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Box 1: Learning points

  • A mental state examination (MSE) is the observation of a patient’s present mental state and forms one part of a working diagnosis.

  • The MSE allows you to assess patients’ risk of harm to themselves or others or both.

  • When conducting an MSE, it is important to write down patients’ words and the order in which they are being expressed verbatim, to avoid them being misinterpreted.

A mental state examination (MSE) gives you a snapshot of a patient’s emotions, thoughts, and behaviour at the time of observation.1 It can help you identify the presence and severity of a variety of mental health conditions and the risk a patient poses to him- or herself, or to others.

Performing an MSE is a skill you will need to be familiar with for psychiatry placements and for psychiatry objective structured clinical examinations at medical school. In this article, we use the structure of an MSE to give pointers on what you should look for and ask patients.

Appearance and behaviour

Observing patients’ appearance and behaviour can give you clues about their mental state.

Appearance

  • Note down your patient’s age, sex, body mass index, ethnicity or religious background or both.

  • How is the patient dressed? Is it appropriate for the setting? Does it give you any clues about his or her mood?

  • Does the patient have any distinguishing features—for example, tattoos or scars?

  • How is the patient’s personal hygiene? This can give you clues about patients’ ability to care for themselves.

  • Behaviour

  • Describe the patient’s behaviour towards you—for example, is the patient talkative, timid, tearful, or aggressive?

  • Does his or her facial expression imply a particular emotional state—for example, smiling, angry, or despondent?

  • Consider patients’ body language—for example, can they maintain eye contact? What does their body posture imply? Do they have any abnormal movements, such as facial or body tics?

  • Note patients’ behaviour during the MSE—for example, do they become more open or suspicious? Do they suddenly start responding to stimuli that you can’t see or hear?

Speech

How would you describe patients’ speech? Consider the following:

  • Rate—are they talking rapidly? Is their speech pressured?

  • Volume—is their speech loud, quiet, or normal?

  • Tone— do their words have a particular emotional intonation? For example,...

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