by Alberto J. Muniagurria and Eduardo Baravalle


The evaluation of the mental state must take into account a series of external manifestations that represent the symptoms of the higher functions of the brain. It is tremendously difficult to be precise in a field in which research has come to only partially interpret the intimate mechanisms of the production of such symptoms. Social, educational, religious factors, sexual differences, age, custom, sectoral factors or patterns, etc., that directly influence the characteristics that all manifestations of the mental state will present must be considered.

These manifestations referred to are general behavior, mood, mechanisms and contents of knowledge and understanding and intelligence.

The following is a series of definitions of terms that must be clear to understand the chapter on mental state.

General behavior

It is made up of a series of factors or elements, namely:

Consciousness . It is the capacity of alertness, of recognition of himself and the environment that surrounds the individual.

Conversation . It is the ability of a person to express their thoughts through spoken language.

Interpersonal relationships . It is the ability to maintain balanced communication with the people around you, taking into account the differences in rank, position, age, etc.

Relations with things . It is the ability to communicate with the animal and inanimate environment.

Activity . It is the ability to develop appropriate behavior in relation to their functions, customs, cultural guidelines, etc.

Eating, sleeping and hygiene habits . It refers to educational customs, regarding food, sleep and hygiene, adapted to cultural, social, religious factors, etc.


It refers to the sustained or stable emotion that colors the way a person views the world.

Affection . It is the instant or immediate response to different situations, which is expressed through attitude, or voice or facial expression.

 Table 3-1. Mental state assessment
  1. General behavior
    • - Awareness
    • - Conversation
    • - Relationships
    • - Relations with things
    • - Exercise
    • - Sleeping, eating, hygienic habits
  2. Mood and affection
  3. Thought: knowledge and understanding
    • - Methodology and content of thought
    • - Orientation
    • - Memory
    • - Attention
    • - Written, spoken language
  4. Intelligence
    • - Information
    • - Vocabulary
    • - Abstract thinking
    • - Judgment

Thought: knowledge and understanding

Thought encompasses both the cognitive capacity (knowing) and those capacities that allow understanding or understanding. It is interesting to note the difference between the thought process and the content of thought. The thought process is the methodology that is followed in hierarchical, logical and coherent order to complete an idea. The content refers to the richness or poverty of the idea.

Within the content of thought it is important to define orientation, attention, memory and written language.

Orientation . It is the capacity of location in time, space and people, depending on memory and attention.

Attention ! It is the ability to concentrate in time through an activity.

Memory . It is the ability to record or record information to be able to remember it when necessary. We speak of recent memory when it refers to episodes of the last days or hours. And remote memory when referring to years past.

Written language . It is the ability to understand the meaning of words, written or spoken, and the ability to write.


The separation of thought and intelligence is fictitious if one thinks in generic terms in the broadest sense. The reason for this division lies in the possibility of better understanding the methods of studying the mental state of the patient. Intelligence is the integrative capacity of higher intellectual functions that depend on the clarity with which perceptions are integrated, mental plasticity, memory, the wealth of associations, imagination and the ability to relate ideas to each other, and also to properly intellectual factors such as attention, volitional control and the ambition to succeed.

Within intelligence are abstract thinking, which is the ability to understand and explain ideas without specific limits, vocabulary, general information and judgment, which consists of the ability to reach an integrating idea or conclusion through a well-crafted reasoning or comparison.

With a brief questioning, the examiner should be able to assess whether the patient is in a state of alertness, that is, normal consciousness.


The attitude is the position that the patient adopts spontaneously in order to relieve pain or discomfort, or simply for comfort. The normal attitude is adopted for comfort, and therefore it is not essential or unique. The attitude examination begins when the patient enters the office, or when the questioning begins in hospitalized patients. The greater or lesser ease with which the movements are carried out to adopt that attitude or posture, the absence or not of involuntary movements and the balance and security in the movements must also be observed.


It is the appearance or physiognomy of a person's face. It depends on the shape of the face, the coloration and the tone or contraction of the facial muscles. The analysis of these characteristics must take into account normal variations according to race or ethnic group, age, profession and sex. Muscle color and tone determine expressions of fear, pain, anxiety, concentration, sleep, sadness, etc. The coloration depends on the melanic pigment, the thickness of the skin, the number of blood vessels and their flow, the content of hemoglobin or other pigments. The shape and symmetry of the face should also be described. It is useful to ask the patient for a photo of his face from some time ago and ask a relative about any changes that have occurred.