Glossary of Common MSE Terms

A vocabulary flashcard set covering standard terminology and clinical manifestations across all 10 domains of the Mental Status Examination (MSE).

appears older / younger than stated age

Apparent age discrepant with chronological age. Seen in: chronic illness, substance use, severe depression.

bizarre attire

Dress that is odd or fantastic in a way that suggests disordered thinking. Seen in: schizophrenia, mania.

bruxism

Grinding of the teeth, often during sleep. Seen in: anxiety, stimulant use.

cachectic

Visibly wasted, severely underweight. Seen in: eating disorders, severe depression, chronic medical illness.

disheveled / unkempt

Clothing rumpled, dirty, or mismatched; hair uncombed; general neglect of self-care. Seen in: depression, schizophrenia, mania, substance use, neurocognitive disorders.

guarded / defensive posture

Body held closed, turned away, or braced. Seen in: paranoid states, anxiety.

hyperhidrosis

Excessive sweating. Seen in: anxiety, alcohol and sedative withdrawal, some medications.

inappropriately dressed

Attire not suited to the setting, weather, or social context (e.g., heavy winter layers in tropical heat). Seen in: mania, schizophrenia, neurocognitive disorders.

malodorous

Noticeable body odor or odor of urine, alcohol, or smoke. Seen in: self-neglect, severe depression, schizophrenia, substance use disorders.

masked facies

A fixed, expressionless face with reduced spontaneous movement, which can be mistaken for flat affect. Also called: hypomimia. Seen in: parkinsonism, antipsychotic adverse effects.

meticulous / fastidious

Grooming excessively precise or over-attended. Seen in: obsessive-compulsive traits, mania.

miosis

Constriction of the pupils. The counterpart of mydriasis, and just as informative. Seen in: opioid intoxication, some medications.

mydriasis

Dilation of the pupils. Seen in: stimulant intoxication, opioid withdrawal, some medications.

sialorrhea

Excessive salivation or drooling, often noticed first as a damp pillow or collar. Seen in: clozapine and other antipsychotic adverse effects.

well-groomed

Hair, nails, clothing clean and cared for; grooming consistent with the person's usual standard and setting.

aggression

Forceful, goal-directed verbal or physical action; the motor counterpart of rage, anger, or hostility. Seen in: mania, psychosis, impulse-control disorders, neurologic damage.

akathisia

A subjective feeling of muscular tension with an irresistible need to keep moving, usually the legs. Easily mistaken for anxiety or agitation. Seen in: antipsychotic adverse effects.

akinesia

Absence of physical movement, or a profound lack of spontaneous motion. Seen in: catatonic schizophrenia, antipsychotic adverse effects.

automatic obedience

Carrying out every instruction without question, in an automatic way. Also called: command automatism. Seen in: catatonia.

automatism

Activity carried out without conscious knowledge of doing it. Seen in: seizure disorders, dissociative states.

bradykinesia

Slowness of movement, sometimes with muscular rigidity. Seen in: parkinsonism, antipsychotic adverse effects.

catalepsy

The person holds whatever body position they are placed in, without resistance and without adjusting. Seen in: severe catatonia.

catatonic excitement

Agitated, purposeless motor activity uninfluenced by anything happening around the person. Seen in: catatonia.

catatonic stupor

Markedly slowed motor activity, often to the point of immobility. Awareness of the surroundings is ordinarily preserved despite the apparent unresponsiveness, and patients often recall the episode afterward. Seen in: catatonia.

cooperative

Engages with the interview, answers willingly.

disinhibition / disinhibited

Loss of the usual social restraint on behavior: overfamiliarity, intrusiveness, sexual forwardness. Seen in: mania, frontal lobe damage, intoxication.

dystonia

Slow, sustained involuntary contractions of muscle, often of the neck, jaw, or eyes. Seen in: antipsychotic adverse effects.

echopraxia

Pathological imitation of another person's movements. Seen in: catatonia, neurologic conditions.

floccillation

Aimless plucking or picking, characteristically at the bedclothes or at one's own clothing. Also called: carphologia. Seen in: delirium, neurocognitive disorders.

guarded (behavior)

Withholding, cautious, gives minimal information; may watch the examiner closely. Seen in: paranoid states, involuntary admission.

hypervigilance

Excessive attention to and watchfulness of the surroundings, with heightened startle. Seen in: paranoid states, PTSD, anxiety.

mannerism

An ingrained, habitual involuntary movement embedded within otherwise normal, goal-directed action.

muscle rigidity

Sustained stiffness with resistance to passive movement. When the resistance releases in small steps it is described as cogwheel rigidity, a sign routinely checked for in people on antipsychotics. Seen in: parkinsonism, antipsychotic adverse effects, neuroleptic malignant syndrome.

