MSE

Question 1

Appearance

Answer 1

Physical state: how old do they appear? Do they appear physically unwell? Are they sweating? Are they too thin or obese? Etc
Clothes and accessories: Are their clothes clean? Are they wearing the same clothes since when you last saw them? Are clothes appropriate for the weather/circumstance? Is the patient carrying strange objects?
Self-care & hygiene: does the patient appear to have been neglecting their appearance or hygiene (eg. Unshaven, malodourous, dishevelled)? Is there any evidence of self-harm (eg cuts to wrists/forearm)?

Question 2

BEHAVIOUR

Answer 2

Abnormal movements: tremors, tics, twitches
How the patient is acting: Are they relaxed/ suspicious/ aggressive/ fearful/ catatonic?
Psychomotor abnormalities: retardation (slow, monotonous speech, slow/absent body movements), agitation (inability to sit still; fidgeting, pacing, hand wringing, rubbing/scratching skin or clothes)
Rapport: What is their attitude towards you? Do they make good eye contact? May be described as cooperative, cordial, uninterested, aggressive, defensive, guarded, suspicious, fearful, perplexed, preoccupied, disinhibited, etc

Question 3

Parkinsonism

Answer 3

drug-induced signs are most commonly a reduced arm swing + unusually upright posture while walking. Tremor + rigidity are late signs, in contrast to idiopathic parkinsonism

Question 4

Acute dystonia

Answer 4

involuntary sustained muscular contractions or spasms

Question 5

Akathisia

Answer 5

subjective feeling of inner restlessness and muscular discomfort, unable to sit still

Question 6

Tardive dyskinesia

Answer 6

rhythmic, involuntary movements of the head, limbs and trunk, especially chewing, grimacing of the mouth and protruding, darting movements of the tongue

Question 7

Bradykinesia

Answer 7

slowness of movement

Question 8

SPEECH

Answer 8

Rate: may be regular, may have pressure of speech (seen in mania), long pauses/hesitancy + poverty of speech
(seen in depression)

Tone: may be regular tonality, monotonous

Volume: regular, increased or decreased

Also comment on dysarthria (articulation difficulties), dysprosody (unusual speech rhythm, melody, intonation or pitch), stuttering, slurring

Question 9

Mood

Answer 9

Refers to a patient’s sustained, subjectively experienced emotional state over a period of time
Assessed by asking the patient how they are feeling

• Described objectively (your impression from the interview) and subjectively (their description of how they feel)

Dysphoric: an unpleasant mood, eg. Depression, anxiety, irritability

Euthymic: the mood is within the “normal” range, implying that mood is neither depressed nor elevated

Expansive: the mood is more elevated than normal, but does not necessarily imply pathology

Euphoric: an intense feeling of well-being

Question 10

AFFECT

Answer 10

A subjective feeling/emotional experience that is manifested by observable behaviours such as attitude, facial expression, tone of voice, etc.

Affect is assessed by observing patient’s posture, facial expression, emotional reactivity

(1) Changeability
• Restricted – characterised by discernible decrease in range + intensity of expressions
• Labile – characterised by rapid & abrupt changes , eg. Friendly + cheerful one minute and then
angry and belligerent the next for no apparent reason

(2) Range = Normal/ increased/ decreased
(3) Appropriateness = congruent/incongruent (discordance between speech and affect)

(4) Intensity
• Blunted – associated with marked diminuition in emotional expression
• Flat – the normal signs of a broad range of affective expression are absent; voice may be
monotonous, face may be immobile/expressionless

Question 11

THOUGHT FORM - Circumstantial

Answer 11

An inability to answer a question without giving excessive, unnecessary detail – differs from tangential thinking, in that the person does eventually return to the original point

Question 12

THOUGHT FORM - tangential

Answer 12

Wandering from the topic and never returning to it nor providing the information requested

Question 13

THOUGHT FORM - Loosening of association

Answer 13

characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next.

