Mental state examination in children and adolescents — formative SAQs

SAQ 1 — Setting up and running the examination (10 marks)

A registrar plans to assess the mental state of a 14-year-old in clinic, taking the whole examination in front of the parent because "it is quicker." [9] [8]

Questions

1. List the seven standard domains of the mental state examination in order, with one observation for each. (5 marks) [8]
2. Explain why time alone and developmental adaptation are required for this adolescent, and contrast the method for a preschool child. (5 marks) [9]

Model answer

Seven domains in order (5). (1) Appearance and behaviour — grooming, eye contact, psychomotor activity, rapport. (2) Speech — rate, rhythm, volume, fluency. (3) Mood and affect — mood the sustained subjective state, affect the observed expression; note congruence and range. (4) Thought, form and content — form the flow (slowed, racing, loose), content what is thought about (worries, obsessions, delusions). (5) Perception — hallucinations, illusions, derealisation. (6) Cognition — orientation, attention, memory; screen delirium versus psychiatric cause. (7) Insight and judgment — does the young person recognise a problem and will they act safely. One mark per domain with a correct observation. [8]

Time alone and developmental adaptation (5). A parent's presence suppresses an adolescent's disclosure of mood, self-harm, substances, and abuse, so time alone with a stated confidentiality line is a quality step, not a courtesy. Use open questions and brief validated screens for the adolescent. By contrast, a preschool child cannot reliably report inner states in words, so the examination rests on structured play, behavioural observation, and parent collateral — read affect from what the child does, and observe separation and reunion. The domains stay the same; the route into them changes with development. [9]

SAQ 2 — Positive screen and a safety decision (10 marks)

A 15-year-old seen alone has a positive PHQ-based depression screen and, on direct questioning, describes passive thoughts of death without a clear plan. [5] [7]

Questions

1. Outline the same-visit actions after a positive depression screen in an adolescent, including the suicide-risk assessment. (6 marks) [5] [7]
2. Name two validated brief screens used in the paediatric and adolescent MSE and what each detects. (4 marks) [1] [3] [4] [6]

Model answer

Same-visit actions (6). Do not file and forget. Perform a same-visit, face-to-face suicide-risk assessment: ideation, plan, intent, access to means, prior attempts, and protective factors, plus whether the young person can stay safe tonight. Weigh the history and collateral, because a single calm snapshot may understate a fluctuating risk. Decide between a crisis or emergency pathway for high risk and an early outpatient review with a written safety plan for lower risk. A psychology referral taking three weeks is not a safe plan for a young person with active intent. [5] [7]

Validated brief screens (4). Two of: SDQ — a broad behavioural screen for emotional, conduct, hyperactivity, peer and prosocial domains, completed by parent, teacher and young person; GAD-7 — a brief anxiety severity screen; CRAFFT — a validated adolescent substance-use screen; C-SSRS — a structured suicide-risk tool mapping ideation and behaviour onto severity domains. Each detects and prompts deeper assessment; none diagnoses alone. Two marks per screen with its target. [1] [3] [4] [6]