The Mental State Examination

Dr Jon Laugharne University of Western Australia

MSE

Symptoms and behaviour at the time of the interview May take into account observations and information from colleagues/relatives Examining mental state is a clinical skill requires practice not just theoretical knowledge

Summary of the MSE

Appearance/Behaviour Speech Mood Depersonalisation Obsessional symptoms Delusions Hallucinations/illusions Other psychotic symptoms Orientation Attention/concentration Memory Insight

Appearance & Behaviour

evidence of poor self care/neglect unusual bright/incongruous clothing odd/bizarre appearance weight loss facial expression posture/movement social behaviour eg withdrawn, overfamiliar, outside cultural norms

Speech

Rate & quantity Volume Content themes, preoccupations Flow blocking, rapid shifts between topics, disorganised/lacking logical thread

Mood

How are you in yourself/your mood? Tearful Hopeless (future)/ Guilt (past) Elated (elevated) or irritable Sleep/appetite/weight/libido/energy Concentration/attention Suicidal thoughts/intent/plans

Mood -anxiety

Subjective anxiety/tension Anxious thoughts (cognitions) Sweating, palpitations, tremor etc Pervasive or situational/discrete

Mood - other aspects

Variability/ lability of mood Flattening of affect Incongruity of mood

Obsessional symptoms & signs

Thoughts, images, impulses persistent, unpleasant, hard to stop, recognized as own

Compulsive rituals eg excessive checking, cleaning counting and other behaviours Always recognised as irrational (nonpsychotic)

Thoughts

Content : themes, preoccupations. May be unusual, bizarre, religiose, grandiose etc

Form : over-valued ideas, delusions, formal thought disorder

Perceptions

Illusions misinterpretation of a stimulus

Hallucinations perception in the absence of stimulus. Occur in all sensory modalities: auditory, visual, tactile, olfactory, gustatory

Other Psychotic Symptoms

Thought insertion Thought withdrawal Thought broadcasting Thought echo Delusional perception Passivity phenomena

Cognitive Function

Orientation time, place, person Attention/ concentration digit span, serial sevens, months backwards Memory immediate recall, short term, recent and remote (long term) MMSE more thorough and gives a score out of 30

Insight

Patients views on nature of the problem/ illness and on possible/ likely causes
Patients views on need for treatment/ type of treatment