The ability to observe and empathically understand other people is the key attribute of a good psychiatrist. It is always important to understand a patient's preoccupations, concerns and experiences. Mental state examination is a formal description of the features that are evident as the patient sits before you. The idea of mental state examination is derived from the distinction in medicine between history (the account that the patient gives of symptoms) and examination (looking for signs that can be demonstrated at the bedside). The parallel is not an exact one, as mental state examination includes exploration of experiences that are intrinsically subjective, and which may not be occurring in the here and now.

Mental state examination requires an understanding of descriptive psychopathology. This is a huge subject, much of it beyond the scope of this book. Here we explore the general principles of mental state examination. We will attempt to clarify those psychopathological issues that most commonly cause confusion.

The limitations of traditional descriptive psychopathology

Generations of British psychiatrists have been trained to follow an approach to psychopathology that is most clearly set out in Frank Fish's seminal book Clinical Psychopathology (Fish and Hamilton, 1985) (sadly, now out of print). However, it is apparent to most clinicians that the traditional approach is outmoded and in need of thoroughgoing revision. Although psychopathology is an important clinical tool, its limitations must be understood. Here we must issue a warning.