Mood affect Mental State Examination

Mental Status Examination

As with Capacity Assessment, the MSE is a core skill that needs to be mastered by all Mental Health clinicians. It is the basis for all clinical interventions and will aide in determining everything from how you talk & react with a client to what sort of activities might be appropriate at that time.

It is important to understand that the MSE is used to capture a “snapshot” of a persons presentation at the time it is done. In most cases it is essential to complete and MSE on every contact you have with a client.

Judgement about mental state should always consider the developmental level of the person and age-appropriateness of the noted behaviour(s).

A typical MSE includes consideration of the following domains:

Appearance

A person’s appearance can provide useful clues into their quality of self-care, lifestyle and daily living skills.

  • distinctive features
  • clothing
  • grooming
  • hygiene

Behaviour

As well as noting what a person is actually doing during the examination, attention should also be paid to behaviours typically described as non-verbal communication. These can reveal much about a person’s emotional state and attitude.

  • facial expression
  • body language and gestures
  • posture
  • eye contact
  • response to the assessment itself
  • rapport and social engagement
  • level of arousal (e.g. calm, agitated)
  • anxious or aggressive behaviour
  • psychomotor activity and movement (e.g. hyperactivity, hypoactivity)
  • unusual features (e.g. tremors, or slowed, repetitive, or involuntary movements)

Mood and affect

It can be useful to conceptualise the relationship between emotional affect and mood as being similar to that between the weather (affect) and the season (mood). Affect refers to immediate expressions of emotion, while mood refers to emotional experience over a more prolonged period of time.

Affect:

  • range (e.g. restricted, blunted, flat, expansive)
  • appropriateness (e.g. appropriate, inappropriate, incongruous)
  • stability (e.g. stable, labile)

Mood:

  • happiness (eg, ecstatic, elevated, lowered, depressed)
  • irritability (e.g. explosive, irritable, calm)
  • stability

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