The document provides an overview of a mental state examination. It discusses examining a patient's appearance and behavior, emotions, thinking, speech, perception, cognitive/intellectual functions, and insight. The examination assesses factors such as motor activity, thought content and form, memory, intelligence, and consciousness. Disorders are explored such as thought disorders, hallucinations, delusions, and levels of insight into illness. The mental state exam provides a framework for understanding a patient's psychological state.

1. Mental State
Examination
By
Mohamed Abdelghani
Ass. Lecturer Of Psychiatry
Available at: http://www.slideshare.net/mabdelghani 10/22/2012

2. I. Appearance and Behaviour
A. Body built:
• Height and weight;
 Very tall: chromosomal abnormality.
 Very thin: anorexia nervosa.
B. Facial appearance:
• mood: anxious, depressed, happiness.
• medical conditions with psychiatric importance: thyrotoxicosis,
Down’s syndrome, renal failure and cushing syndrome.
C. General appearance:
• self care and grooming; hair, nail: may be neglected in schizophrenic,
depressed and addicts.
• clothing; colour, appropriateness with age and sex.
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3. I. Appearance and Behaviour Cont.
D. Motor activity:
• Decreased in depression, and Increased in mania and hypomania.
• Catatonic stupor: markedly slowed motor activity, often to the
point of immobility.
• Catatonic exitement: agitated, purposeless motor activity,
uninfluenced by external stimuli.
• Echopraxia: pathological imitation of movements of one person by
another.
• Psychomotor agitation: excessive motor and cognitive activity,
usually non-productive and in response to inner tension.
• Dystonia: slow sustained contractions of the trunk or limbs.
• Aggression: forceful, goal-directed action that may be verbal or
physical; the motor counterpart of rage, anger and hostility.
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4. II. Emotion
 Emotion: is a complex phenomenon involving reactions in 3
distinct components;
o Feeling experienced by the subject (e.g joy, anger, sadness …).
o Behavioral (expressive) component.
o Autonomic and endocrine component.
 Mood: sustained emotional tone and the subjective
(experienced) aspect of emotion.
 Affect: short-lived feeling state and used to describe the
objective (observable) aspect of emotion.
 Appropriate affect: condition in which the emotional tone is
in harmony with the accompanying idea, thought or speech.
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5. III. Thinking
• Goal-directed flow of ideas, symbols, and associations initiated
by a problem or task and leading toward a reality-oriented
conclusion.
• Thought disorders may be classified according to stream, form,
and content of thought.
A. Stream of thought:
• Too rapid: flight of ideas (d.d loosening of association).
• Too slow: various degrees of retardation up to mutism.
• Interrupted: abrupt interruption in train of thought before a
thought or idea is finished; the patient feels that his mind has
gone blank.
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6. III. Thinking cont.
B. Form of thought:
• It refers to the manner in which thoughts, as reflected in
speech, are linked in language.
• Neologism: new word created by a patient.
• Circumstanciality: indirect speech that is delayed in
reaching the point but eventually gets from original point to
desired goal; characterized by overinclusion of details.
• Loosening of associations: flow of thought in which ideas
shift from one subject to another in a completely unrelated
way. When severe, the speech is incoherent.
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7. III. Thinking cont.
C. Content of thought:
• Obsession: persistence of an irresistible thoughts
or feelings that can not be eliminated from
consciousness by logical effort; associated with
anxiety.
• Phobia: persistent, exaggerated, and pathological dread of
a specific stimulus or situation; results in a compelling
desire to avoid the feared stimulus.
 Specific phobia: dread of a discrete object or situation.
 Social phobia: dread of public humiliation, as in fear of public
speaking, performing or eating in public.
 Agoraphobia: dread of open places.
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8. III. Thinking cont.
• Delusion: false fixed belief, based on incorrect inference about external
reality, not consistent with patient’s intelligence and cultural background;
cannot be corrected by reasoning.
1. Bizarre delusion: totally implausible, strange false belief.
2. Systematized delusion: Its content is usually within the range of possibility.
3. Delusion of persecution: a person’s false belief that he is being harassed, or
persecuted.
4. Delusion of grandiosity: a person’s exaggerated conception of his importance,
power, or identity.
5. Delusion of poverty: a person’s false belief that he or she is bereft or will be
deprived of all material possessions.
6. Somatic delusion: false belief involving functioning of the body.
7. Delusion of guilt.
8. Delusion of infidility: false belief derived from pathological jealousy about a
person’s lover being unfaithful.
