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Psychiatric Assessment >> Mental Status Exam (MSE)

imageClinical Pearl

The MSE is analogous to the physical exam. It focuses on current signs, symptoms, affect, behaviour and cognition.

General Appearance and Behaviour

  • dress, grooming, posture, gait, physical characteristics, body habitus, apparent vs. chronological age, facial expression (e.g. sad, suspicious)
  • psychomotor activity (agitation, retardation), abnormal movements or lack thereof (tremors, akathisia, tardive dyskinesia, paralysis), attention level and eye contact, attitude toward examiner (ability to interact, level of co-operation)

Speech
  • rate (e.g. pressured, slowed), rhythm/fluency, volume, tone, articulation, quantity, spontaneity

Mood and Affect
  • mood - subjective emotional state; in patient’s own words
  • affect - objective emotional state; described in terms of quality (euthymic, depressed, elevated, anxious), range (full, restricted, flat, blunted), stability (fixed, labile), mood congruence, appropriateness, intensity


Mnemonic

Mental Status Exam: ASEPTIC

Appearance and behaviour
Speech
Emotion (mood and affect)
Perception
Thought content and process
Insight and judgment
Cognition

Clinical Pearl

Spectrum of Affect : Full > Restricted > Blunted > Flat

 

Thought Process

  • coherence-coherent, incoherent
  • logic- logical, illogical
  • stream
    • goal- directed
    • circumstantiality - speech that is indirect and delayed in reaching its goal; eventually comes back to the point
    • tangentiality -speech is oblique or irrelevant; does not come back to the original point
    • loosening of associations -illogical shifting between topics
    • flight of ideas - quickly skipping from one idea to another where the ideas are marginally connected, associated with mania
    • word salad - jumble of words lacking meaning or logical coherence
  • perseveration -repetition of the same verbal or motor response to stimuli
  • echolalia - repetition of phrases or words spoken by someone else
  • thought blocking - sudden cessation of flow of thought and speech
  • clang associations - speech based on sound such as rhyming or punning
  • neologism - use of novel words or of existing words in a novel fashion

Links:

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Psychiatric Assessment >> Mental Status Exam (MSE)

Psychiatric Assessment >> Mental Status Exam (MSE) (continued 2)
Psychiatric Assessment >> Mental Status Exam (MSE) (continued 3)
Psychiatric Assessment >> Mental Status Exam (MSE) Psychiatric Assessment >> Mental Status Exam (MSE) Reviewed by Radiology Madeeasy on April 09, 2011 Rating: 5
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