Ten Point Guide to Mental State Examination (MSE) in Psychiatry
The mental state examination [MSE] is an integral, and essential, skill to develop in a psychiatric evaluation. The undertaking of an accurate MSE helps elicit signs and symptoms of apparent mental illness and associated risk factors.
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 MSE 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 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 the mental state.
- The MSE 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, behaviour, speech, mood, affect, thoughts, perception, cognition, insight and judgement and clinical judgement. Rapport may also be included.
- The undertaking of an MSE requires time. If this is not possible [perhaps due to environmental pressures], the focus must be upon risk. (See later)
Al-Diwani, A., Handel, A., Townsend, L., Pollak, T., Leite, M.I., Harrison, P.J., Lennox, B.R., Okai, D., Manohar, S.G., Irani, S.R. (2019) ‘The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data’, The Lancet Psychiatry, 6 (3), pp. 235-246.
Jorgensen, K., Nielsen, T.R., Nielsen, A., Waldorff, F.B., Waldemar, G. (2020) ‘Validation of the Brief Assessment of Impaired Cognition and the Brief Assessment of Impaired Cognition Questionnaire for identification of mild cognitive impairment in a memory clinic setting’, International Journal of Geriatric Psychiatry.