Psychotic Mental State Examination

Mental State Examination

• Mood:
  • Depressed or elevated
• Affect:
  • Normal or flat
• Assess suicidal risk
• Cognitive impairment:
  • Grossly abnormal indicates learning disability or organic disorder

Mental Status Exam

• Appearance: Disheveled, anxious.
• Behavior: Mild PMR, poor eye contact.
• Speech: Soft, constricted prosody.
• Mood: “Beyond terrible.”
• Affect: Mood congruent, depressed.
• Thought process: Perseverative on belief she must go to jail because of perceived wrongdoing.
• Thought content:
  • Delusions she has harmed someone
  • Paranoia
  • -AH, passive SI stating she deserves to die without plan
  • -HI, -TI, -TB, -IOR
• Cognition: Fully oriented.
• Insight/judgment: Poor.

General Behavior

• Disorganized speech indicates thought disorder.
• Stilted and difficult conversation occurs with negative symptoms.
• New words – neologisms best written down.
• Random changes in conversation.
• Fast or pressured speech suggests mania.

How to Approach a Psychotic Patient

• Acknowledge you believe they are experiencing what they are reporting.
• Try not to collude with the patient.
• Try to establish rapport before confronting psychotic beliefs.
• Don’t be overly friendly or it can feed into the paranoia.