Chapter 4
Mental State Examination
22
, Chapter 4: Mental State Examination
Introduction
Mental state examination (MSE) is an examination of a patient’s mental state at the time of the interview.
MSE is not the same as a psychiatric history. MSE differs from a psychiatric history which is a description of
experiences prior to the interview.
MSE (of the brain) is the equivalent of a physical examination (of the body).
If a patient stated that their mood was low yesterday or that they were experiencing auditory hallucinations
last week, these experiences should be described in the history and not in the MSE.
You should be making an assessment of a patient’s mental state throughout the interview. It is misleading to
think of the MSE as something you only start to do after you have finished taking the history.
Information about each component of the MSE is observed or elicited by the doctor or volunteered by the patient.
While you can observe whether a patient’s report of low mood collates with their presentation (they may
look depressed, have hunched shoulders, establish poor eye contact) and elicit clinical signs such as observed
psychomotor slowness, you need to evaluate the presentation through your knowledge of the patient’s cultural
and educational background.
The surroundings in which a person finds themselves are useful to describe in the appearance and behaviour
section of the MSE. The location in which you assess someone, the person/people who were present at that time
and the nature of the surroundings in which the interview took place, can profoundly influence a patient’s
behaviour.
Components of the MSE (each of these components will be discussed in more detail below)
Appearance and behaviour.
Speech.
Mood and affect.
Thought.
Perception.
Cognition.
Insight.
1. Appearance and behaviour
Self-care
o Hygiene and general self-care.
o Clothes (e.g. dishevelled, unconventional, brightly coloured).
o Skin (e.g. tattoos, bruising, needle marks).
Manner
o Polite, pleasant and co-operative.
o Guarded.
o Hostile and/or irritable.
Rapport: a measure of the patient’s ability to communicate their feelings to another person.
Eye contact: good, intermittent or no, eye contact.
Facial expression
Motor activity
o Relaxed
o Hyperactivity: increased motor activity that is goal directed.
o Agitation: motor restlessness.
o Psychomotor retardation: reduced, slow body movements. Associated with depression.
o Stupor: loss of activity with no response to external stimuli.
Movements
o Echopraxia: imitation by the patient of the interviewer’s movements.
o Tremor: rhythmic movement of part of the body.
o Tics: repetitive stereotyped movements or sounds (e.g. coughing, grunting, facial twitching, shoulder
shrugging).
o Schnauz-krampf: a characteristic facial expression in which the nose and lips are drawn together.
o Stereotypies: repetitive voluntary non-goal directed movements that are purposeless (e.g. foot tapping, body
rocking, grunting). Associated with schizophrenia, hyperkinetic disorder and autism.
o Mannerisms: repetitive voluntary goal-directed movements that are purposeful (e.g. the extension of the
little finger while holding a teacup).
o Athetosis: a continuous stream of slow, flowing, writhing involuntary movements.
o Chorea: repetitive, brief, jerky, rapid involuntary movements in which the resulting posture is held for a few
seconds. Usually affects the head, face or limbs.
o Hemiballismus: a type of chorea, usually involving violent, flinging involuntary movements of one arm.
o Akathisia: unpleasant motor restlessness, worse in the lower limbs, leading to constant shifting of posture.
Associated with antipsychotic treatment.
23
Mental State Examination
22
, Chapter 4: Mental State Examination
Introduction
Mental state examination (MSE) is an examination of a patient’s mental state at the time of the interview.
MSE is not the same as a psychiatric history. MSE differs from a psychiatric history which is a description of
experiences prior to the interview.
MSE (of the brain) is the equivalent of a physical examination (of the body).
If a patient stated that their mood was low yesterday or that they were experiencing auditory hallucinations
last week, these experiences should be described in the history and not in the MSE.
You should be making an assessment of a patient’s mental state throughout the interview. It is misleading to
think of the MSE as something you only start to do after you have finished taking the history.
Information about each component of the MSE is observed or elicited by the doctor or volunteered by the patient.
While you can observe whether a patient’s report of low mood collates with their presentation (they may
look depressed, have hunched shoulders, establish poor eye contact) and elicit clinical signs such as observed
psychomotor slowness, you need to evaluate the presentation through your knowledge of the patient’s cultural
and educational background.
The surroundings in which a person finds themselves are useful to describe in the appearance and behaviour
section of the MSE. The location in which you assess someone, the person/people who were present at that time
and the nature of the surroundings in which the interview took place, can profoundly influence a patient’s
behaviour.
Components of the MSE (each of these components will be discussed in more detail below)
Appearance and behaviour.
Speech.
Mood and affect.
Thought.
Perception.
Cognition.
Insight.
1. Appearance and behaviour
Self-care
o Hygiene and general self-care.
o Clothes (e.g. dishevelled, unconventional, brightly coloured).
o Skin (e.g. tattoos, bruising, needle marks).
Manner
o Polite, pleasant and co-operative.
o Guarded.
o Hostile and/or irritable.
Rapport: a measure of the patient’s ability to communicate their feelings to another person.
Eye contact: good, intermittent or no, eye contact.
Facial expression
Motor activity
o Relaxed
o Hyperactivity: increased motor activity that is goal directed.
o Agitation: motor restlessness.
o Psychomotor retardation: reduced, slow body movements. Associated with depression.
o Stupor: loss of activity with no response to external stimuli.
Movements
o Echopraxia: imitation by the patient of the interviewer’s movements.
o Tremor: rhythmic movement of part of the body.
o Tics: repetitive stereotyped movements or sounds (e.g. coughing, grunting, facial twitching, shoulder
shrugging).
o Schnauz-krampf: a characteristic facial expression in which the nose and lips are drawn together.
o Stereotypies: repetitive voluntary non-goal directed movements that are purposeless (e.g. foot tapping, body
rocking, grunting). Associated with schizophrenia, hyperkinetic disorder and autism.
o Mannerisms: repetitive voluntary goal-directed movements that are purposeful (e.g. the extension of the
little finger while holding a teacup).
o Athetosis: a continuous stream of slow, flowing, writhing involuntary movements.
o Chorea: repetitive, brief, jerky, rapid involuntary movements in which the resulting posture is held for a few
seconds. Usually affects the head, face or limbs.
o Hemiballismus: a type of chorea, usually involving violent, flinging involuntary movements of one arm.
o Akathisia: unpleasant motor restlessness, worse in the lower limbs, leading to constant shifting of posture.
Associated with antipsychotic treatment.
23
