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Home / Complete mental-status examination
11-minute clinical-examination master page

Complete mental-status examination

Perform a structured mental-status examination while maintaining rapport, directly assess suicide and violence risk, recognize delirium or psychosis, and communicate a safe disposition.

Candidate instructions

Psychosis and safety — focused mental-status examination

Your task

Perform a focused mental-status examination on an adult presenting with suspiciousness and auditory hallucinations. Assess immediate safety, characterize abnormal experiences, evaluate insight/judgement and summarize your findings and disposition. You have 11 minutes.

Information available at entry
HR 96/minBP 132/78 mm HgRR 16/minSpO₂ 99%Temp 37.0°C
Safety priority: A mental-status examination is incomplete without direct safety assessment. Ask about suicidal thoughts, self-harm, violence risk, command hallucinations, ability to care for self, intoxication/withdrawal and access to means when relevant. New fluctuating inattention suggests delirium until proven otherwise.

What examiners expect

  • Respectful introduction, privacy and explanation of confidentiality/limits when appropriate.
  • Continuous observation of appearance, behaviour and psychomotor state.
  • Assessment of speech, mood and affect.
  • Thought form/content including delusions, obsessions and suicidal/homicidal ideation.
  • Perceptual disturbances including hallucinations and command content.
  • Focused cognition/attention when delirium or cognitive disorder is possible.
  • Insight, judgement and capacity-relevant abilities when indicated.
  • Direct risk assessment and safe disposition.
Timed rehearsal

Run the complete station in 11 minutes

Perform the patient-facing examination efficiently, then reserve the final 90–120 seconds for synthesis, differential, investigations, management and safety.

Review procedureOpen practice library
Station time
11:00

Ready for an 11-minute attempt.

Complete procedure

Exact 11-minute examination sequence

Use the sequence as a flexible performance framework. Patient safety and the task on the door always take priority over completing every maneuver.

0:00–0:45

1. Safety and environment

Say: “Before we start, I want to make sure you and everyone here are safe. Is there anything making you feel you might hurt yourself or someone else right now?”
  • Position yourself with access to exit in agitation risk.
  • Call for support early if behaviour is escalating.
  • Do not conduct a prolonged private interview when immediate violence risk is high.
0:45–1:30

2. Introduce, identify and explain

Say: “My name is ____. I would like to understand what you have been experiencing. I will keep our conversation private except if there is an immediate safety concern or another legal duty to disclose.”
  • Confirm identity.
  • Use calm, non-confrontational tone.
1:30–2:15

3. Appearance and behaviour

Say: Observe rather than interrogate.
  • Grooming, dress, eye contact, rapport.
  • Psychomotor agitation/retardation.
  • Abnormal movements.
  • Response to unseen stimuli.
2:15–2:50

4. Speech

Say: “Tell me what brought you here today.”
  • Rate, volume, quantity, fluency and spontaneity.
  • Pressured speech or latency.
2:50–3:40

5. Mood and affect

Say: “How have you been feeling in yourself?”
  • Patient-stated mood.
  • Observed affect: range, reactivity, congruence.
3:40–5:05

6. Thought form and content

Say: “Have you felt that people are trying to harm you, send you messages, or control your thoughts?”
  • Thought process: linear, tangential, circumstantial, flight of ideas, disorganization.
  • Delusions, paranoia, grandiosity, guilt, obsessions.
  • Ask suicide and homicide directly.
5:05–6:05

7. Perception

Say: “Have you heard or seen things that other people could not?”
  • Auditory/visual hallucinations.
  • Command content and whether patient feels compelled to act.
  • Differentiate hallucination from illusion when relevant.
6:05–7:10

8. Cognition and attention

Say: “I would like to check your concentration briefly.”
  • Orientation.
  • Attention e.g., months backward or digit span.
  • Memory only as needed.
  • Fluctuating inattention strongly raises delirium concern.
7:10–8:10

9. Insight and judgement

Say: “What do you think might be causing these experiences? Do you think you need treatment or help today?”
  • Recognition of illness/symptoms.
  • Treatment understanding.
  • Practical judgement and ability to seek help.
8:10–9:20

10. Structured risk and function

Say: “Have you thought about dying or hurting yourself? Have you thought about hurting anyone else? Do the voices tell you to act?”
  • Intent, plan, means, past attempts/violence.
  • Protective factors.
  • Substances, withdrawal and ability to care for basic needs.
  • Collateral information when necessary and lawful.
9:20–11:00

11. Summary and disposition

Say: “My mental-status examination shows… The immediate risk is… My next step is…”
  • State syndrome and dangerous differentials.
  • For first-episode psychosis, consider substance-induced, mood disorder and medical/neurologic causes.
  • Arrange emergency psychiatric/medical assessment when risk or inability to care for self is significant.
  • Do not promise absolute confidentiality when safety duties apply.
Interpretation

High-yield finding patterns

Finding patternClinical interpretation
Fluctuating attention/disorientationDelirium — search for acute medical cause
Hallucinations + delusions + disorganizationPsychotic syndrome
Elevated/irritable mood + pressured speech + decreased sleepManic syndrome
Low mood + anhedonia + suicidal ideationDepressive syndrome with risk assessment
Fixed cognitive decline without fluctuationPossible major neurocognitive disorder
Clinical reasoning

Prioritized differential

  1. Primary psychotic disorder
  2. Mood disorder with psychotic features
  3. Substance intoxication/withdrawal or substance-induced psychosis
  4. Delirium from medical illness
  5. Neurologic/endocrine/metabolic disorder
  6. Trauma-related or other psychiatric condition

Presentation formula

Start with stability, then the key positive and negative findings, localization or syndrome, leading diagnosis, and the most dangerous alternative that must be excluded.

Avoid: a long unranked list. Explain which finding makes each top diagnosis more or less likely.
Targeted tests

Investigations

Bedside glucose and focused medical assessment when acute/first episode

CBC, electrolytes/renal/hepatic tests and other labs guided by presentation

Toxicology or alcohol testing when clinically relevant and consent/legal framework permits

Pregnancy test before selected medications when relevant

ECG or neuroimaging only when indicated by medication/risk/neurologic features rather than routinely

Immediate plan

Management and disposition

  1. Ensure immediate safety and use the least restrictive environment/intervention.
  2. Treat delirium, intoxication, withdrawal or other medical causes urgently.
  3. Obtain psychiatric consultation for first-episode psychosis, mania, significant suicidality or dangerousness.
  4. Use de-escalation first for agitation when feasible; emergency medication/restraint follows local law/protocol when necessary for safety.
  5. Assess decision-making capacity for the specific decision when treatment refusal is relevant.
  6. Create a clear disposition and safety plan; involve supports with consent or when justified by immediate safety/legal duties.

Safety-netting

State exactly what would trigger urgent reassessment, specialist escalation, monitored care or admission. Do not hide emergency actions inside a generic “follow up” statement.

  • Asks suicide risk directly
  • Asks violence risk directly
  • Assesses command hallucinations
  • Screens for delirium/medical causes
  • Assesses substances
  • Evaluates insight/judgement
Self-assessment

Critical-action checklist

Use this after a timed attempt. These actions carry disproportionate safety value.

0 / 8 completed
0 / 8 critical actions completed
Evidence and next practice

References and linked learning

Reference starting points

Educational preparation only. Patient care must follow current patient-specific assessment, local policy and current guidelines.

Continue practice