negativism

Motiveless resistance to all instructions or attempts to be moved; doing the opposite of what is asked. Seen in: catatonia.

posturing

Voluntary assumption of an inappropriate or bizarre posture, held for long periods. Seen in: catatonia.

psychomotor agitation

Excessive motor activity driven by inner tension and generally unproductive: pacing, wringing the hands, an inability to sit still. Seen in: mania, agitated depression, delirium.

psychomotor retardation

Global slowing of movement and reaction; common in severe depression and in some neurologic conditions. Also called: psychomotor slowing. Seen in: severe depression, catatonia.

responding to internal stimuli

Behavior suggesting the person is attending to perceptions the examiner cannot detect. Seen in: psychotic disorders.

ritual

A repeated, formalized activity performed to relieve anxiety, as in the compulsive rituals of OCD. Seen in: obsessive-compulsive disorder.

stereotypy

A repetitive, fixed pattern of movement or speech that serves no purpose. Seen in: catatonic schizophrenia, autism.

tardive dyskinesia

Involuntary repetitive movements, characteristically lip-smacking, chewing, and tongue protrusion; associated with long-term antipsychotic use. Seen in: long-term antipsychotic use.

tic

An involuntary, sudden, recurrent motor movement or vocalization. Seen in: tic disorders, stress.

tremor

A rhythmic, involuntary oscillating movement. Specify whether it appears at rest, on holding a posture, or on reaching. Seen in: anxiety, lithium and antipsychotic effects, parkinsonism.

waxy flexibility

The person's limbs can be moved into a position by the examiner and are then held there, like bending a wax candle. Also called: cerea flexibilitas. Seen in: catatonic schizophrenia.

aphonia

Loss of voice, so that speech is whispered or absent. Seen in: conversion disorder, laryngeal problems.

bradylalia

Abnormally slow speech. Seen in: depression, parkinsonism, neurocognitive disorders.

cluttering

Speech that is abnormally rapid and erratic in rhythm, so that it becomes hard to follow. Unlike stuttering, the person is usually unaware of it. Seen in: fluency disorders.

coprolalia

Involuntary use of obscene or vulgar language. Seen in: Tourette syndrome, some cases of schizophrenia.

dysarthria

Difficulty articulating words due to motor impairment; speech is slurred or poorly formed, although word choice and grammar are intact. Seen in: neurologic conditions, intoxication, medication effects.

dysphonia

Difficulty producing voice, so that speech sounds hoarse, strained, or breathy. Contrast with aphonia, where voice is lost altogether. Seen in: vocal cord problems, conversion disorder.

echolalia

Repeating another person's words or phrases back to them, often persistently. Seen in: catatonia, autism, neurocognitive disorders.

fluent / non-fluent speech

Whether speech flows normally in the language being used. Seen in: aphasia; also record the language of the interview.

hypophonic

Abnormally soft or low-volume speech. Seen in: depression, parkinsonism.

increased latency of response

A long pause between the question and the person's reply. Also called: increased thought latency. Seen in: depression, psychosis, neurocognitive disorders.

logorrhea

Copious, coherent, pressured, uncontrollable talking. Seen in: manic episodes.

monotone / dysprosodic

Loss of normal melodic variation; inability to convey emotion through intonation. Also called: dysprosody. Seen in: depression, parkinsonism, right-hemisphere lesions.

mutism

Absence of speech. It may be functional or organic, so a neurologic cause must be considered. Seen in: catatonia, severe depression, dissociative states; stroke and other neurologic conditions.

paraphasic error / paraphasia

Substitution of an incorrect word or sound for the intended one. Also called: paraphasia. Seen in: aphasia, schizophrenia.

poverty of speech

A marked reduction in the amount of speech; replies are brief, unelaborated, and offer no additional information unprompted. Also called: laconic speech, alogia. Contrast with: poverty of content of speech.

pressured speech

Speech that is increased in amount, rapid, loud, and difficult to interrupt. Seen in: mania, agitated states.

stuttering

Frequent repetition or prolongation of sounds or syllables, disrupting the flow of speech.

verbigeration

Meaningless, stereotyped repetition of specific words or phrases. Seen in: schizophrenia.

abulia

Reduced drive to act and to think, with indifference to the consequences of not acting. Often recorded in current practice as avolition, and easily mistaken for laziness or non-cooperation. Seen in: schizophrenia, depression, neurologic conditions.

affect

The observable, outward expression of emotion, as read by the examiner from face, voice, and manner.

