Mental State Examination

Component What to assess

Appearance & Physical appearance Gender; ethnicity; body habitus; apparent age; cleanliness and grooming, hair/clothing style,
Behaviour cosmetics and jewellery; syndromic features.

Manner of relating to Ease of separation from each parent; reactions to meeting the clinician (eg eagerness to please,
clinician and parents defiance, overfamiliar); eye contact; facial expression. Note presence of hallucinatory
behaviours (eg talking to self; laughing incongruently).

Activity level Psychomotor slowing or agitation, sustained or episodic, goal-oriented or erratic;

coordination, unusual postures or motor patterns (eg tics, stereotypies, odd mannerisms,
tremors).

Speech Spontaneous and talkative to mute. Fluency, rate, volume, tone.

Mood Predominant emotion over days/weeks (eg euthymic, apathetic, angry, dysphoric, apprehensive,
euphoric). Use 0-10 scale (0: extremely sad & wishing to end life immediately, 10: extremely
happy).

Affect Current observed emotional state. Describe type, range (constricted to labile), reactivity
(blunted or flat to reactive), & appropriateness.

Thought Stream (i.e. speed) Poverty of thought (thought blocking), poverty of content (perseveration), racing
thoughts, flight of ideas.
 Form Logical & goal-directed or disordered (eg circumstantial, tangential, derailment, looseness of
associations, word salad).

Content Obsessions, delusions (eg persecutory, referential, grandiose, somatic, bizarre), phobias,

magical thinking, thoughts of harm to self or others.

Perception Altered bodily experiences (eg depersonalization, derealization), passivity phenomenon,

illusion, hallucination (eg auditory, visual, olfactory, tactile).

Cognition Level of consciousness Alert, drowsy, delirium, stupor.

Orientation Awareness to confusion of self, current setting, date & familiar people.

Attention Need for redirection/repeating, sustained activity, distractibility.

Memory Immediate (eg repeat numbers, names back), short-term (eg recall three objects at 2 and 5
minutes), long-term (e.g. recall events of past week).

Ability Impression of current abilities; concrete to abstract thinking.

Insight & Insight Intact, partial or poor insight. Ability to identify potentially pathological events (eg hallucinations,
Judgment suicidal impulses); acknowledgement of a possible mental health problem; locus of control
(internal v external).

Judgment Intact to impaired judgment. Problem solving ability in context of current psychological state
(can be explored by recent decision making).