The following document was written by Dr Satvir Singh FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry) Kent & Medway NHS and Social Care Partnership Trust Canterbury, Kent in Dec 2007.
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“The examination of mental state is to do with the assessment and observation of one’s mental condition and related behaviour at a given point in time.”

It is usually carried out right at the end of the interview, once the History Taking task has been completed. However, the observation of the patient’s behaviour, affect, mood, thought process and his/her understanding with regard to the possible underlying factors responsible for his/her symptoms and behaviour and what treatment might help him/her remains a continuous process from the minute the patient walks into the room and until the consultation is over.

There is a standard systematic schema to evaluate the patient’s mental state, but in practice, a doctor will take the opportunity during the consultation to evaluate certain aspects of the mental health status of the patient.

Mental State Examination also allows the doctor to complete any gaps that might have been left unattended during the history taking, particularly the risk assessment for self-harm, etc.

The following is the order that we are trained to describe our patient’s mental state formally, although our observation of the facts could have been at different stages of the evaluation of the patient – in the waiting room, history taking and of course during the mental state examination, and indeed when the patient leaves the consulting room:

  1. Appearance and Behaviour
  2. Speech
  3. Affect and Mood
  4. Thought Process
    • Formation
    • Contents
    • Thoughts are goal directed or not
  5. Perception
  6. Cognition
    • Attention
    • Concentration
    • Orientation in time, place and person
  7. Short and long term memory
  8. Insight and Judgement
  9. Sometimes, we may have to complete a Mini Mental State Examination (MMSE) to identify any significant problems with cognition
  10. Detailed Risk Assessment for self-harm or harm to others may need to be carried out and described under the mental state

Evaluation Process of Mental State Findings

As in other branches of medicine, the abnormal findings of the mind are understood to be pathological and in psychiatry, they are collectively termed as “Psychopathology.” If an examiner asks to describe the psychopathology of a given patient, then our concern is only with the abnormal findings and observations about the patient’s mental state and related behaviour at the time of the assessment of the patient. All other behaviours, signs and symptoms will be recorded in history.

Once we have recorded the presenting psychopathology or absence of some key signs and symptoms, the next step is to understand or interpret the significance of the presenting psychopathology.

1. Descriptive Psychopathology

Here one records verbatim the patient’s description of his mood, thought process and perpetual abnormalities and then use the process of empathy to understand how the patient may be feeling with his/her described emotions, feelings, beliefs and other concerns.

2. Phenomenology

This is patient’s personal understanding of his/her current psychopathology. As to why they are behaving in the manner that they are and the significance of their delusions and hallucinations.

3. Interpretative Psychopathology

This is based on the interpretation and understanding of patient’s signs and symptoms (psychopathology), which is then categorised as the basis of preconceived theories. This process is largely employed by Analytic Psychotherapists in their clinical work.

4. Experimental Psychopathology

This is where researchers would carry out scientific studies in controlled environment, such as inducing a certain behaviour response to a given stimulus. This method is often employed in Behavioural Psychotherapy to achieve a desired response or change in behaviour in a given situation.

In current medical and psychiatric practice, what is most relevant is to exclude the possibility of any underlying physical cause to the presenting psychopathology, such as acute onset of visual hallucinations in an older person, secondary to chest infection. Or, a history of chronic visual hallucinations in a blind or partially sighted person (Charles Bonnett Syndrome).

Finally, to carry out a Mental State Examination, we need the right environment to interview a patient and his/her co-operation and willingness to be examined. If a full Mental State Examination is not possible for whatever reason, then those reasons should be recorded and the interpretation drawn. A further attempt at an appropriate time, suitable to all concerned should be arranged.

The Process of Mental State Examination is in the next section – Mental State Examination – 2.

Dr Satvir Singh
FRANZCP (Aust), FRCPsych (UK), MSc (Lon), MRCPsych (UK), DPM, MBBS
Consultant Psychiatrist & Lead Consultant for Undergraduate Medical Education (Psychiatry)
Kent & Medway NHS and Social Care Partnership Trust
Canterbury, Kent


  1. Companion to Psychiatric Studies, Eve C Johnstone, et al, 1998
  2. Shorter Oxford Textbook of Psychiatry, Fifth Edition, M Gelder et al, 2006


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