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Mental Status Examination (MSE)

Summary: The Mental Status Examination (MSE) is the (psychiatric) equivalent of the ‘physical exam’ in the assessment of a patient with mental health needs.
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What is the MSE?

The Mental Status Examination (MSE) is the psychiatric equivalent of the ‘physical exam’ in the Psychiatric Assessment.

 

The MSE are your observations from the patient encounter. Observations from the MSE are started from the moment you meet the patient and throughout the interview until the patient leaves.

Main Elements of the MSE (Mnemonic “ASEPTIC”):

  1. A)PPEARANCE AND BEHAVIOUR

Apparent Age

Stated age? Younger/older?

Dress

Casually? Formally? Poorly?

Grooming

Hygiene

Good or poor?

Good or poor?

Gait

Brisk, slow, intoxicated, ataxic, rigid, shuffling, staggering, uncoordinated?

Psychomotor activity

Normal, reduced, excessive?

Abnormal movements

Grimaces, tics, tardive dyskinias, foot tapping, ritualistic behaviour?

Eye contact

Good or poor?

Attitude

Cooperative, belligerent, oppositional, submissive, etc.?

 

  1. S)PEECH

Rate

Rapid, pressured, slowed?

Rhythm

Hesitant, rambling, halting, stuttering, jerky, long pauses?

Tone

 

Volume

Loud, soft, whispered, yelling, inaudible?

Accent

Clarity

Quantity

Any accent?

Pronunciation, articulation

Responds only to questions, offers information, repetitive, verbose?

  1. E)MOTION (MOOD AND AFFECT)

Mood: Patient’s subjective emotional state

What the patient says their mood is, e.g. “Good”, “Depressed”, “Down”, etc.

Clinician: “How is your mood?”

 

Affect: objective emotional state

 

Congruence to mood

Appropriateness

Congruent mood means that the mood is appropriate to the situation, e.g. patient’s father has passed away and the patient is sad

Incongruent mood means that the mood is inappropriate to the situation, e.g. patient’s father has passed away and the patient is laughing hysterically

Quality

Euthymic, elevated, depressed?

Range

Broad/ restricted?

Stability

Fixed / labile?

  1. P)ERCEPTION

Hallucinations

Auditory: Are you hearing any things that others can’t hear?

Visual: Are you seeing any things that others can’t hear?

Olfactory: Any unusual smells that you notice, e.g. burning smells? (classically seen in temporal lobe epilepsy)

Illusions

Distortions of real images or sensations

Depersonalization

Patient feels that they are not real

Clinician: “Do you ever feel that you are not real?”

Derealisation

Patient feels that the world is not real

Clinician: “Do you ever feel that things around you aren’t real?”

  1. T)HOUGHT CONTENT AND PROCESS

Thought Process

How well are the patient’s thoughts connected? Are the patient’s thoughts coherent, logical, relevant?

Does the patient tend to go off topic? (e.g. circumstantial)

Does the patient completely go from one thing to the next? (e.g. tangential, as often seen in psychoses or mania) 

Flight of ideas

Loosening of associations

Thought blocking

Word salad

Echolalia, Neologisms

Thought Content

 

Delusions

Delusions: (to friends and family): “Does your loved one have any strong or unusual beliefs?”

Delusions: (to the patient) “Everyone has beliefs. Some people believe in God. Some people believe in UFOs. Some people believe that the government is spying on us. Any strong beliefs that you have?”

Paranoid delusions: “Do you feel that people are watching you, following you or trying to hurt you?”

Delusions of grandeur: “Do you have any special powers or skills?”

Suicidal ideation

Suicidal: “With all the stress that you’ve been under, has it ever gotten to the point that you feel life isn’t worth living?” If positive, then ask: “What’s the strongest those thoughts have gotten?” “At this moment, do you have any thoughts of ending your life?”

Homicidal ideation

Homicidal ideation: “Any thoughts of hurting other people?”

 

  1. I)NSIGHT AND JUDGEMENT

Insight

If the patient does indeed have an illness, does the patient understand this?

The stages of change in motivational enhancement can be useful

Good insight: Patient understands they are ill and need treatment

Partial insight may indicate that the patient acknowledges a problem, but is not willing to seek appropriate help or treatment  

Poor insight means that the patient does not see that they are ill nor does the patient need any help or treatment

Judgment

Is patient able to use facts and make reasonable decisions? Judgment may be good, fair, impaired

 

  1. C)OGNITION

Level of consciousness

Alert, confused, lethargic, stuporous

 

Orientation in 3 spheres

 

Name: What is your name?

Place: Where are you right now? Time: What year, month, day is it?

Attention/Concentration

How well does the patient seem to be able to focus? (Good, poor)

Memory

How well can the patient remember?

Short-term: Can the patient recall recent things that have happened?

Long-term: Can the patient recall distant events?

Intelligence (globally and intellectual functions)

Based on your observations and patient’s use of speech, does the patient’s overall intelligence and cognition appear to be 1) below average, 2) average, or 3) above average?

About this Document

Written by Talia Abecassis (Medical Student) and Dr. Dhiraj Aggarwal (psychiatrist), along with members of the eMentalHealth.ca Primary Care Team, which includes Dr’s M. St-Jean (family physician), E. Wooltorton (family physician), F. Motamedi (family physician), M. Cheng (psychiatrist).

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from a health professional. Always contact a qualified health professional for further information in your specific situation or circumstance.

Creative Commons License

You are free to copy and distribute this material in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/ 

Date Posted: Aug 15, 2015
Date of Last Revision: Sep 4, 2015

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