MENTAL STATUS

EXAMINATION (MSE)

The MSE is a "snapshot" of a patient at a specific time.

 COMPONENTS

1. General appearance and behaviour

2. Speech
3. Mood and affect

4. Thought
5. Perception
6. Cognition (higher mental functions)

7. Insight
  GENERAL APPEARANCE AND
BEHAVIOUR 

• General appearance

• Facial expressions

• Posture

• Movements
 General appearance
• Body build and physical appearance (approx. height, weight,
and appearance)
• Looks comfortable/uncomfortable
• Grooming
• Hygiene

• Self-care
• Dressing (adequate, appropriate)
• Non-verbal expression of mood.
 Speech

• Tone
• Volume
• Reaction time
• Speed

• Relevance
• Comprehension
 MOOD AND AFFECT

• Affect is outward expression of person’s current

feeling State
• Mood is sustained Emotional State; Overall General
mood

Affect: How do they appear to you?

Mood: asks the patient directly how he/she feels
• Mood is described as Relaxed, Happy, Anxious, Angry,
Depressed, Hopeless, Hopeful, Apathetic, Euphoric, Euthymic
(Normal/Even Mood), Elite, Irritable, Fearful, Silly
• Affect : Predominant, Intensity, Lability, Appropriateness

Mood is subjective
Affect is objective
 THOUGHT 

1. Disorders of Form of thought

2. Disorders of Stream of thought

3. Disorders of Content of thought

4. Disorders of Possession of thought
 Disorders of form of thought

• Substitution : major thought substituted by a subsidiary thought

• Omission: Senseless omission of a thought or a part of it.

• Derailment : Thoughts slides on to a subsidiary content

• Fusion: Heterogeneous elements of thoughts are woven together

• Driveling: Distorted mixture of constituent part of one complex

thought
• Tangentiality: Oblique, digressive, or even irrelevant manner of
speech in which the central idea is not communicated.
 Disorders of Stream of thought
Disorders of thought tempo Disorders of thought continuity
• Circumstantiality: thinking
proceeds slowly with many
unnecessary details; the goal is • Perseveration: mental
never completely lost operations-a word, phrase or
• Prolixity: ordered flight of idea tends to persist beyond
ideas. the point of relevance
• Acceleration and flight of • Thought blocking: The
ideas: logical connection patient experiences a sudden
between the sequential
break in the chain of
thoughts are present, however,
the goal of the thought is not
thought
maintained for long.
• Retardation: train of thought is
slowed down
 Disorders of possession of thought
• Thought alienation- Patient has the experience that his
thoughts are under the control of an outside agency or that
others are participating in his thinking
• Thought insertion- Patient knows that thoughts are being
inserted into his mind, recognizes them as being foreign and
coming from without.
• Thought deprivation/withdrawal- Patient finds that as he is
thinking his thoughts suddenly disappear and are withdrawn
from his mind by a foreign influence.
• Thought broadcasting/diffusion- Patient knows that as he is
thinking everyone else is thinking in unison with him.
 Disorders of Content of thought
• Delusion :firm/ fixed, false beliefs not in keeping with the
individuals socio-cultural background
• Overvalued ideas :held with less conviction than delusions but are
false or unreasonable belief or idea sustained beyond the bounds of
reason; is usually associated with mental illness.
• Phobias : specific unreasonable fears leading to avoidance
• Misinterpretations: delusional or mistaken meanings associated to
neutral stimuli
• Circumstances : or events that are causing distress- example-somatic
preoccupations, distress related to symptoms
• Poverty of content : decreased number of ideas or mental images
that present themselves; manifest as retarded speech
 PERCEPTION:
• Illusions

• Hallucination:
– Auditory
– Visual
– olfactory
– gustatory
– tactile
 COGNITION
1. Orientation
2. Attention and concentration
3. Memory
4. Intelligence
5. Abstraction
6. Judgment
7. Insight
 Orientation- three aspects are described to time, place and
person.
• T - Time
• P – Place
• P – Person

 Attention and concentration

• The digit span test (Forward & Backward)
• Serial subtraction
• Days or months forward to backward
 Memory
– Immediate memory
– Recent memory
– Remote memory

 INTELLIGENCE - This includes the areas of general

information, comprehension, arithmetic and vocabulary,
General information; information relevant to the patient’s
literacy age or occupation may be asked.
 ABSTRACT THINKING: Abstract thinking testing
assesses patient’s concept formation.

The methods used are:

– Proverb testing: Asking the meaning of simple proverbs.
– Similarities and difference: Chair and desk?
Apple and pear? Poem
and statue?
 JUDGEMENT: Is assesses in the following areas
1) Personal
2) Social
3) Test
• Personal: Judgment is assessed by enquiries about the patient
future plans
• Social: Judgment is assessed by observing behavior in social
situations
• Test: The following 2 problems are presented to the patient in a
manner in which he can comprehend
– Fire problem – If a house on the road side catches fire. What is
the first thing you will do?
– Letter problem- if when you are walking on the roadside you see
a slumped & sealed envelope with an address on it which someone
had dropped, what will you do?
 INSIGHT
patient’s degree of awareness and understanding that they are ill

LEVELS OF INSIGHT : insight is rated on a 6-point

scale from one to six
• Complete denial of illness
• awareness of being sick & needing help but denying it at the
same time
• Awareness of being sick but blaming it on others, on
external factors, or on organic factors
• Awareness that illness is due to something unknown in the
patient
• Intellectual insight
• True emotional insight