9. Erotomanic delusion: delusional belief that someone is deeply in love with the
patient.
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9. IV. Speech
• Ideas, thoughts, feelings are expressed through language.
• Speech abnormalities:
A. quantitative:
• Amount of speech: increased, or decreased up to mutism.
• Rate of speech
• Pauses in speech
• Loudness of voice
B. qualitative:
• Dysarthria: disorder of articulation of speech.
• Aphonia: loss of the ability to phonate.
• Stuttering: repitition of syllable; stut-tut-tuttering.
• Echolalia: repitition of words or phrases heard.
• Aphasia: inability of the formulation of speech.
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10. V. Perception
• Process by which a person interprets sensory stimuli.
• Disorders of perception:
1. Hallucination: perception without existent external stimuls.
• According to complexity:
 Elementary (unformed) hallucination: e.g. whistles, flashes of light.
 Complex (formed) hallucination: e.g. voices, faces, or scenes.
• According to sensory modality:
 Auditory
 Visual
 Olfactory.
 Gustatory.
 Tactile.
2. Illusion: misinterpretation of existent external stimulus.
• Pathological as in delerim and normal phenomenon as in camouflage &
fashion designers.
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11. VI. Cognitive and intellectual functions
A. Consciousness
•It is the awareness of self and environment.
•Glasgow coma scale: used to evaluate the level of consciousness
from 3-14.
Eye opening Verbal response Motor response
Spontaneous 4 Oriented 5 Obeying orders 5
To speech 3 Confused 4 Localizing 4
To pain 2 Words 3 Flexing 3
None 1 Sounds 2 Extending 2
None 1 None 1
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12. B. Orientation
• Is the awareness of the oneself in relation to time, place and persons.
• Disorientation may be:
o Organic mental disorders
o Psychogenic factors e.g. dissociative disorders and factitious disorder.
• In disorientation, sense of time is impaired before sense of place and
the patient improves in reverse order.
C. attention and concentration
• Attention is the ability to focus on certain stimuli and concentration is the
ability to sustain attention.
• Disorders of attention:
 Distractibility: inability to concentrate; state in which attention is drawn
to irrelevant external stimuli.
 Hypervigilance: excessive attention to all internal and external stimuli,
usually secondary to delusional or paranoid states.
 Trance: focused attention and altered consciousness, usually seen in
hypnosis and ecstatic religious experiences.
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13. D. Memory
• Memory is the process of acquisition (registration), retention
(storage), and retrieval (reproduction) of information.
• Levels of memory:
• Immediate memory: retrieval of perceived material within seconds
or minutes. It is checked by asking patients to repeat 6 digits forward
and then backward.
• Recent memory: retrieval of events over past days or weeks. It is
checked by asking patients about their appetite and then about what
they had for breakfast or for dinner the previous evening.
• Remote memory: retrieval of events in distant past. It is checked by
asking patients about informations from their childhood that can be
later verified.
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14. Disorders of memory
1) Amnesia: partial or total inability to recall past experiences;
may be of organic or emotional origin.
 Anterograde: amnesia for events occuring after a point in time.
 Retrograde: amnesia for events occuring before a point in time.
2) Hypermnesia: exaggerated degree of retention and recall.
3) Confabulation: unconscious filling of gaps in memory by
imagined or untrue experiences that a person believes but that
have no basis in fact.
4) Déjà vu: illusion of visual recognition in which a new situation
is incorrectly regarded as a repetition of a previous memory.
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15. D. Intelligence
• Ability to understand, recall, mobilize, and constructively integrate previous
learning in meeting new situations.
• Disturbances of intelligence:
 Mental retardation: lack of intelligence sufficient to interfere with social
and voactional performance.
 Degrees of mental retardation:
o Mild (IQ of 50 to 70).
o Moderate (IQ of 35 to 50).
o Severe (IQ of 20 to 35).
o Profound (IQ below 20).
E. Abstraction
1.Abstract thinking: ability of multidimentional thinking with ability to use
metaphors and hypotheses appropriately.
2.Concrete thinking: limited use of metaphor without understanding
meanings; one-dimentional thought.
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16. VII. Insight
• Is the patient’s degree of awareness and understanding
about being ill.
• Levels of insight:
i. no insight: complete denial of illness.
ii. partial insight: awareness of being sick but blaming it on
others, on external factors, or on organic factors.
iii. true emotional insight: emotional awareness of the
motives and feelings within the patient which can lead to
basic changes in behaviour.
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17. Available at: http://www.slideshare.net/mabdelghani 10/22/2012