Comprehensive Guide to Conducting a Mental Status Examination in Psychiatry

Comprehensive Guide to Conducting a Mental Status Examination in Psychiatry

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  MENTAL STATUS EXAMINATION •It is a standard part of any psychiatric interview • Much of the information is obtained in the course of the interview through informal observation • Although some aspects that need formal questioning. • The data obtained in the MSE will help in the process of making a diagnosis and treatment plan as well as help provide a baseline for future reference Mental Status Exam Sections 1. Appearance 2. Behavior 3. Mood 4. Affect 5. Speech 6. Thought Process 7. Thought Content 8. Cognition 9. Judgment 10. Insight Where interview for MSE can be done? 1. Hospital room 2. Waiting room 3. Out- patient clinic office 4. Emergency Room Etc.
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  How to performMSE S/n MSE Section Subsection and how to assess Examples of Dx 1 Appearance General Appearance: appears older/younger than stated age Clothes: clean, dirty; mismatched clothes Anorexia Nervosa, Mania grooming/hygiene: body odor, perfume, clothes clean or soiled, clothing torn Major depression, substance use Hair: short/long, clean, dirty Trichotillomania Eye contact: Staring, avoiding eye contact 2 Behavior Movements: tapping foot, shifting in chair, hand wringing, chewing, nail biting Involuntary movements or mannerisms: aimless/purposeless, tics, blinking, lip smacking, hand tremor, echopraxia, asterixis OCD, Psychotropic medication side effects Calm: sitting quietly, slowed movements, catatonic Major depression Posture: relaxed, rigid, bizarre, relaxed, stiff, erect Attitude toward interviewer: appropriate, cooperative, compliant, defensive, aggressive, demanding, hostile, threatening, submissive, seductive, suspicious Manic, Psychotic 3 Mood Qn: How do you feel? Dysphoric: sadness Borderline Personality
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  Elevated: Feeling wellor happy (Euphoria) Euthymic: Normal, Irritable: easily annoyed and provoked to anger 4 Affect Appropriateness: Appropriate: Tearful when discussing something sad Inappropriate: laughing when discussing death Mania, Schizophrenia Congruence: is the affect congruent with stated mood? Congruent Vs, Incongruent 5 Speech Rate: slow, relaxed/conversational, rapid, pressured Quantity: talkative, verbose, increased, pressured, minimal, decreased, mute Tone: monotonous, flat, excited, expressive, emphatic Flow: spontaneous, hesitations, pauses, word finding, delayed response, Depression Volume: whispered, soft/quiet, low, loud/yelling Schizophrenia Pressured speech: increased in quantity, accelerated, and difficult-to-impossible to interrupt Mania 6 Thought Process a. Associations Circumstantial: over inclusive of details that are irrelevant but reach the point
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  Tangential: does notdirectly address the point or never reach the original point Flight-of-ideas: continuous flow of accelerated speech with abrupt changes from topic to topic Mania/hypomania Looseness of associations: connection between ideas is not obvious, unclear or nonsensical, Word salad, fragmentation, incoherence, Neologism* Schizophrenia b. Rate or Flow Racing thoughts: trying to do 2-3 things at once Mania/hypomania Perseveration: repetition of verbal responses despite changing questions Thought blocking: interruption of the train of thought before completion of the idea Delirium Derailment: speech stops suddenly and then restarts having shifted to another topic Schizophrenia 7 Thought Content Suicidal ideation: Any hx of attempting suicide Homicidal ideation: thinks about killing or hurting another Delusions: A false belief based on incorrect inference about external reality that is firmly held despite clear contradictory evidence/logical reasoning Delusional disorder, Paranoid Personality,
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  Persecutory/paranoid: Belief thatone’s is going to be harmed Grandiose: a delusion of inflated worth, power, knowledge, identity, or special relationship Jealousy: a delusion that one's sexual partner is unfaithful Somatic: involves bodily functions or sensations tactile, Erotomanic: another person, usually of higher status, is in love him/her Bizarre: a delusion that involves a phenomenon that the person's culture would regard as physically impossible. Example Thought withdrawal, thought insertion, Thought broadcasting, Delusion of control** Schizotypal Personality Hallucinations Auditory – false hearing perceptions Visual: false visual perceptions Tactile: false perceptions of touch Ex. Formication* Olfactory: false perceptions of smell Gustatory: false perceptions of taste Cocaine intoxication Schizophrenia, Schizophreniform disorder, Schizoaffective disorder, Brief Psychotic disorder, Mood disorder with psychosis, Dementia, Delirium
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  Illusions: a misperceptionor misinterpretation of a real stimuli. Ex. Seeing stick as snake Obsessions: persistent ideas, thoughts, or images that are experienced as intrusive and inappropriate and cause marked anxiety and distress. Ex contamination Compulsions: repetitive behaviors (hand washing) or mental acts (praying, counting) that the individual feels driven to perform in response to an obsession OCD Derealization: External world feel unreal or distorted Depersonalization: feeling like one is in a dream, feeling detached from your own body Post-Traumatic Stress Disorder 8 Cognition Orientation to: Time, People, Place and situation Substance Intoxication Level of consciousness: stupor, coma. Sedated or drowsiness Concentration & Attention: Ask him to count number in reverse order Major Depression Manic/Hypomanic Memory Recent memory: recall recent events from past few months Remote memory: can patient recall childhood data?
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  Abstract thinking: canpatient interpret proverbs? Mpe Methali afafanue General Knowledge: Ask Qn depending on level of education 9 Judgment Poor Vs Good: Give him a scenario and ask what he will do 10 Insight To what degree does the patient understand that they are ill? Good/intact, fair/partial, or poor/impaired Prepared by: Sir Jofrey Mtewele Njombe Institute of Health and Allied Sciences mtewele94@gmail.com 0768316304