Mental State Examination

Question 1

What are the different components of the MSE?

Answer 1

• Appearance
• Behaviour
• Speech
• Mood and affect
• Thoughts
• Perceptions
• Cognition
• Insight
• Risk assessment

Question 2

What do you assess in appearance for MSE?

Answer 2

• Distinguishing features
• Weight
• Stigmata of disease
• Personal hygiene/level of self-care
• Clothing
• Objects

Question 3

What do you assess in behaviour for MSE?

Answer 3

• Engagement and rapport
• Eye contact
• Facial expression
• Body language
• Psychomotor activity
• Abnormal postures or movements - involuntary movement, tremors, tics, lip-smacking, akathisias, rocking

Question 4

What do you assess in speech for MSE?

Answer 4

• Rate of speech
• Quantity of speech (excessive - mania or schizophrenia)
• Tone (monotonous - depression, schizophrenia, autism)
• Volume
• Fluency and rhythm

Question 5

What do you assess in mood affect for MSE?

Answer 5

Affect - observed emotion (fixed/restricted/labile, heightened/blunted, congruency)

Mood - how the patient states they are feeling

Question 6

What do you assess in thought form for MSE?

Answer 6

• Speed of thoughts
• Flow and coherence of thoughts - loose associations, circumstantiality, tangential, flight of ideas, thought blocking, knight’s move thinking, word-salad, neologisms)

Question 7

What do you assess in thought content for MSE?

Answer 7

• Delusions
• Obsessions
• Compulsions
• Overvalued ideas
• Suicidal thoughts
• Homicidal/violent thoughts

Examples:
“What’s been on your mind recently?”
“Are you worried about anything?”
“Do you sometimes have thoughts that others tell you are false?”
“Do you ever feel that people are out to do you harm?”
“Do you ever feel that specific events in the world are related to you in some way?”
“Are there any thoughts that you have a hard time getting out of your head?”
“Do you sometimes feel the need to perform certain behaviours repetitively, despite understanding these are irrational?”
“Do you ever think about ending your life?”
“Have you ever felt your life was not worth living?”
“Have you ever attempted to end your life?”
“Do you ever think about harming others?”

Question 8

What do you assess in thought possess for MSE?

Answer 8

• Thought insertion
• Thought withdrawal
• Thought broadcasting

Examples:
“Do you think people can put ideas in your head, without your control?”
“Have you ever felt like people have removed memories or thoughts from your mind?”
“Do you ever feel like others can hear what you’re thinking?”

Question 9

What do you assess in perception for MSE?

Answer 9

• Hallucinations
• Pseudo-hallucinations
• Illusions
• Depersonalisation
• Derealisation

Examples:
“Do you ever see, hear, smell, feel or taste things that are not really there?”
“Did you think this was real at the time?”
“Do you still believe it was real?”
“Do you ever feel like you’ve changed or that you don’t recognise the person you currently are?”
“Do you ever feel like the world around you isn’t real?”

Question 10

What do you assess in cognition for MSE?

Answer 10

• Are they oriented in time, place, and person? -> this is usually enough for MSE
• What their attention span and concentration levels are like
• What their short-term memory is like

Question 11

How do you assess insight for MSE?

Answer 11

“What do you think the cause of the problem is?”

“Do you think you have a problem at the moment?”

“Do you feel you need help with your problem?”

Question 12

How you assess risk for MSE?

Answer 12

Have the voices ever told them to harm themselves/others?
Have they taken any measures to protect themselves?
Do they feel like taking their own life?