Mental state examination

Question 1

Features of MSE

Answer 1

ASEPTIC

Appearance and behaviour

Speech

Emotion (Mood and affect)

Perception

Thoughts

Insight

Cognition

Question 2

Appearance

Answer 2

Age, sex, ethnicity, religious background?

BMI

Dressing
- Is it appropriate for setting/whether

Personal hygiene

Distinguishing features
- Tattoos or scars

Question 3

Behaviour

Answer 3

How do they act towards people in the room?
- Talkative, timid, aggressive?

Facial expression

Body language

• Eye contact
• Posture
• Abnormal movements

Responding to stimuli not there?

Question 4

Speech

Answer 4

Rate

• Rapid/ pressured?
• Slow?

Volume
- Quiet/ loud/ normal?

Tone
- Aggressive? any innotations?

Flow
- Pauses? Grammatica; sense?

Question 5

Mood

Answer 5

Subjective perception

How does the patient say they feel?
- Words written down verbatim

Ask about symptoms associated with mood

• Appetite
• Sleep

Mood congruence
- does mood match affect?

Question 6

Affect

Answer 6

Objective assessment of mood

• Elated
• Low
• Withdrawn
• Irritable
• Anxious

Reactive or unreactive?

Flat or changing emotion?

Question 7

Thoughts

Answer 7

Content

• Beliefs and ideas
• Delusion
• Self harm
• Obsessions and compulsions

Process- how thoughts are expressed

• Sentences link or hopping from topic to topic? (loosening of associations)
• Tangential thoughts? Introducing unrelated thoughts.
• Circumstantial thoughts?
• Thought interference?
• Word salad?

Question 8

Perceptions

Answer 8

Hallucinations

• Visual
• Auditory
• Tactile
• Gustatory

Illusions

Dissociative symptoms
- Feel detached from theirselves? (depersonalisation)