appropriate affect

Emotional expression that is in harmony with the idea, thought, or speech it accompanies.

blunted affect

A severe reduction in the intensity of outward emotional expression. Seen in: schizophrenia.

congruent / incongruent affect

Affect matches, or fails to match, the stated mood and thought content. Seen in: mood-congruent and mood-incongruent psychotic features.

flat affect

Absence or near-absence of any sign of emotional expression; the face is immobile and the voice monotonous. Seen in: schizophrenia.

full range affect

Normal variety and modulation of emotional expression.

inappropriate affect

Emotional expression out of harmony with what is being said or with the situation, such as giggling while describing a frightening event. Seen in: schizophrenia.

labile affect

Rapid, abrupt shifts in emotional expression, unrelated to what is happening around the person. Also called: emotional lability. Seen in: mania, neurocognitive disorders.

restricted affect

A clear reduction in the intensity and variety of emotional expression, but less severe than blunted affect. Also called: constricted affect. Seen in: depression, schizophrenia.

alexithymia

Inability to identify one's own feelings or to put them into words. Seen in: somatic symptom disorders, substance use disorders.

ambivalence

Holding two opposing feelings or impulses toward the same person or thing at the same time. Seen in: schizophrenia, obsessional states.

anhedonia

Loss of interest in, and withdrawal from, activities that used to be pleasurable. Seen in: depression, schizophrenia.

anxiety

A feeling of apprehension caused by anticipating danger, which may be internal and unrecognized rather than external. Seen in: anxiety disorders.

free-floating anxiety

Pervasive, unfocused fear that is not attached to any particular idea or situation. Seen in: generalized anxiety disorder.

apathy

A dulled emotional tone with detachment and indifference. Seen in: depression, schizophrenia, neurocognitive disorders.

depression

A mood state of sadness, loneliness, and hopelessness, typically with reduced activity, pessimism, and self-reproach. Seen in: depressive disorders.

elation

Mood of joy, triumph, and intense self-satisfaction or optimism. In mania it is not grounded in the person's actual circumstances. Seen in: mania.

euphoria

Intense elation with a strong sense of wellbeing, out of proportion to the situation. Seen in: mania, intoxication.

fear

An unpleasant emotional state, with bodily changes, in response to a realistic and recognized external threat. Contrast with anxiety, where the danger is often internal and unrecognized.

grandiosity

An inflated sense of one's own importance, power, or identity. Seen in: mania, grandiose delusional disorder.

grief

Sadness appropriate to a real loss; normally self-limited.

guilt

An emotion arising from having done something felt to be wrong. Delusional guilt out of proportion to any act is a psychotic feature. Seen in: depression with psychotic features.

la belle indifférence

An inappropriately calm, unconcerned attitude toward a disabling symptom. Seen in: conversion disorder.

melancholia

A severe depressive state. In current usage it names a specifier, depression with melancholic features, marked by profound anhedonia, early morning waking, and worse mood in the morning. Seen in: severe depressive disorders.

mood

The pervasive, sustained feeling tone experienced internally, which in the extreme colors the person's whole view of the world.

dysphoria

An unpleasant mood state of dissatisfaction, discomfort, and restlessness. Seen in: depressive and anxiety disorders.

elevated mood

A mood more cheerful than usual, with an air of confidence and enjoyment. Not necessarily pathological on its own.

euthymia

Mood within the normal range: neither depressed nor elevated.

expansive mood

Feelings expressed without restraint, usually with an overestimation of their own importance. Seen in: mania, grandiose delusional disorder.

irritable mood

A state of being easily annoyed and quickly provoked to anger. Seen in: mania, depression, anxiety, substance withdrawal.

labile mood

Mood that swings abruptly from one to another. Also called: mood swings. Seen in: bipolar disorder, personality disorders.

panic

An acute, intense attack of anxiety with personality disorganization and a sense of overwhelming dread. Seen in: panic disorder.

shame

A painful emotion arising from failing to live up to one's own expectations, usually bound up with how the person imagines others see them. Contrast with guilt, which attaches to a specific act.

abstract thinking

The ability to grasp the essentials of a whole, break it into parts, recognize shared properties, and think symbolically.

blocking (thought)

An abrupt interruption in the train of thought; the person stops mid-sentence and often cannot recall what was being said. Seen in: schizophrenia, severe anxiety.

circumstantiality

Over-inclusion of trivial or irrelevant detail that delays getting to the point, but the person does eventually answer the question. Seen in: obsessional states, neurocognitive disorders, schizophrenia.

clang association

Ideas linked by the sound of the words rather than their meaning, through rhyme or repetition of sounds. Seen in: mania, schizophrenia.