Mental State Assessment

The mental state examination is basically the psychiatric “physical examination” i.e. a patient with breathing problems needs a respiratory examination, in the same way; a psychiatric patient needs a mental state examination.

The station involves assessing how the patient appears and/or behaves and any abnormal thoughts or beliefs they may hold.  It does not involve a cognitive (memory) assessment.

It is a psychiatric history/physical station and in order for the patient to open up and be honest with you, you must gain their trust and establish a good rapport.

Subject steps

  1. Start by introducing yourself to the patient, clarify their identity and explain that you would like to talk to them about their thoughts.

  2. There are 8 components to this assessment.

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

  3. Appearance and behaviour

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

    • Rate
    • Tone
    • Quality
    • Form – thought blocking, loosening of associations, flight of ideas, neologisms
    • Content – depressive ideas, delusions
  5. Now ask more specific questions relating to the other parts of the assessment:

  6. 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
  7. 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?
  8. Abnormal experiences

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

    • Delusions
  10. 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?
  11. Cognition – this should be done by the mini mental state examination, although this is generally not part of the OSCE.

  12. Thank the patient for speaking to you.

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