Mental State Examination

By

Mohamed Abdelghani
Ass. Lecturer Of Psychiatry
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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, Downs 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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I. Appearance and Behaviour

D. Motor activity:

Cont.

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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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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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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III. Thinking
B. Form of thought:

cont.

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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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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III. Thinking

cont.

Delusion: false fixed belief, based on incorrect inference about external reality, not consistent with patients 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 persons false belief that he is being harassed, or persecuted. 4. Delusion of grandiosity: a persons exaggerated conception of his importance, power, or identity. 5. Delusion of poverty: a persons 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 persons lover being unfaithful. 9. Erotomanic delusion: delusional belief that someone is deeply in love with the patient.
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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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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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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 Spontaneous To speech To pain 4 3 2 Verbal response Oriented 5 Confused Words 4 3 Motor response Obeying orders 5 Localizing Flexing 4 3

None

Sounds
None

2
1

Extending
None

2
1

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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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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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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) Dj vu: illusion of visual recognition in which a new situation is incorrectly regarded as a repetition of a previous memory.

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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 o o o Mild (IQ of 50 to 70). Moderate (IQ of 35 to 50). Severe (IQ of 20 to 35). 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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VII. Insight
Is the patients 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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