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General appearance

- Average build
- Approximate ht: 5ft 4in; wt: 60 kgs
- Looks comfortable
- Well groomed
- Appropriately & adequately dressed
- Masculine
- Masked facies without any expressions

Attitude towards examiner

- Cooperative
- Appears apathetic

Comprehension

- Was intact

Gait & posture

- Was normal

Motor activity

- Decreased
- Delayed reaction time
- No compulsive acts like nail biting

Social manner & non-verbal behavior

- Decreased
- Hesitant eye contact

Rapport

- Normally built

Speech

- Rate & quantity:


a) Speech is present and spontaneous
b) Underproductive
c) Rate- slow
d) Poverty of speech
- Volume & tone of speech
a) Decreased
b) Low pitch
- Flow and rhythm of speech
a) Hesitant
b) With sudden blocking (pauses)
c) No circumstantiality, tangentiality, flight of ideas, clang associations, stereotypies,
verbigeration

Mood and affect

- Mood: subjective mood described as general warmth; reactive & unstable


- Blunt affect
- Mood is incongruent with affect

Thought

- Stream & form of thought: thought block, unproductive speech, poverty of speech
- Content of thought: Delusion of infedility, no obsessions & irrational fear, no neologisms

Perception

- Hallucination: auditory hallucinations (known male peoples voices)


- No any illusions
- No depersonalization/derealization

Cognition

- Consciousness: conscious
- Orientation: oriented to time, place, person
- Attention : sustained
- Concentration : can concentrate; correct answers 50-3 test with a timing of 10 mins
- Memory: intact immediate, recent, remote memory
- Intelligence: able to read, write, perform simple calculations
- Abstract thinking: concrete, appropriate

Insight

- Slight awareness of being sick & needing help, but denying it at the same time

Judgement

- Normal social judgement and test judgement