MENTAL STATE EXAMINATION FORM _____________________________________________________________________ Appearance and behaviour: Physical appearance? Reaction to situation?

_____________________________________________________________________ Speech: Rate, volume and quantity of information?

_____________________________________________________________________ Mood and affect: Mood? Affect?

_____________________________________________________________________ Form of thought: Amount and rate of thought? Continuity of ideas?

_____________________________________________________________________ Though content: Delusions? Suicidal thoughts? Other?

_____________________________________________________________________ Perception: Hallucinations? Other perceptual disturbances?

_____________________________________________________________________ Sensorium and cognitions: Level of consciousness? Memory? Orientation? Concentration? Abstract thoughts?

_____________________________________________________________________ Insight

_____________________________________________________________________

Insight Extent of individual's awareness of problem. depersonalisation. flight of ideas Continuity of ideas . bizarre ( include description) 2.(alternating between extremes) Affect eg restricted.refers to logical order of the flow of ideas Disturbance in language or meaning eg uses words that don't exist or word salad 5. seductive Motor behaviour eg slowed down. delirium. place. vague. hypochondriacal preoccupations 6. . hair. slurred Quantity of information eg restricted amount of spontaneous speech 3. Form of thought Amount of thought and rate of production eg hestitant thinking. clouding of consciousness Memory: immediate. smells. compulsions. labile . Sensorium and cognition Level of consciousness eg abnormal drowsiness. monotonous Volume eg loud. suspicious. tastes. Perception Hallucinations relating to sounds heard. poisoning) Suicidal thoughts. tremors. Appearance and behaviour Appearance eg grooming. Content of thought Delusions (particular problems arise from delusions of persecution. euphoric. person Concentration: ask the individual to subtract serial 7s from 100 Abstract thinking 8. tactile or somatic sensations. Mood and affect Mood eg depressed. flattened (absence of emotional expression) inappropriate 4. remote Orientation: time. nails. plans or intent Other . heightened/dulled perception) 7. hygiene. other significant features Attitude to situation and examiner eg hostile. quiet. visions. Does the patient think that he or she may act upon these? Other perceptual disturbances (derealisation. recent. Compliance with treatment.eg obsessions. clothing. restless.OVERVIEW OF THE MENTAL STATE EXAMINATION (MSE) 1. Note in particular any command hallucinations. pressured (very rapid). Speech Rate eg slow. withdrawn.

mental state examinations are better carried out over two or three interviews rather than all at once. Privacy is of great importance in creating this atmosphere and so is confidentiality. Indirect probes may help. it is about topics that are meaningful and personal to the patient (their story). None-the-less. Mental state examinations are normally carried out where the person examined is distressed. and be able to talk without fear of being criticised or judged. The MSE may also be used if the clinician feels that an individual under his or her care may be experiencing a relapse of illness. the following general guidance can be given: • The mental state exam form provides a structure that encourages the examiner to record his or her observations of the patient. The first part of the conversation must indicate that the examiner understands that the patient is distressed and that the reasons for the distress will be listened to sympathetically. where it is thought that the patient may be harbouring ideas of serious violence) where persistence will be necessary. for example . should not consist of a series of direct questions. If the patient is reluctant to discuss his or her feelings and thoughts. More than a few direct questions turns the conversation into an interrogation and may be counter-productive. Where possible. "Why's that?" is a useful further question to keep the conversation going when blocks occur. Except in an acute emergency (for example. what would they be?' Most patients will respond to this kind of indirect."If you could have three wishes granted right now. open-ended question and provide the examiner with conversational points which can be explored further.The Mental State Examination is designed to obtain information about specific aspects of the individual's mental experiences and behaviour at the time of the interview. while carrying out these observations. • • • • • . An atmosphere must be created that will encourage the patient to feel free to share his/her inner feelings. The limits of confidentiality should be explained to the patient. direct questions are not likely to produce further results. The form is often filled in after the conversation with the patient has been completed. the examiner has a better idea of what the patient is thinking and feeling and the patient trusts the examiner and is willing to continue the conversation at a later date. Whether the conversation is exploring the patient's history or present distress. the most important outcome of any mental state examination is that. This book does not attempt to explain how to carry out a mental state examination. The patient needs to understand that the purpose of the exercise is for help to be arranged for him or her by the person carrying out the examination. • The actual conversation that the examiner has with the patient. at the end.

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