Mental State Examination (MSE)

Question 1

Why is it difficult to separate MSE from a psychiatric history?

Answer 1

They are conducted at the same time - unlike a normal history and examination

Question 2

Cognitive assessment is carried out separately from a history and MSE in a pyschiatric consultation. TRUE/FALSE?

Answer 2

TRUE

Question 3

Describe ways in which concentration can be tested DURING an MSE?

Answer 3

Ask patient to say months of the year backwards

Question 4

How do we know what a patient’s “range of normal” is?

Answer 4

From previous clinic appearances

Question 5

What is a hallucination?

Answer 5

Perception without a stimulus

Question 6

What is an illusion?

Answer 6

Misperception of a real stimulus

Question 7

What are the various different parts of an MSE?

Answer 7

Appearance 
Behaviour 
Speech 
Affect and mood 
Thoughts: control and content
Perception 
Cognition
Insight

Question 8

What parts of a patients appearance would you note during an MSE?

Answer 8

• Age, Gender, Race
• Body Habitus
• Grooming (neat/ unkempt?)
• Attire
• Posture and Gait
• Evidence of injuries or illness (self-harm, abuse, fights, drug use)
• Smell (alcohol? urine? vomit? body odour?)

Question 9

How is behaviour asssessed during an MSE?

Answer 9

• Eye contact
• Rapport
• acting Open / Guarded / Suspicious?
• Agitated?
• Disinhibition / overfamiliarity (e.g. hugging during interview)

Question 10

How can speech present abnormally in an MSE?

Answer 10

Rate i.e. Abnormally fast or slow

Amount:

• Increased e.g. pressured (pt seems inappropriately urgent for consultation)
• Decreased e.g. monosyllabic/mute
• Variation in tone
• Speech delay
• Volume

Question 11

What time frame is used to assess mood in an MSE?

Answer 11

Time period of the interview

=> Mood is an assessment of how patient is feeling just NOW

Question 12

What is a patients affect

Answer 12

• observation of how the patient appears through the interview i.e. low, very low etc.
• Variation from their normal baseline

Question 13

What 3 questions let us know if a patient does or does not have insight?

Answer 13

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

Question 14

What are the different types of hallucination?

Answer 14

Auditory (2nd/3rd person, echo)
Visual
Olfactory
Gustatory
Somatic (e.g. bodily sensations - insects)

Question 15

What is meant by passivity phenomena?

Answer 15

Patients feel their behaviour is being controlled by an external agency rather than by themself

Question 16

What is speech-thought disorder?

Answer 16

evidence from patient’s speech or writing that there is an abnormality in the way thoughts are linked together
e.g. flight of ideas and loosening of associations

Question 17

What is considered to be a delusion?

Answer 17

false belief/ belief held on false grounds

e.g. hearing voices from inside an RAF plane overhead

Question 18

What themes appear in delusions of depression?

Answer 18

disease
nihilism
poverty
sin
guilt

Question 19

What themes appear in delusions of schizophrenia?

Answer 19

• control
• persecution
• reference
• religion
• love

Question 20

What themes appear in delusions of mania?

Answer 20

grandiosity
persecution
religion

Question 21

How can a patients cognitive function be assessed after their MSE

Answer 21

Orientation to Time, Place and Person:

• today’s date? Day/month/year?
• Where are we just now? Ward number/ floor?

Concentration:
- Months of the Year in reverse order

Memory

• Personal
• Retrograde memory e.g. dates of WW2
• Anterograde memory i.e. new memories => remember 3 things, name and address