Mental state examination

Appearance: Caucasian male, medium height and build, looks of stated age, short brown hair unbrushed, unshaven. Dressed in semi formal office clothes, clothes clean though rumpled.

Behaviour: calm demeanour, good eye contact though prone to reverie, no abnormal movements, gait symmetrical. Cooperative with interview.

Conversation: normal rate, tone, volume, rhythm of speech. Brief answers verbally, more expansive in writing. Some tangentiality and loosening of associations. Occasional inappropriate humour. Themes of anger, being misunderstood, narcissism.

Affect: reactive, engaged. Claims subjective inner turmoil.

Perception: apparently normal. No attendance to internal stimuli.

Cognition: not formally assessed. Grossly intact.

Intelligence: above average though possibly not as high as he asserts.

Insight: good though limited in the context of accepting and integrating criticism.

Judgment: impaired by innate laziness.

Rapport: superficially established.

Impression: ?tormented artist
?selfish prick
?dysthymia
?intern burnout.

Plan: 1. Ship him off to another hospital and let them sort him out.
2. Put him in the scuppers with a hosepipe on him.
3. Encourage writing: entertaining at times.