The Mental State Examination
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Transcript of The Mental State Examination
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The Mental State Examination
Dr Jon Laugharne
University of Western Australia
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MSE
Symptoms and behaviour at the time ofthe interview
May take into account observations andinformation from colleagues/relatives
Examining mental state is a clinical skill –
requires practice – not just theoreticalknowledge
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Summary of the MSE
Appearance/Behaviour
Speech
Mood
Depersonalisation
Obsessional symptoms
Delusions
Hallucinations/illusions
Other psychotic
symptomsOrientation
Attention/concentration
MemoryInsight
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Appearance & Behaviour
evidence of poor self care/neglect
unusual bright/incongruous clothing
odd/bizarre appearance weight loss
facial expression
posture/movement social behaviour eg withdrawn, over-
familiar, outside cultural norms
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Speech
Rate & quantity
Volume
Content – themes, preoccupations
Flow – blocking, rapid shifts betweentopics, disorganised/lacking logical thread
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Mood
How are you in yourself/your mood?
Tearful
Hopeless (future)/ Guilt (past)
Elated (elevated) or irritable
Sleep/appetite/weight/libido/energy Concentration/attention
Suicidal thoughts/intent/plans
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Mood -anxiety
Subjective anxiety/tension
Anxious thoughts (cognitions)
Sweating, palpitations, tremor etc
Pervasive or situational/discrete
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Mood - other aspects
Variability/ lability of mood
Flattening of affect
Incongruity of mood
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Obsessional symptoms & signs
Thoughts, images, impulses – persistent,unpleasant, hard to stop, recognized as
own
Compulsive rituals eg excessive checking,
cleaning counting and other behaviours
Always recognised as irrational (non-psychotic)
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Thoughts
Content : themes, preoccupations. Maybe unusual, bizarre, religiose, grandiose
etc
Form : over-valued ideas, delusions,
formal thought disorder
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Perceptions
Illusions – misinterpretation of a stimulus
Hallucinations – perception in the absenceof stimulus. Occur in all sensorymodalities: auditory, visual, tactile,
olfactory, gustatory
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Other Psychotic Symptoms
Thought insertion
Thought withdrawal
Thought broadcasting
Thought echo
Delusional perception Passivity phenomena
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Cognitive Function
Orientation – time, place, person
Attention/ concentration – digit span,
serial sevens, months backwards
Memory – immediate recall, short term,recent and remote (long term)
MMSE – more thorough and gives a scoreout of 30
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Insight
Patient’s views on nature of the problem/illness and on possible/ likely causes
Patient’s views on need for treatment/type of treatment