Mental State Examination

Overview

The mental status examination (or mental state examination in the UK and Australia) abbreviated MSE, is an important part of the clinical assessment process in psychiatric practice.

 

It is a structured way of observing and describing a patient's current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgement.There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Author(s): Dr. Celice McDermottView Details of Author
Year: 2009
Keywords: mental state examination, psychiatry, psychopathology
Licensing Condition:

cc-by-nc-sa© 2009, KNUST

Unless otherwise noted, the content of this programme is licensed under the terms of a Creative Commons Attribution-NonCommercial-ShareAlike3.0 Unported License.

Disclaimer

 

Any medical information in this material is intended to inform and to educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. You should speak to your physician or make an appointment to be seen if you have questions or concerns about this information or your medical condition.



Note: No real patients were filmed in the production of the programme. The "patients" who appear here are actually talented student-actors who have learned to portray common psychiatric disorders. Their identities are listed in the "Credits" panel below.

 

Introduction

 

Clinical Observation and Psychiatric Diagnosis (Video and Notes)

This module will help you test your skills in making clinical observations and phsychiatiric diagnoses. (version 1.0)

Watch Introductory video 

Introductory video

The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning.

 

The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalised psychological tests.

 

Objectives

 

To be able to observe and describe a patient's state of mind.

To be able to make an accurate diagnosis and formulation for coherent treatment planning.

 

Lesson Content

 

Comments on the Mental State Examination:

The standard format for documenting the Mental State Examination varies a little, but as long as all areas are covered the exact order is not crucial. Standard texts such as the Shorter Oxford Textbook of Psychiatry and the Oxford Handbook of Psychiatry should be consulted for further information on each section and descriptions of psychopathology. The reader is referred to standardised assessments such as the Present State Examination (Wing et al, 1974) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN, World Health Organisation, 1992) as well as the above texts for advice on how to elicit psychopathology.

 

I suggest the following format for documenting the Mental State Examination:

Appearance and Behaviour

Speech

Mood

- Subjective

- Objective

Risk

Thoughts

- Form

- Content

- Beliefs

- Overvalued or Delusional

Perceptions

Cognition

Insight

 

The format suggested here for documentation is fairly standard but has not been followed chronologically during the interviews that you will view in the videos. This is normal as the Mental State Examination must flow as naturally as possible from one section to the next. You will note that the doctor begins with subjective questions about mood. This is because "Appearance," "Behaviour" and "Speech" depend on the doctor's observations alone. You will also note the careful enquiry necessary in other areas, and the tactful methods used by the doctor to make such enquiries.

 

Watch the Simulated Patient Videos

Simulated Patient No. 1

Simulated Patient No. 1

When the interview is finished, and you have completed your notes, click on the link below to view the diagnosis and the simulated patient script:

Script for patient 1

 

Simulated Patient No. 2

Simulated Patient No. 2

When the interview is finished, and you have completed your notes, click on the link below to view the diagnosis and the simulated patient script:

Script for patient 2

 

Simulated Patient No. 3

Simulated Patient No. 3

When the interview is finished, and you have completed your notes, click on the link below to view the diagnosis and the simulated patient script:

Script for patient 3

 

 

Credits

 
celice

Author/Content Expert:

Dr. Celice McDermott, BSc MB ChB MRCPsych

Visiting Lecturer, Department of Behavioral Sciences, School of Medical Sciences, KNUST, Kumasi, Ghana.

Psychiatrist, Cornwall Partnership Trust

Honorary Clinical Fellow, Peninsula College of Medicine and Dentistry, Cornwall, England

dr

 

Physician Interviewer:

Dr Nana Osem Osei Tutu,

Resident in Psychiatry, Komfo Anokye Teaching Hospital, Kumasi Ghana

pt1

Simulated Patient #1:

Akua Nketiah Adjapong

4th year medical student, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

pt2

Simulated Patient #2:

Kojo Twum Nimako

4th year medical student, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

pt3

Simulated Patient #3:

Oppong Victor Barnor

4th year medical student, School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

Video Production and Web Design:

umichblock knust seal

Cary Engleberg, M.D.

Professor of Internal Medicine, Microbiology & Immunology,

University of Michigan Medical School, Ann Arbor, MI

Veronica Okyere

Artist & Media Specialist,

Komfo Anokye Teaching Hospital,

Kumasi, Ghana

 

Acknowledgments:

• The authors acknowledge the assistance of Prof. Fr. John Appiah-Poku for providing resources needed to produce this programme.

• Images from Gray's Anatomy, 1918, were modified to create the cover art on this site; they are in the public domain.

 

 

Acknowledgment

 

This programme was produced with support from the following:

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