Mental State Examination (MSE)

Question 1

MSE

Answer 1

Mental State Examination

Question 2

What is it?

Answer 2

a snapshot of individual’s psychological functioning at a given point in time.

Question 3

Involves appraisal of: (4)

Answer 3

1 appearance
2 behaviour
3 mental functioning
4 overall demeanour of a person.

Question 4

Judgements about mental state should always consider: (2)

Answer 4

1 developmental level of person

2 age-appropriateness of noted behaviours

Question 5

If there is any indication of current suicidal or homicidal ideation…?

Answer 5

the patient must be referred for RISK ASSESSMENT by a qualified mental health clinician.

Question 6

domains of assessment: (8)

Answer 6

1 appearance
2 behaviour
3 mood & affect
4 speech
5 cognition
6 thoughts
7 perception
8 insight & judgement

Question 7

appearance (4)

Answer 7

1 distinctive features
2 clothing
3 grooming
4 hygiene

Question 8

behaviour (ie non verbal communication) (10)

Answer 8

1 facial expressions
2 body language and gestures
3 posture
4 eye contact
5 response to the assessment
6 rapport and social engagement
7 level of arousal (eg calm/agitated)
8 anxious or aggressive behaviour
9 psychomotor activity and movement (eg hyper/hypo activity)
10 unusual features (eg tremors, abnormal or  slowed/repetitive/involuntary movements)

Question 9

mood and affect (like season and weather)

mood (3+)

Answer 9

how it’s described by the person.
1 happiness (eg ecstatic, elevated, lowered, depressed)
2 irritability (eg explosive, irritable, calm)
3 stability

Question 10

speech (5)

Answer 10

1 rate (eg rapid, pressured, reduced tempo)
2 volume (eg loud, normal, soft)
3 tonality (monotonous, tremulous)
4 quality (minimal, voluble)
5 ease of conversation

Question 11

cognition (7)

Answer 11

1 level of consciousness (eg alert, drowsy, intoxicated)
2 orientation to reality (time/place/person)
3 memory functioning
4 literacy and arithmetic skills
5 attention and concentration
6 language (naming objects, following instructions)
7 planning

Question 12

thoughts content and form

- thought content (7)

Answer 12

1 delusions (rigidly held false beliefs)
2 overvalued ideas (unreasonable belief eg person w/ AN believing they’re overweight)
3 preoccupations
4 depressive thoughts (self worthlessness)
5 self-harm, suicidal, aggressive, homicidal ideation
6 obsessions (preoccupying and repetitive thoughts about a feared outcome)
7 anxiety (generalised, or specific)

Question 13

perception

- dissociative symptoms (2)

Answer 13

dissociative symptoms:
1 realisation (one's surroundings are not real)
2 depersonalisation (feeling detached from oneself)

Question 14

insight & judgement

- insight (3)

Answer 14

1 acknowledgement of a possible mental health problem
2 understanding of possible treatment options and ability to comply
3 ability to identify potentially pathological events (eg hallucinations, suicidal impulses) and ability to make SAFE decisions about it

Question 15

mood and affect (like season and weather)

affect (3+)

Answer 15

how you observe person’s emotional state.
1 range (eg restricted, blunted, flat, expansive)
2 appropriateness (eg appropriate/congruent, inappropriate/incongruous)
3 stability

Question 16

thoughts content and form

- thought form (5+)

Answer 16

rate or thought production continuity of ideas
1 highly irrelevant comments (loos associations of derailment)
2 frequent changes of topic (flight of ideas or tangential thinking)
3 excessive vagueness (circumstantial thinking)
4 nonsense words (or word salad)
5 pressured or halted speech (thought racing or blocking)

Question 17

perception

- illusions (2)

Answer 17

1 the person perceives things as different to usual, but accepts that they are not real, OR
2 things are perceived differently by others

Question 18

perception

- hallucinations (6)

Answer 18

1 indistinguishable by sufferer from reality
2 can affect all sensory modalities - most common = auditory
3 in children, common to experience self-talk or internal voice
4 command hallucinations (voice telling person to do something - should be investigated)
5 NB degree of fear/distress associated w/ hallucinations

Question 19

insight & judgement (2)

- judgement (2)

Answer 19

1 person’s problem-solving ability
2 evaluated by exploring recent decision-making or by posing a practical dilemma (what should you do if you see smoke coming out of a house?)

Question 20

When conducting MSE, consider: (7)

Answer 20

1 how to establish engagement/rapport
2 types of questions to elicit information
3 clinician’s presentation, style and language
4 subjectivity/objectivity (how information is interpreted)
5 privacy, confidentiality and safety
6 environment and setting
7 cultural considerations

Question 21

When documenting: (3)

- the do’s

Answer 21

1 use simple, clear, descriptive, professional language
2 be comprehensive (do not leave blank spaces; state why a section is incomplete)
3 be as objective as possible - support with evidence that is subjective expressions (verbal and non-verbal) from the person. use quotation marks to indicate pt.s verbatim statements

Question 22

When documenting: (5)

- there are influences on our judgement…

Answer 22

1 stereotyping
2 making unsubstantiated assumptions
3 basing judgement only on appearance
4 your own pre-conceived ideas
5 our own knowledge parameters