Mental state examination

1. Mental state examination

2. MSE
An ordered summary of the examining doctor’s observations as to the patient’s
mental experience and behavior at the time of interview
1. Appearance
2. Behaviour
3. Speech
4. Mood and affect
5. Thoughts
6. Perception
7. Cognition
8. Insight
Summary

3. Appearance
• Apparent age
• Weight:
• Personal hygiene : indicates ability to care for themselves
• Clothing: appropriate for circumstances
• Distinguishing features: scars, tattoos.

4. Behaviour
• Engagement and rapport
• Eye contact
• Facial expression: relaxed, angry, disengaged
• Body language: threatening or withdrawn
• Psychomotor activity: retardation( paucity of movements and delayed
responses); restlessness: fidget, refuse to sit still
• Abnormal movements or postures: involuntary movements, tremors,
tics, lip smacking, akthasia
• Sterotypy : repetitive, purposeless movement (rocking)
• Mannerism: goal directed, understandable movement (doing
Namaste)

5. Speech
• Rate:
pressure of speech: tendency to speak rapidly, motivated by an urgency.
slow speech: due to psychomotor retardation
• Quantity:
minimal : associated with depression
excessive: a/w mania and schizophrenia
• Tone and rhythm:
monotonous: a/w depression, schizophrenia
tremulous: a/w anxiety
• Relevance
• Perseveration: repeating words or topics. Sign of frontal lobe impairment
• Neologisms: made up words. Can occur in schizophrenia
• Normal speech: spontaneous, logical, relevant and coherent.

6. Mood and Affect
• Mood (underlying subjective emotion): dysthymic, euthymic or elated
• Affect ( observed external manisfestation of emotion): Normal affect can
be described as affective
Abnormal affects:
• Blunted/ non reactive affect: lacking any form of emotional responses eg. Negative symptoms of
schizophrenia
• Heightened : a/w with mania
• Labile : excessively changeable
• Irritable: in mania or depression
• Incongruous: out of tune with subjects being discussed

7. Thought
Thought form: refers to processing and organization of thoughts
• Normal : eg I am reading this book because I want to pass my exam
• Loose associations: moving rapidly from one topic to another with no apparent connestions
Eg: I am reading. Climate change where is the tiger?
• Flight of ideas: there is abnormal connection between statements based on a rhyme or pun
rather than meaning.
Eg : I read this book because the hotel has a cook Alister cook is my favourite batsman
• Circumstantial thoughts: lots of unnecessary details to come to a point
• Tangential thoughts: digression from main conversation topic
• Thought blocking: sudden cessation of thoughts

8. Thought content
• Delusions
• Obsessions : repeated intrusive thoughts, images or impulses
• Compulsions
• Suicidal thoughts, plans and intent
• Homicidal/ violent thoughts
Thought possession
• Thought insertion
• Thought withdrawal
• Thought broadcasting

9. Perception
• Hallucinations:
• Pseudohallucinations : patient is aware that the hallucination is not
real
• Illusions
• Depersonalization: feeling detached, unreal, watching oneself from
outside.
• Derealization : a sense that the world around them is not a true
reality

10. Cognition
• Memory : immediate, recent and remote
• Orientation
• Attention
• Intelligence
• Judgement
Insight
Patients understanding of their condition, its cause and need for treatment.
Summary