Example questions for mental state examination

Introduction

When carrying out a psychiatric assessment much of the information regarding the patient's mental state will be acquired in course of obtaining the history. However it will be necessary to ask some specific questions in order to get a more detailed account about some aspects of the mental state and to probe for specific abnormalities which may not have emerged from the history. Sometimes it can be hard to think of the best way to word these questions and this document provides some examples of what you might say. Obviously, you would adapt them according to circumstances. Many are intended to act as general screening questions which could be followed up further. For example, if the patient answers "Yes" to the question "Can other people tell what you are thinking?" that does not mean that they definitely have thought broadcast. Rather, it means that you would enquire further about this experience. While some of the questions are open others are closed and some are leading.

These questions are the ones used in the East London "Psychiatric Guide for Interpreters" available at www.eastlondon.nhs.uk/PAG .

Questions to ask about mood

How do you generally feel most of the time?
What's your mood like?
How would you say you feel generally - happy, sad, frightened, angry?

Mood words

Happy
Very happy
Fine
OK
Fed up
Sad
Low
Miserable
Depressed
Cross
Angry
Worried
Afraid
Down
Cheerful
Bad
Excited
Bright

Questions to ask about low or high mood

Do you feel miserable all the time?
Do you ever cheer up, even a little bit?
Do you ever enjoy anything?
If something nice happens, do you cheer up a bit?
Do you cry?
Would you say that you're more cheerful than usual?

Questions about suicidal intent

Do you ever feel really desperate?
Do you ever feel life is not worth living?
Do you ever feel it would be better if you were dead?
Do you ever feel that it wouldn't matter if you didn't wake up in the morning?
Do you ever wish you were dead?
Have you thought seriously about killing yourself?
Have you thought about how you might kill yourself?
Have you done anything about getting ready to kill yourself? (E.g. paying bills, hoarding tablets.)
Do you think that you might actually kill yourself?
Do you really want to die?
Would you say that you were determined to kill yourself?

Questions about biological features of affective disorder

Is there any pattern to how your mood changes through the day?
Is there any time of day when you tend to feel better or worse?
Do you tend to feel worse in the evening?
What's your appetite like?
How are you eating?
Is there any change in your weight?
How are you sleeping?
What time do you get to sleep and what time do you wake?
Do you sleep right through or wake in the night?
After you've woken do you get back to sleep?
What time do you eventually wake in the morning?
Is there any change in your interest in sex?
Are you less interested in sex than usual?
Is there any change in how often you defecate / have your bowels open?
Do you experience constipation?
Is there any change in your energy levels?
Do you have more or less energy than usual?

Questions about thought form

Do your thoughts seem faster than normal?
Do you find you have lots and lots of different thoughts?
Does your mind seem to be slowed down?
Do you ever have the experience when your thoughts suddenly stop?
Do you ever feel that your mind is suddenly wiped blank and you have no thoughts at all?

Questions about delusions

Do you ever feel that people are following you?
Do you ever feel that people are seeking to harm you in some way?
Do people spy on you?
Has anything strange or unusual been going on?
Is there anything special about yourself which makes you different from other people?
Is there anything you can do which other people can't?
Is there anything which particularly bothers you?
How did you find out this was happening?
When did you realise this?
How do you know about this?
Are you sure this is happening or might you be imagining it?
Are you absolutely certain this is what's going on?
Do you think that somebody has put a spell on you?
Is a spirit/djinn/demon causing problems for you?

Questions about thought insertion

Do you ever have thoughts in your mind which are not your own?
Does anything else use your mind to think with?
Does anything put thoughts into your mind from outside?
Where do those thoughts come from?

Questions about thought withdrawal

Does anything ever take your thoughts away?
Do you ever have your mind wiped blank?
Does anything take thoughts out of your mind so that they're not there any more?

Questions about thought broadcast

Can other people tell what you are thinking?
Do your thoughts ever go out of your own mind?
Do your thoughts go out of your mind to other people?
Are your thoughts ever put on the television or radio?
Do your thoughts go out of your mind to somewhere else?

Questions about passivity

Do you ever feel that somebody else controls your body?
Do you ever have something else moving your arms or legs?
Can anybody else move your body without you being able to stop them?
Do you ever find that a spirit/djinn/demon controls your body?
Has anything inside your body or brain been changed?
Is there anything strange inside your body?

Questions about depressive cognitions

What's your opinion of yourself?
Do you think you're better than most people, worse, or about the same?
Are you a good or bad person?
Are there things you feel guilty about?
Do you feel more guilty about things than most people?
Do you feel guilty about things which other people wouldn't feel guilty about?
What's your view of the future?
Do you think things will get better or worse?
Do you hope things might get better?
Is there any possibility that things might get better?
Do you see any possibility at all that things might get better, even a little bit?

Questions about panic attacks

Do you get panic attacks?
Do you get times when you feel very frightened?
Do you feel anxious?
Do you feel afraid?
Does your heart beat fast?
Do you feel your heart beating hard?
Do you feel dizzy?
Do you feel faint?
Do you feel sick?
Do you feel shaky?
Do you have an uncomfortable feeling in your stomach?
Do you feel breathless?
What do you think is going to happen?
Do you think you're going to die?
Do you think you're going to faint?
Does this happen in particular places?
Can this happen when you're at home?

Questions about compulsions

How often do you wash?
Do you wash your hands a lot?
Do you always do it in a particular way?
Do you feel that you have to do it?
Do you try to resist but find that you can't?
What would happen if you didn't do it?
Do you have to check you've locked the door properly?
Do you check locks, windows, switches, electrical appliances?
How many times would you check?
Do you do the checking in a particular order?
How much time does it take you?

Questions about perceptual abnormalities

Do you hear voices?
Do you see visions?
Do you hear people talking when there's nobody there?
Do you hear things other people don't hear?
Do you ever hear anything strange?
Where do the voices come from?
Are the voices in your head or outside?
Are these thoughts in your mind or sounds that you would hear with your ears?
How many voices are there?
Do they talk to you or do they talk to each other about you?
Do they ever talk about what you are doing?
Do they repeat your thoughts or comment on your thoughts?
Do your thoughts ever sound loud, as if somebody next to you could hear them?
Do the voices tell you to do things?
Do you ever hear angels talking?
Do you ever hear spirits/djinns/demons talking?
Do you see strange things?
Do you see things other people don't see?
Do things ever smell strange or taste strange?
Do you feel things touching you?
Do you feel things changing inside your body?

http://www.mds.qmw.ac.uk/statgen/dcurtis/lectures/MSEquestions.html

Link to version formatted for mobile devices: http://www.mds.qmw.ac.uk/statgen/dcurtis/lectures/MSEquestionsmobile.html

Link to other notes: http://www.mds.qmw.ac.uk/statgen/dcurtis/lectures.html

Dave Curtis (http://www.mds.qmul.ac.uk/statgen/dcurtis.html)

Copyright Dave Curtis 2005-2011. You can distribute this material freely provided my copyright remains acknowledged.