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Mental State Exam OSCE:

Mental State Exam:


- Appearance
o Dress and bearing
o Hygiene
o Tattoos, injuries, scars
o Apparent age
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- Behaviour
o Interaction
o Volatility
o Tics, extra-pyramidal symptoms
o Distraction / external stimuli
o Personality type
- Mood and Affect
o Mood as reported by individual
o Range, variability,
o Congruency
o Affect as detected by interviewer
o Poverty
- Speech
o Tone
o Volume
o Flow, pressure
o Idiosyncratic, rhyming, echolalia,
- Thoughts
o Flow: linear, scattered, circumstantial, derailing, blocking, poverty
o Content: Overvalued ideas, delusions,
o Rate of thought production: scattered, pressure, delayed, poverty
- Perception
o Hallucinations
o Illusions
- Cognition
o Orientation in time / place / person
o Executive function
- Judgement
o Societal norms, outcomes of actions
o Safety of self and others
o Impulse control
- Insight
o Diagnosis, association of diagnosis and symptoms, need for treatment

Diagnosis:
- Primary psychiatric diagnosis:
o Acute psychosis, schizophrenia (early / late / chronic), schizo-affective disorder
o Depression, anxiety, bipolar disorder
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- Primary organic diagnosis:
o Alzheimer’s dementia, Parkinson’s Dementia, Frontotemporal dementia, Lewy Body dementia,
Vascular / Multi-infarct Dementia
o Creutzfeld-Jacob Disease, Huntington’s Disease, Traumatic Brain Injury
o Neurodevelopmental abnormality
- Substance abuse: EtOH, benzodiazepines, Ice, opiates, etc
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Risk assessment:
- Assessment of risk to self:
o Suicide and self-harm
o Housing / homelessness
o Substance abuse, abuse of self by others
- Risk to others assessment:
o Delusions and hallucinations (particularly command), persecutory
- Risk of absconding

Key findings:
- Psychosis:
o Formal thought disorder: though blocking / insertion / broadcast / withdrawal
o Positive symptoms: delusions, hallucinations,
o Negative symptoms: absent interaction, poor eye contact, flattened affect, social withdrawal,
anhydonia
- Depression:
o Anhydonia, psychomotor retardation, apathy, amotivation
o Guilt, shame, worthlessness
o Persistent for >2 weeks
- Bipolar:
o Mania / hypomania
o Depression / anxiety /
- Personality disorders:
o Borderline: splitting of world and person-views
o Hystrionic: Dramatisation
o Narcissistic: Lack of conscience, disruptive and manipulative
o Anti-social: Disruptive, criminal,
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Questions:
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