History Taking - Mental State Examination (MSE)

Question 1

What do you look for when performing an MSE?

Answer 1

ASEPTIC

Appearance + behaviour 
Speech 
Emotional/affective state
Perceptual abnormalities 
Thoughts 
Insight 
Cognitive and intellectual function

Question 2

What do you look for when assessing Appearance and behaviour?

Answer 2

Physical appearance

i) Body build – nutritional state
ii) Significant distinguishing features – tattoos, deformity, scarring etc
iii) Cleanliness – hair, teeth and nails
iv) Quality, style and state of clothing

General attitude

i) Rapport
ii) Attitude towards interview
iii) Eye contact

Motor behaviour
i) Restless, fidgety, apathetic, slow etc

Question 3

What do you look for when assessing Speech?

Answer 3

Volume and speed
i) Pressure of speech vs retardation

Construction
i) Flight of thought, rhyming, punning, incoherence etc

Enunciation
i) Dysarthria, stammer

Question 4

What do you look for when assessing Emotional/affective state?

Answer 4

Is a subjective experience so ask (=mood)

i) Positive or negative (valanced i.e. charged) emotions?
ii) Arousal – engaged, hiding something or ambivalent
iii) Motivational salience – any suicidal ideation or intent? Any other extreme decisions? Any action on them?

Objective impression (= affect)
i)	Elevated, low, angry, resentful, euthymic (stable, non-depressed, placidity) etc 

Reactivity
i) Whether the persons mood/behaviour changes in response to the flow of consultation

Congruity with speech content
i) I.e. are they sad when talking about something sad? Or the opposite?

Stability
i) I.e. do they fluctuate wildly within the session

Question 5

What do you look for when assessing Perceptual abnormalities?

Answer 5

Auditory hallucinations

i) Exact description
ii) Familiar/unfamiliar, 2nd/3rd person, commands and reactivity to them?

Visual, olfactory, sensory hallucinations etc

See schizophrenia for more info

Question 6

What do you look for when assessing Thoughts?

Answer 6

Content

i) Preoccupations, recurring pervasive themes
ii) Depressive ruminations
iii) Grandiose ideas
iv) Referential thinking – tendency to view innocuous stimuli as having specific meaning for the self (pleasant or unpleasant)
v) Delusions (internal) vs Illusions (external/sensory distortion)
vi) SI?

Obsessional thoughts
i) +/- compulsive rituals

Objective signs of thought disorder

Subjective experience of thought disorder

See schizophrenia for more info

Question 7

What do you look for when assessing Insight?

Answer 7

Attitude towards illness – perceptions of difficulties, how people view them etc

Attitudes towards treatment – what is needed? What about tablets? What happens if they dont take their medicines?

Complete lack of insight – anosognosia i.e. in delusional disorders; might show different levels of insight throughout

Question 8

What do you look for when assessing Cognitive and intellectual function?

Answer 8

MOCK

Memory

i) Immediate recall – digit span
ii) Recent – address
iii) Remote – i.e. from personal history

Orientation
i) Time, place, personal identity

Consciousness level (GCS)

Knowledge and intelligence (also gained from history)