Mental status exam

No all elements in the MSE requires specific questioning. Simple observation may be enough.

1. Appearance/Behaviour/Attitute (Observe)

Comment on:

• Appearance and hygiene
• Attitutde towards examiner
• Psychomotor activity

2. Speech (Observe)

e.g. Pressured speech, slow quiet speech.

3. Mood/Affect (Ask and observe)

i.e. "How would you describe your mood now?"

Also comment on:

• Affect variability
• Appropriateness
• Anxiety
• Homicidal/suicidal ideation
• Helplessness/hopelessness/worthlessness

4. Thought

Stream (Observe)

e.g. flight of ideas, poverty of ideas

Possession (Ask)

e.g. thought insertion, thought broadcasting

Form (Observe)

i.e. how ideas are presented and linked.

e.g. circumstantiality, tangentiality, loosening of associations, verbigeration (vague speech), "word salad", neologisms (making up new words), clang associations (rhyming), echolalia (repetition)

Content (Ask)

i.e. Delusions

e.g. persecutory, grandiose (special power and reading thoughts), idea of reference, derealisation

5. Perception (Ask)

i.e. Hallucination

e.g. visual, auditory, sensory, olfactory

6. Cognition (Ask)

Do a mini-mental state exam - covers most areas.

Includes orientation, concentration, memory, and intelligence.

7. Judgment/Insight (Ask and observe)

What's your plan when you get out of here?

Do you think if anything is wrong with you?