Mental State Examination form

Mental state examination for

The Mental State Examination (MSE) is a systematic method for observing, examining and recording a person's emotions, thoughts and behaviour.

The MSE is a standard component of the psychiatric examination, and follows a set schema all mental health professionals are trained to use.

The MSE is used both in cross-sectional assessments and longitudinally to monitor mental state, and (particularly when performed by the same assessor over time) is a sensitive indicator of a person's mental health.

While the MSE may be worked seamlessly into the general interview as the experience of the mental health worker increases, all components of the MSE (listed below) should be considered at each assessment (Andrews, Erskine & Gee, 2004).

  • Appearance
  • Behaviour
  • Speech
  • Content of speech
  • Mood and affect
  • Thought
  • Perception
  • Cognition
  • Insight

These are discussed in more detail in the following sections.


Thought

  • Thought is not directly observable, it is inferred from observing speech and behaviour. The quantity of thought should be noted: poverty of thought may occur in depression, dementia or schizophrenia. The rate of thought is affected in a similar manner to the rate of speech for the most part: many people with mania have pressure of thought and some people with depression have bradyphrenia (slowed thought stream).
  • The form of thought may indicate specific problems. Several types of thought disorder, such as tangentiality, derailment and neologisms may indicate psychosis. Clanging or punning associations are often indicative of mania, and thought blocking and echolalia (automatic repetition of another's words) may indicate the presence of catatonia. Thought disorder may be so severe that no sense can be made of the person's conversation ('word salad').
  • The content of thought may include delusional thinking: a fixed false belief that is not normal for the person's background. The nature of the delusion and the degree of conviction with which it is held may be very important in determining risk.
  • Suicidal and homicidal ideas, and the presence and nature of any obsessions, are also considered in thought content.

Perception

  • Hallucinations (a perception in the absence of sensory stimulus) may affect any sense (auditory, tactile, olfactory, visual and gustatory).
  • The most common type of hallucination in mental illness is auditory.
  • It is particularly important to enquire about command hallucinations, where individuals hear and sometimes obey voices that command them to perform certain acts - especially if that may influence them to engage in behaviour that is dangerous to themselves or others.
  • Illusions are similar to hallucinations, but involve misperception of a real stimulus.
  • Depersonalisation and derealisation are odd experiences where the person feels as though either they themselves or the world around them are unreal. Both are often associated with anxiety.

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