposing Family History

Birth Complications
Drugs & Alcohol

Patient's Schema Work/Unemployment
Precipitating Disease Other mental illness Significant Life event
Perpetuating Drugs & Alcohol

Concordance to medication

Insight into illness Emotional support from family & friends