Mental state examination

Question 1

What is the MSE?

Answer 1

Objective assessment of the current episodes of illness

Question 2

What features do you look for in an MSE?

Answer 2

Appearance + Behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight
Risk

Question 3

What are you looking for in someone’s appearance and behaviour?

Answer 3

Age, gender, ethnicity and occupation
Dress and self-care 
Manner
Posture and movement
Rapport

Question 4

What are you looking for in someone’s speech?

Answer 4

Rate
Rhythm 
Tone 
Volume
Pressure / Poverty
Coherence

Question 5

What is pressured speech?

Answer 5

When someone is talking very fast as if they are being pressured to release words

Question 6

What is poverty of speech?

Answer 6

Lack of content, little speaking

Question 7

What are you looking for in someone’s mood?

Answer 7

Subjective
Objective
Affect

Question 8

What is affect?

Answer 8

How a patient presents in the consultation

Question 9

What is an incongruant affect?

Answer 9

If the affect does not match

Question 10

What is a reactive affect?

Answer 10

Describes an affect that varies appropriately to the scenario / situation - is normal

Question 11

What is a labile affect?

Answer 11

Describes an affect that is very extreme, react more than they should to things

Question 12

What are you looking for in someone’s thought?

Answer 12

Content
Preoccupations
Delusions
Form

Question 13

What impacts thought content?

Answer 13

Thought insertion, withdrawal or broadcasting

Question 14

How can you tell someone is preoccupied in thought?

Answer 14

Recurrent thoughts which the person is unable to put aside

- worries, overvalued ideas, obsessions, thoughts of harm

Question 15

What are delusional thoughts?

Answer 15

Grandiose 
Persecutory
Hypochondriacal
Nihilistic
Guilty
Infidelity 
Amorous
Control

Question 16

What are the forms of thought?

Answer 16

Pressure 
Poverty
Thought blocking
Loosening of associations
Knight's move
Neologisms
Perseveration
circumstantial
Derealisation

Question 17

What is knight’s move thoughts?

Answer 17

When thoughts jump and have no clear link

Question 18

What are you looking for in perception?

Answer 18

Hallucinations
Illusions
Depersonalisation
Derealisation

Question 19

What are you looking for in cognition?

Answer 19

Orientation
Attention and Concentration
Memory
Grasp

Question 20

What is Insight?

Answer 20

Does the patient consider themselves well and do they consider that they need their treatment?

Question 21

What are you looking for in a patient’s risk?

Answer 21

Risk to themselves
Risk to others
From others
Ask about dependents !

Question 22

How could a patient be a risk to themself?

Answer 22

Neglect
Deliberate self harm
Forgetful (leave things on)

Question 23

How could a patient be at risk from others?

Answer 23

Abuse

Financial

Question 24

How are there other ways to assess cognition?

Answer 24

Abbreviated mental test score
Mini mental state exam
Addenbrooke’s cognitive examination (ACE)
Frontal lobe testing

Question 25

How do you test someone’s frontal lobe?

Answer 25

Verbal fluency (recall as many words as possible)
Cognitive estimates (Educated guesses)
Abstract thinking (proverb interpretation)