The mental state examination and its terminology

What it is

The mental state examination follows the history, and it is taken item by item: appearance, behavior, speech, mood, affect, thought, perception, cognition, judgment, insight. One rule runs through it: start with the positive points, then the negative.

Appearance, behavior and psychomotor activity

Appearance: looking stated age; wearing hospital uniform; clean; appropriate for weather; appropriate way of wearing; disheveled or neglect; good self-care; and evidence of substances misuse, that is injection marks for drug abuse, or spider navi or jaundice for alcoholic liver disease. The longer form adds: level of consciousness (alert, hypervigilant, decreased arousal); dressing (appropriate, eccentric, careless); grooming; hygiene (clean, shaven, unshaven, malodourous); physical characteristics (needle marks, scars, skin lesions, tattoos, obesity, thinness, sweating, handicaps, amputated limbs); eye contact (avoid, good, staring, looks in unexpected directions).

Behavior: cooperative or calm; psychomotor disorder; agitated or irritable; parkinsonism, that is slow gait and tremor (EPS); guarded; staring; muttering to self; restricted; searching eyes; overfamiliar. Attitude on the form: cooperative, disinterested, guarded, suspicious, regressed (childlike), disinhibited, arrogant-grandiose, vigilant, hostile, agitated.

Five behaviour terms are defined for you. Agitation: a combination of psychic anxiety and excessive, purposeless motor activity. Compulsion: a stereotyped action that the patient cannot resist performing repeatedly. Disinhibition: loss of control over normal social behaviour. Motor retardation: decreased motor activity, usually a combination of fewer and slower movements. Posturing: the maintenance of bizarre gait or limb positions for no valid reason.

Psychomotor activity on the form: normal; stupor; slowing or retardation (bradykinesia); restlessness; agitation (hyperkinesia); excitement; special gait; special posture; waxy flexibility; tremors (resting, postural and action, intention); tardive dyskinesia (tongue protrusions, lip-smacking, twisting); acute dystonia (twisting of the neck and back, oculogyric crisis, torticollis, backward arching, difficulty in talking, swallowing or breathing); tics, simple and complex; mannerisms; stereotype; perseveration; echopraxia; compulsive acts (checking, counting, washing or cleaning, ordering, religious rituals, hoarding, seeking assurance from others); suggestibility (negativism, automatic obedience, resistance).