Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Mental State Examination (MSE)

26,887 views

Published on

  • Too busy to workout? NO PROBLEM! ONE MINUTE WEIGHT LOSS, CLICK HERE ♥♥♥ http://ishbv.com/1minweight/pdf
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Mental State Examination (MSE)

  1. 1. Mental State Examination (MSE) The aim of the MSE is to elicit the patient’s CURRENT psychopathology – no historical details. It collects both Objective and Subjective Information:  Objective – what you observe about the patient DURING the interview o Appearance, Behaviour, Speech, Cognition and Mood  Subjective – the patient’s CURRENT psychological symptoms o Mood, Thoughts, Perception and Insight Appearance:  Demographics o Gender / Apparent Age / Racial Origin  Physique, Hair and Make-up  Clothing Style o E.g. Manic patients – bright / oddly assorted clothes  Cleanliness o Look for signs of self-neglect e.g. Dirty, unkempt, stained or crumpled clothing  Weight Loss o Consider bio-psycho-social causes, for example: Cancer vs. Anorexia vs. Financial Difficulties Behaviour:  Rapport o Attitude: Relaxed/ Co-operative/ Suspicious/ Guarded/ Pre-occupied/ Over Familiar o Eye Contact – Avoidant / Appropriate / Intense  Psychomotor Activity: Agitation vs. Retardation  Movement disorders o Tics = Irregular repeated movements, in a group of muscles e.g. Sideways head o Choreiform Movements = Co-ordinated, brief, involuntary movements e.g. Grimacing o Dystonia = Painful muscle spasm which may lead to contortions  Signs of Impending Violence o Restlessness/ Sweating / Clenched Fists / Pointing Fingers / Raised Voice o Intruding onto the interviewer’s Personal Space Speech:  Physical characteristics only – content comes under ‘Thoughts’  Quantity: o Pressure of Speech: Rapid, ‘can’t get a word in’, lengthy speech – typical of Mania o Poverty of Speech: Minimal Responses e.g. Yes / No – typical of Depression  Quality: o Volume: Loud (Mania) or Quiet (Depressive) o Tone and Fluency o Spontaneity: Prompt Response (Mania) and Slow response (Intoxicated / Depressed) Mood (or Affect)  Change in mood = Commonest symptom of a psychiatric disorder  Should be documented both Subjectively and Objectively: o Subjective Mood  Ask the patient ‘How are you feeling in yourself?’  Document their response without alteration – record any other details in Hx o Objective Mood  Nature of mood during examination, if no mood is noted = ‘Euthymic’
  2. 2.  Constancy of mood – does mood change during the interview?  Congruity of Mood – is the patient’s mood appropriate to context? Thoughts  Deduce what the patient is thinking using: Verbal, Written and Behavioural clues  Abnormalities can occur in 3 different aspects of thought: Stream, Form and Content… Aspect of Thought Description Abnormalities Stream The amount and speed of thoughts  Pressure of thought – unusually rapid, abundant /varied thoughts  Poverty of thought – unusually slow, few or unvaried thoughts  Blocking of thoughts – abrupt and complete emptying of the mind Form The way in which thoughts are linked together  Flight of ideas – one train of thought is not completed before another begins, ideas may be linked by: o Rhyme (aka: ‘Clang Associations’) o Puns – words which sound similar e.g. Mail and Male o Distraction – by something in room / surroundings  Loosening Associations – Complete lack of logical connections in a sequence of thoughts, not even by above links. Also known as: “Knights move” thinking  Preservation – persistent inappropriate repetition of the same sequence of thought e.g. same answer for every varied question. Content What ideas the thoughts contain  Preoccupations – recurring thoughts that can be put out of the mind at will, but result in distress and/or disability.  Morbid thoughts – Hopelessness, Suicidality and Suicidal Intention. Don’t be afraid to ask about self-harm or suicide.  Delusions – a fixed false belief, unaffected by rational argument and unsupported by cultural or educational background. o Ask for explanations regarding unusual statements / events  Obsessions –recurring and persistent thoughts. The patient recognises them as senseless products of their own mind, but cannot get rid of them.  Compulsions – actual actions secondary to obsessions Perceptions  Perception = becoming aware of what is presented to the body through the 5 senses. There are four perception abnormalities: 1. Changes in Perception Intensity e.g. Colours brighter to a patient with mania 2. Changes in Perception Quality e.g. Flowers smelling acrid to a patient with Schizophrenia 3. Illusions = A misperception of a real stimulus  More likely to occur in the presence of: Sensory Impairments / Inattention / Impaired Consciousness / Emotional Arousal.  Ask: “Have you seen anything unusual?” 4. Hallucinations = A perception experienced in the absence of a real stimulus. Ask sensitively: “When their nerves are upset, some people have unusual experiences…” Cognition: There are 6 aspects to assess when assessing higher cortical function: 1. Consciousness = an awareness of self and environment. States include:  Clouding of Consciousness – a state of drowsiness, with incomplete reaction to stimuli and impaired: attention; concentration; memory and thinking.  Stupor – State in which the patient is: mute, immobile and unresponsive. However they may appear conscious as eyes are open and follow objects  Confusion – Muddled thinking, can be: Acute (Delirium) OR Chronic (Dementia)
  3. 3. 2. Orientation = Awareness of person, place and time – Who are you / where are you etc… 3. Attention = Ability to focus on the matter in hand – Serial Sevens (100-7 = 93 etc…) and Concentration = Ability to sustain focus – can also be assessed by Serial Sevens 4. Memory: Assess immediate, recent and long-term memory  Immediate = Digit Span Test, ask patient to repeat a series of digits straight after you  Recent = Remember 3 Random Objects or an Address, recall 5mins later  Long-Term = Recall personal events or well-known public events 5. Language: Assess the patient’s ability to: Name common objects; follow written and verbal instructions and write in sentences. 6. Visio-Spatial Functioning: Ask the patient to draw an old fashioned clock, showing 14:50 Insight  Insight = the extent to which the patient’s view of their illness is congruent to that of their healthcare professional. Usually assessed as: Good / Moderate / Poor.  Assessment of Insight is important in order to: Determine the likelihood of patient co-operation with treatment and aid efforts to change patient’s health beliefs to improve prognosis  Should consider whether the patient is: o Aware their thoughts / behaviours are abnormal and treatment is required o Accepting that the abnormalities are as a result of a Mental Health Illness and that subsequent professional recommendations should be followed. “The Difficult Patient”- Challenges in Assessment  Unresponsive Patients o To confirm whether the patient is mute, ensure you:  Are speaking the appropriate language / provide adequate response time / try a variety of topics / different forms of communication e.g. writing. o If still no response, record general appearance and whether eyes are open and if objects are followed, a full neurological examination may also be necessary. o Warning: Stuporous can suddenly become violent – ensure you are accompanied  Overactive Patients o Use a quiet, confident and concise approach to elicit the most important information  Confused Patients: o Orientate and reassure the patient, explaining the examination in the simplest terms o Test cognitive function early on, in the interview – so that a corroborative history can be sought where necessary. Summary:  MSE sub-titles differ between textbooks, but essentially cover the same thing.  MSE should generally include a contemporaneous assessment of: 1. Appearance 2. Behaviour 3. Speech 4. Mood 5. Thoughts 6. Perception 7. Cognition 8. Insight References:  Metal State Examination Sheet – Provided at Secondary Care, Hellesdon 02/10/2012  Geddes, J. Psychiatry: 4th Edition Oxford University Press; 2012  Semple, D. Oxford Handbook of Psychiatry: 2nd Edition. Oxford University Press; 2009

×