MENTAL STATE EXAMINATION (MSE)

APPEARANCE SPEECH MOOD THOUGHT PERCEPTION COGNITION

AND AND
BEHAVIOUR AFFECT

JUDGMENT INSIGHT

Components of MSE
 Appearance and Behaviour

Clothing
Appearance in Accessibility Body Build
relation to age Appropriate to age,
Does the person Friendly, co- Tall, short, thin, season, setting and
appear to be operative, hostile, obese. Provide a occasion? Clean, neat,
younger, or older alert, confused, eye weight and height. tidy, meticulous, worn,
than the contact, rapport, properly worn?
chronological age? indifferent etc
Are the colours worn:
bright, dull, drab? ¢
Cosmetics
Worn / applied
properly, carefully or
carelessly?
 Hygiene and grooming Facial expression Eye Contact
Does the person appear Note whether the Indirect, fixed, fleeting,
clean, dirty, un-bathed? person appears sad, glaring, darting, no
Meticulous? perplexed, worried, contact
Is he neat, dirty, well fearful, scowling,
groomed? excited, elated,
preoccupied, bored,
Odor suspicious, smiling,
Perspiration, alcohol, responsive, interested,
stool or body odour? animated, blank, dazed,
Cologne, shaving or tense
lotion?

Appearance and Behaviour (Cont.)

 Speech
Rate and quantity of speech Flow and rhythm of speech
• Whether speech is present or • Smooth/hesitant.
absent (mutism). • Dysprosody (pseudo-foreign
• If present, whether it is accent syndrome).
spontaneous. • Blocking (sudden).
• Productivity is increased or
decreased.
• Rate is rapid or slow.
• Pressure of speech or
poverty of speech.
 Volume and tone of Form: Specific formal thought
speech disturbance:
Increased/decreased. Coherent/Incoherent, Loosening of association
Relevant/Irrelevant Flights of ideas / prolixity
Monotonous / tremulous.
e.g. mostly coherent but Perseveration etc
sometimes irrelevant

Speech (cont.)
 Mood and Affect

■ Affect refers to immediate

expressions of emotion, while mood
refers to emotional experience over
a more prolonged period of time
– weather (affect)
– season (mood)
 Subjective: Objective: Quality: Appropriaten
ess:
Mood e.g. sad, Affect neutral, euthymic Appropriate/inap
anxious, worried, (normal), propriate;
relaxed, happy, expansive, elated, congruent/incong
angry, hopeless, aloof, indifferent, ruent to thought
hopeful, irritable, perplexed, content
fearful, silly dramatic,
sarcastic,
apathetic,
bewildered,
anxious

Mood and Affect (cont.)

Range: Depth: Consistency:
Broad: Normal Deep: Normal Stable / Labile
Restricted: Abnormal Shallow: blunted (some
emotional tone)
Flattened (no emotional
tone/mask-like)

Mood and Affect (cont.)

Thought

■ 2 components
– Content
■ Delusion
■ Obsession
■ Suicidal ideation
– Possession
■ Thought
insertion/broadcasting/wit
hdrawal
 Thought - Delusion
■ Definition – “a fixed, false belief not in keeping with the person’s background”
■ If it does not fit the definition, then it is called ‘over-valued ideation’
■ Types of delusion
– Erotomanic: Someone who believes that another person, often someone important or famous, is in love
with him or her. The person might attempt to contact the object of the delusion, and stalking behavior is
not uncommon.
– Grandiose: The person has an over-inflated sense of worth, power, knowledge, or identity. The person
might believe he or she has a great talent or has made an important discovery.
– Jealous: A person with this type of delusion believes that his or her spouse or sexual partner is unfaithful.
– Persecutory: They believe that they (or someone close to them) are being mistreated, or that someone is
spying on them or planning to harm them. It is not uncommon for people with this type of delusion to
make repeated complaints to legal authorities.
– Somatic: A person who believes that he or she has a physical defect or medical problem.
– Mixed: People with two or more of the types of delusions listed above.
 Recurrent persistent
thoughts, impulses or
images that enter the mind
despite efforts to exclude
them
Subjective sense of struggle to
resist them
Recognized as his own (not
implanted)
Regarded as untrue and senseless
Common themes
Dirt & contamination
Aggressive thoughts
Orderliness
Illness
Sex: e.g. perverse sexual acts
Religion: doubts about fundamental
beliefs e.g. “Does God exist?, scrupulosity

