Assessment of Mental State

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1. Start by introducing yourself to the patient and explain that you would like to talk to him about his thoughts.

2. There are eight components to this assessment:

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

3. a)  Appearance and behaviour

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

4. b)  Speech

   • Rate
   • Tone
   • Quality
   • Form: thought blocking, loosening of associations, flight of ideas, neologisms
   • Content: depressive ideas, delusions

   Then ask more specific questions relating to the other parts of the assessment.

5. c)  Mood

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

6. d)  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?

7. e)  Abnormal experiences

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

8. f)  Abnormal beliefs

   • Delusions

9. g)  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?

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

11. Thank the patient for speaking to you.

12. Summarise your findings for the examiner, offering a differential diagnosis.