Question 14

THOUGHT FORM - Neologisms

Answer 14

Creation of a new word, often consisting of a combination of other words, that is understood only by the speaker

Question 15

THOUGHT FORM - Flight of ideas

Answer 15

A rapid shifting of ideas with only superficial associative connections between them that is expressed as a disconnected rambling from subject to subject and occurs especially in the manic phase of bipolar disorder

Question 16

THOUGHT FORM - Thought blocking

Answer 16

Occurs when a person’s speech is suddenly interrupted by silences that may last a few seconds to a minute or longer

Question 17

THOUGHT FORM - preservation

Answer 17

Persistent repetition of

words or ideas even when another person attempts to change the topic

Question 18

THOUGHT FORM Echolalia

Answer 18

Echoing of another speech

Question 19

THOUGHT FORM - Alogia

Answer 19

Poverty of speech, either in amount of content

Question 20

Thought Content - Preocupations

Answer 20

over-valued or recurrent thoughts

Question 21

THOUGHT CONTENT - obsessions

Answer 21

Distressing recurring unwanted thoughts

Question 22

THOUGHT CONTENT - Delusions

Answer 22

A fixed false belief not accounted for by patient’s cultural background

Question 23

THOUGHT CONTENT - PARANOID DELUSIONS

Answer 23

The person/group is being attacked, threatened, harassed, endangered, deceived or persecuted

Question 24

THOUGHT CONTENT - GRANDIOSE DELUSIONS

Answer 24

a delusion in which the
person has an exaggerated view of his/her own
importance, power, knowledge, or identity

Question 25

THOUGHT CONTENT - DELUSIONS OF REFERENCE

Answer 25

events/objects/other
people in the subject’s immediate environment
are seen to have unusual & special significance

Question 26

THOUGHT CONTENT - IDEAS OF REFERENCE

Answer 26

similar to delusions of

reference but the beliefs are more shakeable

Question 27

THOUGHT CONTENT - DELUSIONS OF CONTROL/ PASSIVITY EXPERIENCES

Answer 27

belief that the person’s feelings/ impulses/ thoughts/ actions are not his or her own, but rather are inserted by another

Question 28

THOUGHT CONTENT - SOMATIC DELUSIONS

Answer 28

Relates to functioning of the body e.g being pregnant, rotting brain

Question 29

THOUGHT CONTENT - NIHILISTIC DELUSIONS

Answer 29

false belief that self, part of self, others, or the world is nonexistent or ending

Question 30

PERCEPTION

Answer 30

Determine whether the abnormal perceptions are genuine hallucinations, pseudohallucinations, illusions, or intrusive thoughts
• Describe from which sensory modality the hallucinations arise – eg. Auditory, visual, tactile, olfactory, gustatory, somatic
• Determine whether auditory hallucinations are elementary or complex
• If complex – are they experienced in first person (audible thoughts, thought echo), second person (critical,
persecutory, complimentary or command hallucinations) or third person (voices arguing or discussing the
patient, or giving a running commentary)
• It is also important to note whether the patient is responding to hallucinations during the interview, as
evidenced by them laughing as though they are sharing a private joke, suddenly tilting their head as though listening, or quizzically looking at hallucinatory objects around the room

Question 31

COGNITION

Answer 31

• Screened by checking orientation to person, place, time

* Usually not formerly assessed unless you have time for an MMSE

Question 32

INSIGHT

Answer 32

• Often described as good, partial, or poor – however usually patients lie somewhere on a spectrum and vary over time
Key questions to answer;
- Does the patient believe they are unwell in any way? Do they believe they are mentally unwell?
- Do they think they need treatment?
- Do they think they need to be in hospital?

Question 33

JUDGEMENT

Answer 33

• Reasoning regarding current important issues
• Ideas about decisions or actions to be taken, including about current illness
• Evidence from past judgements as clues to current thinking