Introducing the Mental State Examination Consultant Mental Health Nurse key learning outcomes by the end of the session(s) you will: be aware of the purpose and structure of the MSE o have engaged in an exercise involving the use of the MSE as a framework for mental health assessment o have considered the merits and drawbacks of the MSE o 1
key exercises o search for and review journal papers on the use of the MSE o familiarise yourself with thestructure of themse o review the suggested video excerpts on mental health assessment / the use of the MSE & make notes of your observations of each client using the MSE o form a list of what you consider to be the merits and drawbacks of the MSE o the psychiatric equivalent of the physical examination, the MSE is a key aspect of the bio-psycho-social approach o to evaluate objectively and subjectively a range of mental functions & behaviours at a specific time o providing important information for diagnosis, and for considering the course of the illness & likely response to intervention o undertaken and interpreted alongside other aspects of the wider assessment process e.g. history, physical examination & investigations, information from others 2
insight & judgement awareness & understanding of situation / illness & acceptance of help sensorium & cognition level of consciousness, attention, memory, orientation, concentration & abstract thinking appearance, attitude & behaviour physical appearance, reaction to situations & behaviour e.g. grooming, hygiene, dress, posture, eye contact, guarded, withdrawn, restless perception e.g. hallucinations, derealisation, depersonalisation, heightened or dulled perceptions speech rate, tone, volume & quantity of information e.g. mute vs pressured speech Mental State Examination: an overview thought content e.g. delusional beliefs, ideas of reference, suicidal / homicidal thoughts, paranoid thoughts, obsessions, fears, preoccupations thought processes rate & amount of thought (e.g. slowed thinking, flight of ideas), continuity of ideas (e.g. flow of ideas, relevance, focus), & disturbance in language (e.g. neologisms, incoherence) mood & affect feelings (e.g. depressed, euphoric, labile, fearful. irritable) & expression (appropriateness) now take a look at the following two video excerpts & make notes of your observations of each client using the MSE option: you could use the structure shown on the following slide for this MSE demonstration video (from an Alcohol & Drug Service in Perth, Australia) https://www.youtube.com/watch?v=83i2mwmqph8 psychiatric interview for teaching: mania (from University of Nottingham, UK) https://www.youtube.com/watch?v=za-fqvc02om 3
Mental State Examination part 1: for your brief notes Appearance & Behaviour Speech Thought Processes Thought Content Mental State Examination part 2: for your brief notes Mood & Affect Perception Sensorium & Cognition Insight & Judgement 4
What do you think are some of the merits and drawbacks of the MSE? e.g. some drawbacks / limitations 1. the outcome is dependent upon the skills and experience of the interviewer, & it is subjectto interviewer / interpreter bias 2. theindividual s presentation maydifferin differentsettings 3. it relies upon the person being able to express themselves verbally and to clearlydescribetheirinner experiences 4. it only represents the state of the person at the time of the interview (a cross sectional form of assessment) 5. you cannot base a risk assessment solely on a MSE (would need to carefully consider their individual circumstances & history) Andrews, G., Erskine, A. & Gee, H. (2004) Management of Mental Disorders: Treatment protocol project. Darlinghurst: New South Wales WHO, Collaborating Centre for Evidence in Mental Health Policy References & Bibliography Martin, D.C. (1990) The Mental Status Examination. In H.K. Walker, W.D. Hall & J.W. Hurst (eds) Clinical Methods: the history, physical and laboratory examinations (3 rd Edn) (Chap. 207). Boston: Butterworths MHPOD (2015) Mental Health Histories and Mental State Examination. Retrieved from: http://www.mhpod.gov.au/assets/sample_topics/combined/ment al_health_histories_and_mse/3mhhm_objective2/index.html Snyderman, D. & Rovner, B (2009) Mental Status Examination in Primary Care: a review. American Family Physician 80(8), 809-814 5