Mental state examination (MSE)

Question 1

Appearance

Answer 1

Clothes - colourful, loud (mania?) vs. dirty (self-neglect)

Weight - anorexia, self-neglect, side effect of medication eg. obesity

Facial expression -
Depression - turned down corners of mouth
Anxiety - creases on forehead, dilated pupils
Anger and irritability

Posture - depression in hunched posture
Anxiety - sitting on edge of seat, restless

Question 2

Behavior

Answer 2

Movements - overactive, agitated, restless (mania)
schizophrenia (catatonic features)
Abnormal movement eg. dystonia, tremor (neurological disorder or side effect from medications)

Social behavior - mania (over familiar) or schizphrenia (withdrawn and preoccupied)
Rapport - suspicious and uncooperative in schizophrenia
Eye contact - poor in depression

Question 3

Speech

Answer 3

Rate
Quantity
Volume
Flow and can it be interrupted?
Spontaneity

Question 4

Mood

Answer 4

Subjective mood - How does the patient describe their mood?

Objective mood - What is your impression of the mood? - elated/irritable, depressed, anxious, labile

Question 5

Affect

Answer 5

affect is the observable behaviour associated with changing emotions.

Common terms to describe affect:
blunted or flattened affect - dulling of normal emotional response
labile affect - sudden rapid and often marked shifts of affect
inappropriate or incongruent affect - can be inappropriate to the thought content (e.g. laughter upon recounting the death of loved one) or inappropriate to the magnitude of events (e.g. emotional outburst after a small and insignificant event)

Question 6

Thoughts

Answer 6

Form
train of thought
We assess the thought form through patient's speech.
eg.
flight of ideas
loosening of associations/derailment
thought block
poverty of thought

Content
Overvalued ideas
Phobia (i.e. irrational fear)
Obsessions/ruminations
Delusions

“I would like to ask you some questions that may seem a little strange. These are questions that we put to all of our patients. Is that OK? Do you have any beliefs that your friends and family do not share?”
“Is anything bothering or weighing on you at the moment?”

Question 7

Perceptions

Answer 7

sensory distortion (depersonalisation, derealisation)
illusion
hallucinations

“I gather that you are quite stressed recently. When people are under stress, they can sometimes find that their imagination plays tricks on them. Have you had any similar experience?”
“Have you heard/seen anything unusual?”
“Have you noticed anything unusual about the way things look or sound, or smell, or taste?”
“Have you heard voices when there was no one around?”

Question 8

Cognitive examination

Answer 8

Orientation in time, place and person
Attention and concentration (serial-7 test or backwards spelling)
Memory - immediate recall, delayed recall, long-term memory/knowledge

Question 9

Insight

Answer 9

Is the patient aware that there is anything wrong?
If there is anything wrong, does the patient think it is due to an illness?
If an illness, is it physical or mental illness?
If it is a mental illness, can it be helped?
Is the patient willing to accept help or treatment?
This may include hospital admission - will the patient agree?