Mental State Examination (MSE)

Question 1

What are the domains in the MSE?

Answer 1

Appearance
Behaviour
Speech
Mood & affect
Thoughts
Perception
Cognition
Insight

Question 2

What do you observe for in a psychiatric patients APPEARANCE?

Answer 2

Distinguishing features
Weight
Stigmata of disease
Personal hygiene - kempt or unkempt?
Clothing - appropriate? put on correctly?
Objects around patient

Question 3

What do you observe for in a psychiatric patients BEHAVIOUR?

Answer 3

Engagement and rapport - are they distracted? or engaging with hallucinations?

Eye contact - reduced? or excessive?

Facial expression - relaxed? angry? disengaged?

Body language - threatening? or withdrawn?

Psychomotor activity - psychomotor retardation? or restlessness/agitation/anxious?

Abnormal movements or postures - involuntary movements? tremors? tics? lip-smacking? akathisia? rocking?

Question 4

What do you observe for in a psychiatric patients SPEECH?

Answer 4

Rate of speech - pressure of speech? or slow speech?

Quantity of speech - minimal or absent? (e.g. in depression) or excessive? (e.g. mania and schizophrenia)

Tone of speech - monotonous? (e.g. depression, schizophrenia, autism) or tremulous? (e.g. in anxiety)

Volume of speech

Fluency and rhythm of speech - stuttering? slurred speech? (e.g. major depression)

Question 5

What do you observe for in a psychiatric patients MOOD & AFFECT?

Answer 5

Mood - subjectively (in patient’s own words) and objectively (my observation of the patient’s internal mood, e.g. depressed, euthymic, or elated)

Affect - apparent emotion, range and mobility of affect (fixed, restricted or labile), intensity of affect (heightened, blunted or flat), and congruency of affect

Question 6

What do you observe for in a psychiatric patients THOUGHTS?

Answer 6

Thought form - speed of thoughts (racing? or slow?), flow and coherence (loose associations? circumstantial thoughts? tangential thoughts? flight of ideas? thought blocking? perseveration? neologisms?)

Thought content - delusions? obsessions? compulsions? overvalued ideas? suicidal thoughts? violent thoughts?

Thought possession - insertion? withdrawal? broadcasting?

Question 7

What do you observe for in a psychiatric patients PERCEPTION?

Answer 7

Abnormalities in perception include:
Hallucinations
Pseudo-hallucinations
Illusions
Depersonalisation
Derealisation

Question 8

What do you observe for in a psychiatric patients COGNITION?

Answer 8

Orientated to time, place and person?
Attention span and concentration levels like?
Short-term memory okay?

Formal assessments e.g. MMSE, AMTS, ACE-III

Question 9

What do you observe for in a psychiatric patients INSIGHT?

Answer 9

Insight - do you have a problem? do you need help? what is medication for? why are you taking the medication?