MENTAL STATE EXAMINATION (MSE)
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Transcript of MENTAL STATE EXAMINATION (MSE)
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MENTAL STATE EXAMINATION (MSE)
*PURPOSE: • To reach a tentative diagnosis. • It is the diagnosis of general cerebral functions. • Designed to detect abnormal functions. • An experienced nurse can complete all the MSE.• Important information can be taken from first
sight (when entering the room, sitting or talking. Also, level of consciousness can be observed.
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1. GENERAL APPEARANCE:• Good indicator of pts. overall mental functioning.
It includes weight, height and general body built.A. Nutritional Status: • Poor nutrition can result from medical or
psychiatric disorders. • In anorexia nervosa pt. is emaciated but still
thinks she is fat.• Overweight can point to overeating as in
affective disorders with hyperphagia.
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B. Hygiene and dress: • Self care and cleanliness reflects pt.'s awareness and
activity level. • In depression: pt. loses interest in his appearance
and hygiene. • In mania: pt. dresses in colorful and flamboyant
manner. She may use too much makeup and mismatched dress.
• In schizophrenia: pt. may use strange items for dress e.g. antennas, bags to protect them from the control of space people.
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C. Eye contact: • People usually maintain eye contact when they
speak & track movement & gestures of interviewer. • Abnormal eye movements can be diagnostic:-Wandering eyes show distractibility, visual hallucinations, mania or organic states.-Avoidance of eye contact may be due to hostility, shyness, or anxiety. -If pt. is suspicious, he tracks your movements and looks to every gesture.
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2. PSYCHOMOTOR BEHAVIOR:A. Psychomotor activity: • Reduced in depression & catatonic
schizophrenia or increase in mania.B. Posture: • The way pt. sits, walks, and behaves. C. Facial Expression: • Sad face in depression, mask face of
Parkinsonism.
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D. Activity level: • Restlessness in anxiety. • Agitation in some depressed patients.• Excitement in mania.
E. Abnormal movements: • Voluntary: such as the mannerisms of the
schizophrenia or bizarre movements also seen in schizophrenia.
• Involuntary: such as hand tremor in anxiety.
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3. MOOD AND AFFECT:A. Mood: • The pervasive and sustained emotion that colors the
person's perception of the world. • In depression: pt. sees the world through dark glasses.
• In mania: pt. is euphoric or elated, feels superior and able to do great things.
• In anxiety: pt. feels afraid of the unknown. Patient is tense and expecting the worst.
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B. Affect: • External expression of emotional responsiveness. • What is observed in pt.'s facial expression & expressive
behavior in response to internal or external stimuli. • Evaluated for its intensity, duration, appropriateness to
situation, range of affective expression, and control. • In schizophrenia: blunted (flat), restricted, or
inappropriate to situation. • In mania: expansive and out of control. • In hysterical pts.: labile affect that changes from
extreme happiness to extreme sadness in minutes.
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4. SPEECH:A. Amount of Speech: • Increased in mania and anxiety states were the pt.
is talkative.• Pt. with mania may experience a pressure to speak
continuously.• Pt. with depression speaks very little and brief.
B. Speed: • Anxious pt. speaks rapidly.• Depressed pt. speaks slowly.
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C. Articulation: • Speech can be slurred (dysarthria) as in
organic brain disorders or intoxication with alcohol or hypnotic.
D. Rhythm: • In depression speech is monotonous.
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5. THOUGHT:A. Thought Process:• The way pt. puts thoughts together and associates
between them. • In mania: rapid and pt. feels pressure of thoughts, and
may go on to form flight of ideas. • In depression: slow • In schizophrenia: loss of association between thoughts
or poverty of thoughts were they could be empty or vague.
• Blocking: interruption of process as if they were withdrawn from pt.'s head as in schizophrenia.
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B. Thought Content: • Delusions: -Fixed false beliefs held by pt. and not shared by persons in his culture. -They indicate that pt. is psychotic e.g. delusions of persecution, reference or grandiosity.
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• Overvalued ideas: -Unreasonable sustained false beliefs held less firmly than delusions.
• Phobias: -Unreasonable fear of exposure to specific objects or situations e.g. agoraphobia, claustrophobia.
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• Obsessions: -Irresistible recurrent thought or feeling that can not be eliminated by logical effort and associated with anxiety.
• Compulsions: -Meaningless acts that pt. feels compelled to perform as counting, washing…
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• Hypochondria: -Exaggerated concern over one’s health based on false interpretation of physical signs and not supported by realistic pathology.
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6. PERCEPTION: • Interpretation of events. • Some types of hallucination appear in some
clients according to the senses. • We have to be sure that pt. has no organic
problems especially in ? visual hallucination. • Hallucination types: Visual, Auditory,
Olfactory, Tactile, and Taste.
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7. SENSORIUM AND COGNITION: A. Level of Consciousness: • Pt. awareness of and responsiveness to his internal
and external environments. • It can be clouded in organic states and intoxication. • In psychiatric disorders as in dissociative hysteria or
fugue states.
B. Orientation: • Pt.'s awareness of his time, place and person. • Usually disturbed in organic brain syndromes.
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C. Concentration: • Ability to keep one’s attention on a certain
task. • See if the patient can subtract 7 from 100 and
notice his effort and time taken to perform this task.
• Impaired in mania were the pt. is distractible by minor stimuli and in anxiety states.
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D. Memory: • Ability to recall information. • It is divided into: -Immediate: ask pt. to repeat 6 digits in the same order (within seconds to less than a minute). -Short term: tell pt. three items and ask him to repeat them after 5 to 10 minutes. -Long term: ask pt. what he did yesterday. -Remote: ask pt. about information in his childhood, school…
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E. Abstract thinking: • Ability to deal with concepts. • Ask pt. to explain a known proverb or the
similarity between two things. • Answers may be concrete as if the patient says
that an orange and apple are both round, • Or abstract if he says that they are both fruit.• Abstract thinking is impaired in schizophrenia
and organic brain syndrome.
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F. Intelligence and information: • If impairment is suspected, ask pt. to perform
simple tasks as calculations, • Ask him what remains of a 100 $ if he buys a
shirt with 35 $ and a pants with 64 $. • If he finds this difficult, ask easier questions. • Pt.'s fund of information should be relevant to
his educational & social background. • Ask about important dates, persons, or…
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8. INSIGHT AND JUDGMENT: A. Insight: • Degree of pt.'s awareness that he is ill.
• Pt. may deny completely that he has any problem (insight is totally lost).
• Some pts. realize that there is a problem but explain it to be the result of somatic or social cause (partial insight).
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B. Judgment: • Ability to choose appropriate goals and
appropriate means to reach them.
• Ask pt. what he would do if he smelled smoke in his house or found a closed addressed letter in the street.
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9. IMPULSE CONTROL: • Is the patient ability to control his sexual,
aggressive and other impulses.
• Some patients cannot resist impulses to explore your office; they look in books and turn things e.g. mania.
• Impulse control can be assessed from the patient’s history.
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10. RELIABILITY: • How reliable is the information gathered about the
patient?
• Did he/she report his/her condition accurately or was there any difficulty due to mental retardation, dementia or impaired consciousness?
• Is there a need for further investigations?
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11. SUMMARY: • Major positive and negative data from the
history and MSE are summarized.
• A provisional diagnosis is suggested and a differential diagnosis is given.
• Investigations and tests needed are listed.