MSE

MENTAL STATUS EXAMINATION

Objectives
 Definition
 Purpose
 Components
 Elicit
 Report
MENTAL STATUS EXAMINATION
 Systematic collection of data based on observation of the patient’s behavior
 Part of clinical assessment
 Obtain evidence of symptoms and signs of mental disorder
 At the time of the interview
 Can change from day to day or hour to hour
MSE
 Appearance and behavior
 Speech
 Mood and affect
 Perceptual disturbances
 Thought content
 Thought process
 Cognition
 Impulse control
 Insight
 Judgment

Appearance and Behavior

 Approximate age – young, adult, elderly, old looking
 Body type – healthy, thin, overweight
 Clothing/ hair – dressed appropriately, t-shirt and jeans, layered clothing, colorful
accessories
 Grooming/ hygiene – neat, disheveled, unkempt
 Posture – stooped, curled, straight
Appearance and Behavior
 Distinguishing features - scars, tattoos, ear piercings
 General behavior – agitated, restless, calm
 Psychomotor activity – gestures, rigidity, gait
 Eye contact – poor, good, fleeting
 Attitude towards examiner – cooperative, overfamiliar, hostile, guarded
Speech
 Rate, rhythm, volume, amount, accent, fluency, dialect
 Rapid, pressured, slow, normal rate
 Spontaneous, non-spontaneous
 Monotonous, animated
 Soft, mumble, loud, shouting
 Slurred, clear
 Talkative, poverty of speech
 Tagalog, chavacano, english
 British accent, visayan accent

Mood and Affect – tell me how youre feeling???

 Mood – internal, subjective, and more sustained emotional state
 Euthymic, depressed, irritable, anxious, angry, expansive, labile
 Affect – externally observable and more changeable emotional state
 Range – flat, blunt, constricted, broad
 Appropriateness
Perceptual Disturbances
 Hallucinations – auditory, visual, taste, olfactory, tactile
 Illusions – with stimulus
 Depersonalization/ Derealization – extreme feelings of detachment from self or
environment

Perceptual Disturbances
 May mga naririnig ka ba na di naririnig ng ibang tao?
 May mga nakikita ka ba na di nakikita ng ibang tao?
Thought Content
 Delusions – fixed false beliefs not within the patient’s cultural background
 Type?
 Paranoid
 Grandiose
 Jealous
 Somatic
 Mood congruent?
 Bizarre?
Thought Content
 “Pakiramdam mo ba may gusto manakit sa iyo?”
 “Pakiramdam mo ba may especial kang kapangyarihan?”
 “Pakiramdam mo ba pinaguusapan ka ng ibang tao?”
 “Pakiramdam mo ba yung mga iniisip mo lumalabas sa tv or dyaryo?”
 “Pakiramdam mo ba may naglalagay ng kaisipan sa isip mo?”
Thought Content
 Preoccupations - worries, concerns, thoughts
 Obsessions
 “May mga kaisipan ba na paulit-ulit pumapasok sa isip mo?”
 Compulsions
 “May mga ginagawa ka ba na paulit-ulit?”
 Phobias – what are you most afraid of?
Thought Content
 Suicidal thoughts
 “Naiisip mo ba na saktan ang sarili mo?”
 Homicidal thoughts – have you ever thought of harming others?
Thought Process
 Way in which the person puts together ideas and associations
 Tangentiality
 Circumstantiality
 Looseness of associations
 Flight of ideas
 Perseveration
 Thought blocking
Cognition
 Sensorium – alert, awake, drowsy, unconscious
 Orientation
 Person
 Place
 Time
 Attention and concentration
 Serial 7s or 3s
 Spell WORLD backward
 Days of the week backward
 Name 5 animals that start with B
Cognition
  Memory
 Recent – “Ano ang kinain mo kaninang almusal?”
 Recent past “Ano ang ginawa ninyo sa school nung nakaraang linggo?”
 Remote – “Kailan ang birthday mo?”
 Immediate – mango, table, coin
 Fund of knowledge
 based on educational attainment
 “Sino ang kasalukuyang presidente ng Pilipinas?”
Cognition
 Language functions
 Naming objects – point to a watch
 Reading – read “Today is a good day.”
 Writing – write on paper
 Repeating -
 Drawing
Cognition
 Abstract thinking
 Ability to deal with concepts
 Similarities and differences
 “Ano ang pagkakatulad ng mangga at mansanas?”
 Proverbs
 “Ano ang ibig sabihin ng aanuhin pa ang damo kung patay na ang
kabayo?”
Impulsivity
 Capability to control aggressive, sexual, and other impulses
 Measure of the patient’s potential danger to self and others
 Based on history and observed behavior

Insight
 Awareness and understanding of the problem
 Motivation to change
 “Ano sa tingin mo ang karamdaman mo? Paano kaya ito mabibigyang lunas?”
Insight
 Levels:
 Complete denial of illness
 Slight awareness of being sick but denying it at the same time
 Awareness of being sick but blaming it on others
 Awareness that illness is due to something unknown
 Intellectual insight
 True emotional insight

Judgment
 Capacity to make appropriate decisions
 Response to hypothetical situations
 Ano ang gagawin mo kung may mapulot ka na wallet sa sahig?
 Response and decision making in terms of self care, interactions, and other
aspects of behavior
 Ano ang gagawin mo kung mapagalitan ka uli ng nanay mo?

Prepared by:
Prof Raquel M Oasan-De Villa, MAN RN
Psychiatric Mental Health Nursing