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By Douglas, Molly; Walker, Harriet; Casey, Helen; Matta, Simon

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INSIGHT This is a means of assessing the level of understanding the patient has about their symptoms/illness. Questions can be asked to determine how much insight the patient has. = Do you think that you are ill? = Do you accept that your condition is caused by a psychiatric illness? = Do you accept psychiatric treatment? You can use the answers to these three questions to report the level of insight that the patient has. 4 Risk assessment 15 EXAMPLE CASE An example case is given below to demonstrate how to report the mental state examination.

Any fluctuations in mood? Á more or less so than normal? = Incongruent Á is the patient’s mood inconsistent with their thoughts and feelings? g. talking about a bereavement but laughing. g. 10 0 best-ever mood. It is also useful to ask them to rate what their mood is like normally on the same scale. PERCEPTION Definitions: = Perception: cognitive processing and interpretation of data arriving via the sense organs. g. g. ‘seeing’ faces in clouds). = Hallucinations: = a false sensory perception in the absence of a real external stimulus: – auditory Á frequently seen in psychosis and are discussed in detail in Chapter 6 Schizophrenia and delusional disorders, Schizophrenia.

Mental health disorders = MICRO-print Other tools used in dementia: = Clinical dementia rating Á global assessment; = Neuropsychiatric inventory Á behavioural and psychological assessment; = Bristol scale Á ADLs. 2 Dementia 41 INVESTIGATIONS = Baseline investigations to be performed to exclude organic causes: FBC to exclude infection and anaemia; U&E to exclude uraemia and electrolyte imbalance; = glucose to exclude hypoglycaemia or diabetes mellitus; = calcium to exclude hypercalcaemia; = LFTs to exclude liver failure; = TFTs to exclude thyroid dysfunction; = serum B12 and folate (important as deficiencies may cause confusion); = syphilis screen to exclude neurosyphilis (if suspected); = human immunodeficiency virus (HIV) screen to exclude HIV/ acquired immune deficiency syndrome (AIDS) (if suspected).

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