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The Mental State Examination

Dr Jon Laugharne

University of Western Australia

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MSE

Symptoms and behaviour at the time ofthe interview

May take into account observations andinformation from colleagues/relatives

Examining mental state is a clinical skill – 

requires practice – not just theoreticalknowledge

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Summary of the MSE

 Appearance/Behaviour

Speech

Mood

Depersonalisation

Obsessional symptoms

Delusions

Hallucinations/illusions

Other psychotic

symptomsOrientation

 Attention/concentration

MemoryInsight

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 Appearance & Behaviour

evidence of poor self care/neglect

unusual bright/incongruous clothing

odd/bizarre appearance weight loss

facial expression

posture/movement social behaviour eg withdrawn, over-

familiar, outside cultural norms

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Speech

Rate & quantity

 Volume

Content – themes, preoccupations

Flow – blocking, rapid shifts betweentopics, disorganised/lacking logical thread

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Mood

How are you in yourself/your mood?

Tearful

Hopeless (future)/ Guilt (past)

Elated (elevated) or irritable

Sleep/appetite/weight/libido/energy Concentration/attention

Suicidal thoughts/intent/plans

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Mood -anxiety

Subjective anxiety/tension

 Anxious thoughts (cognitions)

Sweating, palpitations, tremor etc

Pervasive or situational/discrete

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Mood - other aspects

 Variability/ lability of mood

Flattening of affect

Incongruity of mood

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Obsessional symptoms & signs

Thoughts, images, impulses – persistent,unpleasant, hard to stop, recognized as

own

Compulsive rituals eg excessive checking,

cleaning counting and other behaviours

 Always recognised as irrational (non-psychotic)

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Thoughts

Content : themes, preoccupations. Maybe unusual, bizarre, religiose, grandiose

etc

Form : over-valued ideas, delusions,

formal thought disorder

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Perceptions

Illusions – misinterpretation of a stimulus

Hallucinations – perception in the absenceof stimulus. Occur in all sensorymodalities: auditory, visual, tactile,

olfactory, gustatory

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Other Psychotic Symptoms

Thought insertion

Thought withdrawal

Thought broadcasting

Thought echo

Delusional perception Passivity phenomena

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Cognitive Function

Orientation – time, place, person

 Attention/ concentration – digit span,

serial sevens, months backwards

Memory – immediate recall, short term,recent and remote (long term)

MMSE – more thorough and gives a scoreout of 30

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Insight

Patient’s views on nature of the problem/illness and on possible/ likely causes

Patient’s views on need for treatment/type of treatment