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Mental Status Exam

Assessing Thought Content

April 1st, 2023


Thought content refers to the subject matter, themes, and ideas that an individual expresses during a mental status examination or clinical interview. Assessing thought content is essential for understanding the individual's current mental state, identifying potential psychiatric conditions, and formulating an appropriate treatment plan.


Delusions are rigidly held false beliefs not consistent with a person's background.
  • Examples of Delusions

  • Grandiose delusions - of wealth / power
  • Hypochondriacal / somatic delusions - false convictions of fatal disease, infestations or degeneration of organsPsychosis, psychotic depression
  • Nihilistic delusions: feeling of not existing or having a body
  • Delusional perception: a normal perception followed by a delusional conclusionSchizophrenia
  • Delusions of infidelityPsychosis
  • Delusions of guilt and povertyPsychotic depression
  • Capgras's syndrome: the delusion that a significant person (e.g. spouse) has been replaced with an imposter
  • Erotomania: the delusion that a stranger (e.g. a celebrity) is in love with the patient
  • Delusions of Reference: Beliefs that unrelated events, objects, or people hold personal significance or messages.

Disorganised Thinking

  • Significance

  • Thought insertion, thought broadcasting and thought withdrawal are delusion-like features and are positive features of psychosis.
  • Types of Disorganised Thinking

  • Thought insertion: the feeling that the patient's thoughts are being placed into their mind by some external power
  • Thought withdrawal: the feeling that the patient's mind is blank due to the removal of their thoughts by some external power
  • Thought broadcasting: the feeling that the patient's thoughts are audible to those around them


Forceful, intrusive, repetitive thoughts that cannot be repelled.
  • Significance

  • A classical feature of obsessive-compulsive disorder.

Overvalued Ideas

Overvalued ideas are unreasonable beliefs that the patient spends a large amount of time and energy on.
  • Examples of Overvalued Ideas

  • Anorexia / bulimia nervosa - a belief that they are overweight.
  • Body dysmorphic disorder - excessively preoccupied with a perceived flaw in their physical appearance, which may be minor or even nonexistent.
  • Orthorexia - an unhealthy obsession with eating only "pure" or "clean" foods, potentially leading to a highly restricted diet, excessive focus on food quality and preparation, and social isolation.
  • Extreme political or religious beliefs - strong convictions about a particular political or religious belief to the point that it dominates the person's thoughts and daily life, despite limited evidence or rational basis for their beliefs.
  • Hypochondriasis - excessive preoccupation with the idea of having a serious, undiagnosed medical condition despite having no or only mild symptoms, leading to persistent worry, frequent medical consultations, and excessive self-monitoring.
  • Excessive perfectionism - excessive concern with the need to achieve perfection in various aspects of life such as work, academics, or personal appearance.
  • Pseudocyesis: a belief that one is pregnant when they are not.
  • Apotemnophilia: a belief that one or more limbs do not belong to them.
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