This document summarizes the components of a mental state examination (MSE), which is a structured way to observe and describe a patient's current mental condition. The MSE aims to gather a comprehensive description of the patient's mental state to aid in accurate diagnosis and treatment planning. It evaluates appearance and behavior, speech, mood and affect, thoughts, perceptions, cognitive functions, insight, and judgment. Specific abnormalities are described for each component to note signs of various mental health conditions.

1. MENTAL STATE
EXAMINATION
Dr. Imdadul Magfur
Department of Psychiatry
Sylhet MAG Osmani Medical College&Hospital

2. Mental State Examination:
It is a structured way of observing and describing a
patient’s current state of mind.
Purpose:
oTo gather comprehensive description of patient’s
mental state
oTo make an accurate diagnosis
oTo formulate a proper treatment plan

3. Components of MSE
 Appearance & behaviour
 Speech
 Mood & affect
 Thoughts
 Perceptions
 Cognitive function
 Insight
 Judgment

4. Appearance & behaviour
General appearance
Dress with neatness
Clothes clean & good, appropriate
Hair & nail cleanness
Concern about appearance

5. (contd.)
Facial appearance & expression
Appropriate or not
Look- attentive/ apathetic / indifferent
Expression- elation / fear / anger / sad / blank
Eye to eye contact- avoid gaze / excessive scannina
Vertical furrows, horizontal wrinkling of head, dropping
of angel of mouth , etc

6. Contd.
 Rapport
 Attitude- co operative / friendly / hostile / evasive
etc
 Social behaviour
 Motor behaviour – over activity / grimacing /
chewing or sucking / stereotypy etc
 Posture & movement – stooped /relaxed / sitting on
the edge of chair etc
 Oddity of behaviour

7. Mood & affect
Normal
Depressed
Anxious
Blunt
Incongruity
Lability
Elated
Depersonalisation & derealization

8. Speech
Rate & quantity
 speech present / absent
Pressure of speech (fast,spontaneous, increased in
amount)
Poverty of speech (slow,sparse &monotonous)
Relavent / irrelevant

9. (Contd.)
 Volume & tone-increased/decreased/appropriate
 Pitch- normal/ low/ high
 Oddity of speech - nelogism, problem finding &
articulating word ( dysarthria, dysphasia)

10. Thoughts
 Disturbance of stream of thought –
pressure/poverty/thought block
 Disorders of the form of thought – persevaration,
flight of ideas,loosening of association
 Possession of thought
a) thought insertion
b) thought withdrawal
c) thought broadcasting

11. (Contd.)
 Content of thought – any pre ocupations with
thought
 Delusion
Obsession
Phobia
Overvalued idea

12. Delusion
 A delusion is a belief that is firmly held on
inadequate grounds, that is not affected by rational
argument or evidence to the contrary, and that is not
a conventional belief that a person might be
expected to hold given their educational, cultural,
and religious background

13. Various types of delusion
 According to fixity
a) Complete b) partial
 According to onset
a) Primary b)secondary
 According to theme
persecutory / paranoid/ grandiose/ delusion of
reference/ bizarre/ nihilistic / delusion of control

14. (Contd.)
sexual or aoramorous / hypochondriacal/ jealous /
religious/ Thought insertion/ thought broadcasting/
thought withdrawal
Obsessions ( are recurrent persistent thoughts,
impulses or images that enter the mind despite
efforts to exclude them )

15. (Contd.)
Various forms of obsessions
 Obsessionsal thoughts
 Obsessional ruminations
 Obsessional doubts
 Obsessional impulses
 Obsessional phobias
 Obsessional slowness

16. (Contd.)
Overvalued ideas ( is comprehensible &
understandable idea which is pursued beyond
the bounds of reason)

17. Perception
 Normal
 Hallucination (a percept that is experienced in the
absence of an external stimulus to the corresponding
sense organ )
 Illusions (are misperceptions of external stimuli)

18. Various types of hallucination
 Acording to complexity
a)Elementary b)complex
 According to sensory modality
Auditory
Visual
Somatic
Olfactory and gustatory

19. (Contd.)
 Acoording to special features
Auditory -second person, third person
gedankenlautwerden, echo de la panse
visual - extracampine
 Autoscopic hallucinations
Reflex hallucinations
hypnagogic and hypnopompic

20. Cognition
 Consciousness- conscious / confused / clouding /
confused/somnolence/delirium/stupor/coma
 Orientation - time (year / season / date / day month)
-place ( town / city / hospital etc)
-identity ( e.g ; person )
 Attention & concentration – months of year in reverse
order, 7 minus from a given number etc

21. (contd.)
 Memory
a )Immediate – immediate repetition of 3
objects or a name & adress
b) Recent – what the have eaten or a well
known news item
c) Remote - events before presumed onset of
memory disorder

22.  Language (naming , repeat a sentence or phrase,
verbal fluency etc)
 Intelligence
Insight
Judgment

23. THANK YOU ALL