Download Mental State Examination (MSE)

Mental State Examination (MSE)
Often it is not possible to organise immediate assessment with a mental health specialist. For this reason
primary care health workers should be able to carry out their own assessment to determine the severity and
nature of an individual’s problems and the risk of danger to self or others.
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It is important for all health staff to be able to use the same terminology when discussing diagnosis and
management
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A MSE should be used for persons with initial mental health presentation and for those experiencing a
relapse of their illness
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Severity of symptoms may not be apparent unless identified in a structured way
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Included with the MSE and the mental health history is the risk assessment that determines level of risk
for suicide, self harm, vulnerability and violence
Mental state examination (MSE) involves making observations and asking questions under the following
headings. Document and act on your findings in a timely manner.
Appearance
Behaviour
Speech
Mood and affect
Perception
Thought form
Thought content
Judgement
Insight
Cognition
Describe the individual’s physical presentation: clothing, grooming, hygiene and cultural
appropriateness
Describe the individual’s behavioural style, including agitation, aggression, retardation, and any
inappropriate or unusual behaviour
Describe the rate, rhythm and volume of speech, and whether it is spontaneous
Ask the individual to describe their mood
Affect is the outward appearance of their emotional state. Comment on the quality, variability,
range, intensity and appropriateness of affect
Hallucinations can occur in any of the five senses
Although any type of hallucination can occur in psychosis, the presence of non-auditory
hallucinations increases the chance that the person has a medical problem, such as alcohol
withdrawal or seizures
Explore whether the person believes the hallucinations are real
For auditory hallucinations ask what the voices are saying and determine if the person is
receiving commands to harm themselves or others. Make note if the person has responded to
the voices
Thought form refers to how thoughts are connected. If a person exhibits thought disorder,
ideas may be connected in a strange or illogical fashion. It is useful to record some quotes of
the person’s speech
Individuals may; be incoherent, use certain words because they rhyme,
use certain words because they have secret meanings, different to what the words actually
mean
Anxieties, obsessions, preoccupations and delusions are described in this section
It is useful to explore what the person thinks of their ideas; they may understand that their
concerns are excessive
Thoughts are described as delusional if a person is certain that their ideas are reasonable
despite convincing evidence to the contrary
Beliefs may be out of keeping with cultural and religious background
Delusions are commonly grandiose, persecutory or bizarre
Examples of common bizarre delusions include believing that the television is talking to them,
that others can hear their thoughts, or that their mind and body are being controlled
Assess the individual’s capacity for reasoned and responsible decision making, in particular
regarding safety issues
Comment on the individual’s insight into his or her symptoms, diagnosis, and need for
treatment
Describe:
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orientation to time, person and place
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memory, attention and ability to concentrate - determine if the person can repeat three
words, and then recall them after a few minutes
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ability to follow instructions
If there are concerns the individual is delirious, it is helpful to observe them write a sentence, or
draw a clock face including the numbers and hands
Be mindful that ‘general knowledge’ can vary greatly depending on cultural background
Risk assessment [1]
Suicide/ self harm
Static factors
Previous serious attempt, history of suicide attempt, family history of
suicide, long standing problems (eg unemployment, physical illness/pain,
mental disorder
Dynamic factors
Intent/plan thoughts, current suicide attempt, hopelessness, perceived
lack of control over life, distress/anger, isolated / lonely, stressors in last 6
months, psychotic symptoms (e.g. command hallucinations)
Overall risk summary
Suicide risk
Violence
Other
self harm
risk
(including
sexual
violence) risk
Aggression
Vulnerability risk
Dependent children
Vulnerability
Child protection risk
screen
Static changes
Under 25 years of age, history of violence / sexual offence, criminal
Low disorder, history Medium
High
history, conduct
of substance abuse
Dynamic Factors
Impulsivity, anger, intoxication / withdrawal / cognitions supporting
violence, recent threats or other aggressive actions / thoughts, carries
weapon / access to firearm. Psychotic symptoms (command
hallucinations,
Yes threat-control-override
No and misidentification symptoms,
morbid jealousy) at risk of sexually abusing others
At risk of being sexually abused by others, at risk of domestic/family violence.
At risk of being financially abused by others, at risk of being financially
abusive to others, at risk of self neglect (basic ADL’s, complex living
skills), cognitive impairment / intellectual disability
Does the client have custody or care responsibilities for children (full time
or periodic)?