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 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.