MENTAL STATUS

EXAMINATION
(MSE)
Dr Rafidah Bahari
 Components of MSE

APPEARANCE SPEECH MOOD AND THOUGHT PERCEPTION COGNITION

AND BEHAVIOUR AFFECT

JUDGMENT INSIGHT
 Appearance and Behaviour

Appearance in Accessibility Body Build Clothing

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?
Appearance and Behaviour (Cont.)

Hygiene and grooming Facial expression Eye Contact

Does the person appear Note whether the person Indirect, fixed, fleeting,
clean, dirty, un-bathed? appears sad, perplexed, glaring, darting, no
Meticulous? worried, fearful, scowling, contact
Is he neat, dirty, well excited, elated,
groomed? preoccupied, bored,
suspicious, smiling,
Odor responsive, interested,
Perspiration, alcohol, stool animated, blank, dazed, or
or body odour? Cologne, tense
shaving lotion?
 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.
 Speech (cont.)

Volume and tone of speech Form: Specific formal thought

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
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)
Mood and Affect (cont.)

Subjective: Objective: Quality: Appropriateness

:
Mood e.g. sad, Affect neutral, euthymic Appropriate/inappr
anxious, worried, (normal), opriate;
relaxed, happy, expansive, elated, congruent/incongr
angry, hopeless, aloof, indifferent, uent 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)
Thought

■ 2 components
– Content
■ Delusion
■ Obsession
■ Suicidal ideation
– Possession
■ Thought
insertion/broadcasting/wi
thdrawal
 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.
Thought - Obsession

Recurrent persistent thoughts,

impulses or images that enter
Common themes
Dirt & contamination
the mind despite efforts to Aggressive thoughts
exclude them
Orderliness
Subjective sense of struggle to resist Illness
them
Sex: e.g. perverse sexual acts
Recognized as his own (not implanted)
Religion: doubts about fundamental beliefs
Regarded as untrue and senseless e.g. “Does God exist?, scrupulosity
Perception

■ Normal or abnormal
■ Abnormal
– Hallucinations
– Illusion
– Depersonalization
– Derealisation
 Perception- Hallucinations

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 - Illusion

■ Misinterpreted
perception of a sensory
experience

This Photo by Unknown Author is licensed under CC BY-NC

 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
 Cognition
General Recent Memory
Alertness and Co-operation Test registration and recall
Either - give 5 unrelated
objects e.g. apple, book,
lamp, ball, flag or 5 items of
fictitious name and address
Orientation
Time - approximate time (±
2 hours), time of meals
Place - place of interview,
building, town, state
Person - recognition of
familiar persons
 Cognition (continued)
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
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 (Forwards Praxis
and Backwards)
Proverbs (NOT idioms!)
Recent Memory - 5 minute’s recall
Show - Wave
Similarities - apple and good-bye and
(the items given earlier)
orange, table and chairs,
bird and aeroplane Long-term memory Comb hair
• General information: Current
Events, Geographic Facts,
Historical facts, Past Prime
Ministers
• Episodic memory: personal events
Judgement

Personal Social Test

What do you plan to do What do you think about What do you do if you see
when you leave hospital? people who are rude to a house on fire?
their mothers? What do you do if you see
an envelope with an
address and a stamp on
it?
 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
videos and try to
ACTIVITY 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
 To Recap…

APPEARANCE SPEECH MOOD AND THOUGHT PERCEPTION COGNITION

AND BEHAVIOUR AFFECT

JUDGMENT INSIGHT
This Photo by Unknown Author is licensed under CC BY-SA