The process of the mental state examination begins when the patient enters into the room and concludes when they leave it. It includes elements of passive observation as the history is being conducted, such as observations of the appearance of the patient and their behaviour during the interview. Crucially, the examination also involves an active exploration of the patient's experience of the world. This is the empathic process of the phenomenological method we discussed in the previous section. It utilizes the techniques of history taking you've already heard about and is driven hopefully by your curiosity and inquisitiveness in seeking to place yourself in the patient's world to understand their subjective experience of the world, and to describe it objectively. It becomes obvious that the process of interviewing a patient is not a simple one. Three parallel and related processes are occurring. There is not only an exploration of the patient's account of the events prior to the interview and they're psychosocial constitution, that is their history, a passive observation and active exploration of their experience of the world in the here and now, that is their mental state examination, and a process of formulation, that is putting together an understanding of the patient that drives further inquiry. An example of this complexity might be an inquiry into a patient's perception of the world. This may involve passive observations of the manner in which the patient attends to the interview, whether they look at you, or whether their eyes are drawn to a part of the room, whether they turn their heads as if to listen attentively to a different part of the room. While this is being observed, the questioning of the patient may involve inquiry into the sensory experience of the patient and are they hearing of the sounds apart from your voice? How many? Are they loud or soft? Simple sounds or voices? Male or female voices? What is the tone of voice? What are the voices saying? How are you feeling about what they are saying? Et cetera. Following the termination of the interview, there's a convention involved in reporting the findings. To some degree, the convention is arbitrary, and the sequence of its reporting, generally begins with the passive observations of the patient's appearance, followed by their behaviour, and the motor aspects of their speech. The general appearance of the patient should involve several sentences devoted to creating a pin portrait of the patient, sufficient for one of your colleagues to pick them from a small crowd. The types of observations you might make are suggested in the accompanying slides. The behaviour is again a passive observation of the psychomotor activity of the patient during the interview and the speech description is devoted to the form of the speech, for example, volume, pronunciation, etc, rather than its content, which more correctly relates to the patient's thoughts. The further categories of reporting a mental state examination are expanded in the next few videos and the following convention of affect, followed by thought and perception, cognition and insight. It is important to remember that the mental state examination seeks to describe the here and now of the patient at the interview. It is not a history of the symptoms experienced by the patient before the interview, which is the task of the history, of the presuming complaint, nor is it the task of the mental state examination to interpret the patient's experience of the world in the context of the patient's life, which is the task of the formulation. A common error is for students to report in the mental state examination the patient's subjective description of their experiences leading up to the interview, for example, hallucinations, rather than the patient's experience of hallucinations at the interview.
