Mental State Examination

Question 1

What are the components of the MSE?

Answer 1

Appearance
Behaviour
Speech
Mood + Affect
Thought
Perception
Cognitive function
Insight

Question 2

What should be included in the appearance section of MSE?

Answer 2

Age, gender, race
Grooming (neat/unkempt)
Attire
Posture
Gait
Odd movements e.g. tics, tremors, stereotypes
Evidence of injury/illness e.g. self harm, drug use
Smell

Question 3

What might be included in the behaviour section of MSE?

Answer 3

Eye contact
Rapport
Open/guarded/suspicious
Agitation
Psychomotor retardation
Disinhibition/over-familiarity

Question 4

Which components of the speech should be described?

Answer 4

Rate
Amount
- increased --> pressured
- decreased --> monosyllabic --> mute
Variation in tone
Speech delay
Volume

Question 5

What is the difference between mood and affect?

Answer 5

Mood:
- subjective –> how is the patient feeling today (in their own words)

Affect:
- objective assessment –> your observation of how the patient feels

Question 6

Which terms might be used to describe a patient’s affect?

Answer 6

Appropriately reactive
Labile
Unreactive
Flattened
Blunted
Incongruent

Question 7

What are the 3 components of the thought section of MSE?

Answer 7

Thought form
Thought content
Thought control

Question 8

What are the two main examples of disordered thought form?

Answer 8

Flight of ideas

Loosening of associations (Knight’s move thinking)

Question 9

What is the difference between flight of ideas and loosening of associations?

Answer 9

Flight of ideas –> links recognisable between words/phrases

Loosening of associations –> no logical associations

Question 10

What are you looking for in thought content?

Answer 10

Abnormal beliefs –> delusions

Question 11

What are you looking for in thought control?

Answer 11

Passivity phenomena –> behaviour experienced as being controlled by an external agency

Question 12

What are the three examples of passivity phenomena in relation to thought?

Answer 12

Thought insertion
Thought withdrawal
Thought broadcasting

Question 13

What in included in the perception section of MSE?

Answer 13

Hallucinations

Question 14

What is a hallucination?

Answer 14

A perception which occurs in the absence of an external stimulus
- can occur in any sensory modality

Question 15

What are the different types of auditory hallucination?

Answer 15

Second person (directly addresses patient)
Third person (talking about, commenting)
Thought echo (patient's own thoughts out loud)

Question 16

What are the components of cognitive function assessed in MSE?

Answer 16

Orientation to time, place + person
Concentration (months of the year backwards)
Memory

Question 17

What are the components of insight in the MSE?

Answer 17

Do they recognise that they are unwell?
Do they attribute it to a mental health problem?
Do they accept the need for treatment/hospitalisation?