Appearance? Distinguished features (eg scars (eg self-harm), tattoos or signs of intravenous drug use)? Weight (eg significant underweight or overweight)? Stigmata of disease (eg jaundice)? Personal hygiene? Clothing? Objects? Behaviour? Engagement and rapport (eg distracted, appear to be engaging with hallucinations)? Eye contact (eg reduced or excessive)? Facial expression (eg relaxed, angry, disengaged)? Body language (eg exaggerated gesticulations or unusual mannerisms)? Psychomotor activity (eg retardation or restlessness)? Abnormal movements or postures (eg involuntary movements, tremors, tics, lip smacking, akathisias, rocking)? Speech? Rate of speech (eg pressure of speech or slow speech)? Quantity of speech (eg minimal or absent or excessive)? Tone of speech (eg monotonous or tremulous)? Volume of speech? Fluency and rhythm of speech (eg stammering or stuttering or slurred speech)? Mood (eg low, anxious, angry, enraged, euphoric, guilty, apathetic, suspicious)? Affect (eg sad, angry, hostile, euphoric)? Range and mobility of affect (eg fixed, restricted or labile)? Intensity of affect (eg heightened or blunted or flat)? Congruence of affect (eg inappropriate)? Thought? Thought form? - Speed of thoughts? - Flow and coherence of thoughts, eg? - Loose associations? - Circumstantial? - Tangential? - Flight of ideas? - Blocking? - Perseveration? - Neologisms? Thought content? - Delusions? - Obsessions? - Compulsions? - Overvalued ideas? - Suicidal thoughts? - Homicidal/violent thoughts? Screening questions for thought content abnormalities? “What’s been on your mind recently?” “Are you worried about anything?” “Do you sometimes have thoughts that others tell you are false?” “Do you have any beliefs that aren’t shared by others you know?” “Do you ever feel that people are out to do you harm?” “Do you ever feel that specific events in the world are related to you in some way?” “Are there any thoughts you have a hard time getting out of your head?” “Do you sometimes feel the need to perform certain behaviours repetitively, despite understanding these are irrational?” “Do you ever think about ending your life?” “Have you ever felt your life was not worth living?” “Have you ever attempted to end your life?” “Do you ever think about harming others?” - Thought possession (eg insertion, withdrawal, broadcasting)? Screening questions for thought possession abnormalities? “Do you think people can put ideas in your head, without your control?” “Have you ever felt like people have removed memories or thoughts from your mind?” “Do you ever feel like others can hear what you’re thinking?” Perception (eg hallucinations, pseudo-hallucinations, illusions, depersonalisation, derealisation, heightened/dulled perception)? Screening questions for perceptional abnormalities? “Do you ever see, hear, smell, feel or taste things that are not really there?” “Did you think this was real at the time?” “Do you still believe it was real?” “Do you ever feel like you’ve changed or that you don’t recognise the person you currently are?” “Do you ever feel like the world around you isn’t real?” Cognition? Level of consciousness? Memory (immediate, recent, remote)? Orientation (time, place, person)? Concentration and attention span? Abstract thinking? Mini-mental state exam (MMSE) Abbreviated mental test score (AMTS) Addenbrooke's cognitive examination III (ACE-III) Insight and judgement? Insight? Questions to assess insight? “What do you think the cause of the problem is?” “Do you think you have a problem at the moment?” “Do you feel you need help with your problem?” Judgement? Question to assess judgement? “What would you do if you could smell smoke in your house?” Intent of self-harm or harming others? Short documentation: Smartly dressed, very good rapport, no depressive symptomatology, no suicidality, no parasuicidality, no abnormal experiences, no abnormal beliefs, cognition intact Reference(s): Geeky Medics (2021): Mental State Examination (MSE) – OSCE Guide Patient UK (2015): Psychiatric Assessment