Ten Point Guide to Mental State Examination (MSE) in Psychiatry

Posted on:November 30, 2020
Last Updated: April 11, 2024
Time to read: 17–20 minutes

The Mental Status Examination [MSE], also referred to as Mental State Examination, is an integral and essential skill to develop in a psychiatric evaluation. Conducting an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors. This examination, deeply rooted in the tradition of clinical psychiatry, demands a high level of diagnostic skill.

The psychiatrist must be first and foremost and all the time a physician… In fact, psychiatry is neurology without physical signs, and calls for diagnostic virtuosity of the highest order… The simple fact (is) that a psychiatrist is a physician who takes a proper history at the first consultation. [Henry Miller, Neurologist, 1969, Address at the WPA]

The Mental Status Examination is a structured tool and process that allows you to observe and assess a patient’s current mental state. It can also be helpful to use as part of a working diagnosis and identifies possible areas for intervention. MSEs are usually incorporated into every mental health assessment and clinical contact.

Key principles in the approach to a Mental Status Examination (MSE)

  • Welcome the patient, state the reasons for meeting and make them feel comfortable.
  • Maintain privacy, encourage open conversation and always acknowledge and respect the patient’s concerns and distress.
  • Write down the patient’s words and the order in which they are expressed verbatim. This should avoid misinterpretation.
  • Take into account the patient’s age, culture, ethnicity, language and level of premorbid functioning. (e.g. Is an interpreter required to make the assessment fair and accurate?)
  • Consider physical health problems which can impact their mental state.

The Mental Status Examination is not to be confused with the Mini-Mental State Examination (MMSE), which is a brief neuropsychological screening test for cognitive impairment and suspected dementia. However, the MMSE can be used for more detailed testing in the cognitive section of this MSE.

This MSE includes all 10 aspects: appearance, behavior, speech, mood, affect, thoughts, perception, cognition, insight and judgment; and clinical judgment. Rapport may also be included.

The undertaking of a Mental Status Examination requires time. If this is not possible (perhaps due to environmental pressures), the focus must be upon risk.