Thought - Obsession
Perception

■ Normal or abnormal
■ Abnormal
– Hallucinations
– Illusion
– Depersonalization
– Derealisation
 Definition Types
perception in the absence of external Hallucinations can occur in any sensory
stimulus that has qualities of real modality - visual, auditory, olfactory,
perception gustatory, tactile etc.
Can be due to different factors – Hypnagogic,
hypnopompic, drug-induced etc.

Perception- Hallucinations
Perception - Illusion

■ Misinterpreted
perception of a sensory
experience

This Photo by Unknown Author is licensed under

Perception - Depersonalization &
Derealisation
■ Depersonalization
– Detachment within the self, regarding one's mind or body, or being a
detached observer of oneself
– Being outside reality while looking in
■ Derealization
– Alteration in the perception or experience of the external world so that
it seems unreal
– Feeling as though the environment is lacking in spontaneity, emotional
colouring and depth
■ Derealization is a subjective experience of unreality of the outside
world, while depersonalization is sense of unreality in one's personal
self
■ Can happen to anyone who is subject to temporary anxiety or stress
General Recent Memory Orientation
Alertness and Co- Time - approximate time
operation (± 2 hours), time of meals
Test registration and recall
Place - place of interview,
Either - give 5 unrelated building, town, state
objects e.g. apple, book,
Person - recognition of
lamp, ball, flag or 5 items
familiar persons
of fictitious name and
address

Cognition
Attention
Serial 7s, 3s, 1s - 100-7, …,
40-3, …., 20-1, …
Spell WORLD (DUNIA)
backwards
Months of the year
backwards
Days of the week
backwards
Cognition (continued)
Language
Naming - watch and pen
and their parts
Repetition - “No Ands, Ifs,
or Buts” or “Dulu, Kini, Dan
Selamanya”
Calculation - Division
and Subtraction
“If an apple is 60 sen, and
you have RM10, how many
apples can you get, and
how much is the balance?”
 Cognition (continued)

Right Hemisphere Function

COPY Intersecting pentagons

DRAW Clock Drawing Test
Cognition (continued)

Memory
Abstraction Immediate - Digit Span Praxis
Proverbs (NOT idioms!) (Forwards and Backwards) Show - Wave
Recent Memory - 5 minute’s
Similarities - apple and
recall (the items given earlier) good-bye and
orange, table and
chairs, bird and Long-term memory Comb hair
aeroplane • General information: Current
Events, Geographic Facts,
Historical facts, Past Prime
Ministers
• Episodic memory: personal
events
 Personal Social Test
What do you plan to do What do you think about What do you do if you
when you leave people who are rude to see a house on fire?
hospital? their mothers? What do you do if you
see an envelope with an
address and a stamp on
it?

Judgement
 Insight

Intellectual insight Emotional insight Full insight -> Partial

insight -> No insight
Reasoning about the Fully understands
illness / not full his/her illness, the
conviction need to be admitted
and the necessity to
take
medication/adhere to
treatment
programme
 Watch the following

ACTIVITY videos and try to

conduct a mental
status examination.
Video 1

■ Appearance and behaviour

■ Speech
■ Mood and Affect
■ Thought
■ Perception
■ Cognition
■ Judgment
■ Insight
Video 2

■ Appearance and behaviour

■ Speech
■ Mood and Affect
■ Thought
■ Perception
■ Cognition
■ Judgment
■ Insight
Video 3

■ Appearance and behaviour

■ Speech
■ Mood and Affect
■ Thought
■ Perception
■ Cognition
■ Judgment
■ Insight
APPEARANCE SPEECH MOOD AND THOUGHT PERCEPTION COGNITION
AND AFFECT
BEHAVIOUR

JUDGMENT INSIGHT

To Recap…