Module 3.2: Mental State Exam (MSE)

Question 1

List the 10 components of the MSE

Answer 1

1) appearance
2) behaviour
3) mood
4) affect
5) speech
6) thought process
7) thought context
8) perception
9) cognition
10) insight

Question 2

Appearance

Answer 2

May provide some clues to their lifestyle and ability to self-care.

• Distinctive features
• clothing
• posture / gait
• grooming / hygiene
• evidence of self-harm

Question 3

Behaviour

Answer 3

A patient’s non-verbal communication may provide insights into their current mental state.

• eye contact
• facial expression
• psychomotor activity
• body language / gestures / aggression
• level of arousal - calm/agitated/aggressive
• ability to follow direction
• rapport / engagement

Question 4

Speech

Answer 4

• Rate of speech- pressured / slowed
• Quantity - absent/minimum/excessive
• Tone - monotonous/ tremulous
• Volume - loud / quiet
• Fluency & rhythm - articulate/clear/slurred

Question 5

Mood & Affect

Answer 5

Both relate to emotion, however they are not the same.

Affect : represents an immediately expressed and observed emotion (eg. The patient’s facial expression or overall demeanour).

Mood: represents a sustained emotion present over a prolonged period of time that can alter the individuals perception of the world. (How are you feeling?)

• mood is the climate, affect is the weather.
• in the MSE affect is what you observe, whereas mood is what you enquire about.

Question 6

Thought - Form

Answer 6

Continuity & connection of ideas, disturbance of language

Speed - accelerated/racing/ retarded

Flow / coherence

• linear - in logical order
• incoherent - no logical sense
• circumstantial - irrelevant details
• tangential- flight of ideas
• perseveration- repetition of a particular response

Question 7

Thought - content

Answer 7

• A description of what the person is talking about:

Abnormal beliefs/delusions
Obsessions 
Overvalued ideas (perception of weight- anorexia)
Suicidal thoughts 
Homicidal / violent thoughts

Question 8

Thought - possession

Answer 8

• thought insertion - belief thoughts can be put into the patient’s mind.
• thought withdrawal- be removed
• thought broadcasting- belief others can hear the patient’s thoughts

Question 9

Perception

Answer 9

*Related/ response of the senses

Hallucinations- believe they are real

Pseudo-hallucinations- patient knows it is not real.

Illusions - misinterpreted perception (mistake a shadow for a person)

Question 10

Cognition

Answer 10

Level of consciousness

Basic testing-

• orientation (time/place/person)
• attention and concentration
• short-term memory

Detailed testing-
* mini-mental state exam (MMSE or ACE-III)

Question 11

Insight & Judgement

Answer 11

Insight-

• does the patient recognise the problem?
• Does the patient understand its nature?
• do they want help?

Judgement - asses the patient’s general problem-solving ability

Question 12

Define the MSE

Answer 12

Is a semi-structured interview to assess another persons current neurological & psychological functioning across several dimensions at ‘that point in time’. Observation, Interview, Documentation.

Question 13

What is the purpose of the MSE? (5)

Answer 13

• Clarify the presence & extent of the persons mental health problems
• Evaluate the person’s present mental state
• Identify areas for immediate intervention (consider risk)
• Provide a baseline so that future MSEs can evaluate changes in the person’s condition & response to treatment
• Assists in the determination of appropriate clinical pathways & interventions