Today we'll be talking about the mental state examination. So quite often Mental States will follow on from taking a history when you first meet a patient with a psychiatric problem, and this helps to clarify symptoms and get a better understanding of their possible diagnosis and treatment plans.
The MSE is broken down into lots of different sections and it can be quite difficult to remember them, especially in order. So, I tend to group them into pairs and then put the last three together as well. So, the first two within that are A and B, so easy to remember at the beginning and this covers appearance and behaviour. The next two are speech and mood and then following on from that thoughts and perceptions, the final three look at cognition, insight and then in some cases risk assessment is also considered. Depending on your institution and where you're learning about Mental Health This might not be part of their usual MSE but always useful to mention.
So, I'll take this back into those pairs and go through each one.
So, the first section we looked at was appearance when we're thinking about the appearance of our patients, we are thinking are they well dressed? Do they look scruffy? Are they unkempt and is their hygiene good? Are they wearing have bright colours? Do they look like they're looking after themselves? Okay, then when we think about behaviours, we’re thinking more about what they're telling us with their actions. So, are they hunched over a chair? Are they fidgeting? do they seem to be pacing up and down? The character I am drawing here looks potentially quite angry, so they might not be very happy either. So, you can get a lot from what they’re doing that gives you a clue to the diagnosis.
Next is speech and mood. When we think about speech we think about the volume and the rate of speech and that links in with some of the thought disorder types that we have considered in some of the other videos. So, you can pick up evidence of thought disorder here. Things like tangentiality, circumstantiality, derailment and other thought disorders. Mood we think about in two different groups. So, we think about subjective and objective mood. Subjective being how they feel, you can ask them “How do you feel?” “What’s your mood been like?” And objective is almost whether or not you agree with that assessment, do they appear low, do they appear to be in the mood that they are suggesting, or does it actually look quite different.
The next two to consider our thoughts and perceptions. For Thoughts we think more about the content and also the form. The form links back into thought disorder which we talked about a bit which is usually identified within speech. So, you could really list it within both areas depending on what content you uncovered. When we think about thought content with think about any delusional content, overvalued ideas and really just asking ourselves what has been the focus of this discussion? What are the main things that they've told us? On the other hand, perceptions are thinking more about sensory experiences. So that could be any kind of modality: auditory, visual, smells, tastes, some kinds of proprioception and movement type phenomena. But there can be some overlap between thoughts and perceptions, especially when you're thinking about delusional content so it can be difficult sometimes to place them within a category.
Finally, then we think about cognition, insight, and risk. When we think about cognition you can assess that in lots of different ways. So, clock drawing and things like the tests you can use from the MMSE are very helpful, or a longer test such as Addenbrookes or mini Addenbrookes if you don't want to do the full one. Within the MSE potentially you might not have time, especially if you're in an OSCE type situation, to go through those big long assessments so you can think about just getting a brief idea of orientation and do they know where they are, when they are and can they tell you what kind of time roughly it is. Those kind of things. And then insight fits into that a little bit as well. Do they know what is happening with their mental health? Do they feel like they are unwell, do they feel like they need treatment? Where is their understanding?
Finally, then I put risk within my mental state examinations and that helps to just remind me to think about all the different risks and how mental state exam might fit into that. So, within your history and conducting your examination, you might find that there are suicidal thoughts or self-harm. They might talk about harm to others particularly if they've got command hallucinations or delusions involving other people. It's worth finding out if they have any dependents, if they drive, self-neglect fits into how they appeared at the beginning and any physical health problems or potentially access to things like weapons or stockpiles of medication.
So, thank you very much for your attention. And please do like subscribe and share if you enjoyed the video.