[PSYCH LEC] GUIDE TO MSE

Mental State Examination (MSE)

Mental State Examination (MSE)

a structured way of observing and describing a patient’s current state of mind, under the domains of appearance, attitude, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight and judgment

to obtain a comprehensive cross-sectional description of the patient’s mental state that allows the clinician to make an accurate diagnosis and formulation.

what is the purpose of MSE?

apperance

may provide some clues as to their lifestyle, current mental state and ability to care for themselves.

distinguishing features

may include scars (e.g. self-harm), tattoos, signs of IV drug use

weight

note if they significantly appear underweight or overweight

stigmata of disease

a mental or physical mark that is characteristic of a defect or disease

personal hygiene

can provide insight into the patient’s current ability to care for themselves

clothing

note if this is appropriate for the weather/circumstances and if the clothes have been put on correctly

objects

look around to see if the patietn has brought any objects with them and note what they are

behavior

may provide insights into their current mental state.

engagement and rapport

note if they appear distracted or if they appear to be engaging with hallucinations (e.g. replying to auditory hallucinations in schizophrenia)

eye contact

note if this appears reduced or excessive

facial expression

note if it looks relaxed, angry, disengaged, etc.

body language

• observe if it appears threatening (e.g. standing up close to you) or withdrawn (e.g. curled up or hands covering their face)

• note any evidence of exaggerated gesticulation (gesture) or unusual mannerisms)

psychomotor retardation

associated with paucity of movement and delayed responses to questions

restlessness

patient may continuously fidget, pace, and refuse to sit still

tremor

rhythmic, oscillatory movements affecting different parts of the body.

tics

sudden, repetitive, non-rhythmic moveents or sounds which are typically brief and intermittent (e.g. Tourette’s syndrome)

akathisias

neuropsychiatric syndrome and movement disorder that makes it difficult to sit or remain still due to an inner restlessness

list of abnormal movements

tremor, tics, lip-smacking, akathisias, rocking

pressure of speech

A tendency to speak rapidly, motivated by an urgency that may not be apparent to the listener (often a manifestation of thought abnormalities such as flight of ideas)

Slow speech

May occur dud to psychomotor retardation (associated with major depression)

Minimal or absent speech

quantity of speech associated with depression

Excessive speech

Quantity of speech associated with mania and schizophrenia

Monotonous speech

Tone of speech associated with depression, schizophrenia, autism

Tremulous speech

Tone of speech associated with anxiety

Stammering/stuttering

Rhythm of speech associated with anxiety

Slurred speech

Rhythm of speech associated with major depression due to psychomotor retardation

Affect

represents an immediately expressed and observed emotion; it is what you observe

Mood

represents a patient’s predominant subjective internal state at any one time as described by them; it is what the patient tells you

facial expressions and overall demeanor

assess the affect of the patient by observing their?

Apparent emotion

This is reflected by the patient’s affect

Range and mobility of the affect

refer to the variability observed in the patient’s affect during the assessment.

fixed affect

patient’s affect remains the same throughout the interview, regardless of the topic.

restricted affect

patient’s affect changes slightly throughout the interview, but doesn’t demonstrate the normal range of emotional expression that would be expected.

labile affect

characterized by exaggerated changes in emotion which may or may not relate to external triggers. Patients typically feel like they have no control over their emotions.

heightened

intensity of affect associated with mania and some personality disorders

blunted or flat

type of affect associated with schizophrenia, depression and post-traumatic stress disorder.

congruency

patient’s affect appears in keeping with the content of their thoughts

incongruent affect

A patient sharing distressing thoughts whilst demonstrating a flat affect or laughing; associaed with schizophrenia

thought form

Refers to the processing and organisation of thoughts.

speed of thoughts

Patient’s may demonstrate abnormally fast (i.e. racing) or abnormally slow thought processing

steady pace and in a logical order

In healthy individuals, thoughts flow at a

distorted

in several mental health conditions, the flow and coherence of thoughts can become ____

loose associations

moving rapidly from one topic to another with no apparent connection between the topics.

Circumstantial thoughts

these are thoughts that include lots of irrelevant and unnecessary details.

Tangential thoughts

digressions from the main conversation subject, introducing thoughts that seem unrelated, oblique, and irrelevant.

Flight of ideas

• there is an accelerated tempo of speech often referred to as ‘pressure of speech’.

• In addition to the increased rate of delivery, the language employed is characterised by a wealth of associations, many of which seem to be evoked by more or less accidental connections.

thought blocking

sudden cessation of thought, typically mid-sentence, with the patient being unable to recover what was previously said.

perseveration

refers to the repetition of a particular response (such as a word, phrase or gesture) despite the absence/removal of the stimulus

neologisms

words a patient has made-up which are unintelligible to another person.

delusions

a firm, fixed belief based on inadequate grounds, not amenable to a rational argument or evidence to the contrary and not in sync with region and cultural norms.

persecutory delusions

the patient erroneously believes another individual or group is trying to harm them or ideas of reference, in which the individual incorrectly believes specific events relate to them.

obsessions

thoughts, images or impulses that occur repeatedly and feel out of the person’s control. The patient is aware these obsessions are irrational, but the thoughts continue to enter their head.

compulsions

repetitive behaviors that the patient feels compelled to perform despite recognising the irrationality of the behaviour.

overvalued ideas

a solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the sufferer’s life (e.g. the perception of being overweight in a patient with anorexia nervosa)

thought insertion

a belief that thoughts can be inserted into the patient’s mind.

thought withdrawal

a belief that thoughts can be removed from the patient’s mind.

thought broadcasting

a belief that others can hear the patient’s thoughts.

perception

involves the organisation, identification and interpretation of sensory information to understand the world around us.

hallucinations

a sensory perception without any external stimulation of the relevant sense that the patient believes is real (e.g. the patient hears voices but no sound is present).

pseudo-hallucinations

the same as a hallucination but the patient is aware that it is not real.

illusions

the misinterpretation of an external stimulus (e.g. mistaking a shadow for a person).

depersonalisation

the patient feels that they are no longer their ‘true’ self and are someone different or strange.

derealisation

a sense that the world around them is not a true reality.

cognition

refers to “the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses”.

insight

refers to the ability of a patient to understand that they have a mental health problem and that what they’re experiencing is abnormal.

judgment

refers to the ability to make considered decisions or come to a sensible conclusion when presented with information.