Site Map	Assess Mental State and Cognition

• Introduce yourself and check the patient's identity
• Establish rapport with patient
• Appropriate use of questions, open, closed and clarifying
• Use of verbal and non-verbal encouragement
• Note apperance and non-verbal behaviour
  • Dress
  • Gait
  • Activity
  • etc...
• Observe patients social manner
• Assess
  • Speech pattern
    • Rate
    • Volume
    • Flow
  • Abnormal thinking
    • Thought disorders
    • Delusions
    • Ruminations
    • Obsessions
  • Mood
    • Especially depression & suicidal intent
  • Higher cognitive functions
    • Frontal & parietal lobe signs
• Elicit abnormal experiences
  • Auditory hallucinations
  • Other hallucinations
• Perform Mini Mental State Examination
  • Orientation
    • What is the: year | season | month | day | date (Max 5 points)
    • Where are we: country | county | town/city | building | floor (Max 5 points)
  • Registration
    • Name 3 common objects (eg apple, table, penny) taking 1 second over each one
    • Ask the patient to repeat all 3 after you have said them (Max 3 points)
    • Repeat the words until the patient has learnt all 3, count and record the number of trials
  • Attention
    • Spell WORLD backwards, the score is the number of letters in the correct order (Max 5 points)
  • Recall
    • Ask the patient to repeat the 3 objects from the registration section (Max 3 points)
    • Note this can not be tested if registration was incomplete
  • Language
    • Name 2 common objects: eg a pencil and a watch (Max 2 points)
    • Repeat the following: "No ifs, ands, or buts" (Max 1 point)
    • Follow a 3 stage command: "Take a paper in your right hand, fold it in half and put it on the floor" (Max 3 points)
    • Read and obey: "Close your eyes" (Max 1 point)
    • Write a sentence (Max 1 point)
    • Copy, from an example, interlocking pentagons (Max 1 point)
  • Record total points out of 30
• Consider patient insight and attribution of problem
• Summarise important features of mental state examination in psychopathological terms

	Any comments or feedback please contact me by email: Tom Williams