Mental status examination
The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice.
The purpose of the MSE is to obtain a comprehensive cross-sectional description of the patient's mental state, which, when combined with the biographical and historical information of the psychiatric history, allows the clinician to make an accurate diagnosis and formulation, which are required for coherent treatment planning.
The data are collected through a combination of direct and indirect means: unstructured observation while obtaining the biographical and social information, focused questions about current symptoms, and formalised psychological tests.
[5] From Jaspers' perspective it was assumed that the only way to comprehend a patient's experience is through his or her own description (through an approach of empathic and non-theoretical enquiry), as distinct from an interpretive or psychoanalytic approach which assumes the analyst might understand experiences or processes of which the patient is unaware, such as defense mechanisms or unconscious drives.
The purpose is to obtain evidence of symptoms and signs of mental disorders, including danger to self and others, that are present at the time of the interview.
[8] It is carried out in the manner of an informal enquiry, using a combination of open and closed questions, supplemented by structured tests to assess cognition.
The mnemonic ASEPTIC can be used to remember the domains of the MSE:[14] Clinicians assess the physical aspects such as the appearance of a patient, including apparent age, height, weight, and manner of dress and grooming.
Observations can also include any odor which might suggest poor personal hygiene due to extreme self-neglect, or alcohol intoxication.
[16] Attitude, also known as rapport or cooperation,[17] refers to the patient's approach to the interview process and the quality of information obtained during the assessment.
More global behavioural abnormalities may be noted, such as an increase in arousal and movement (described as psychomotor agitation or hyperactivity) which might reflect mania or delirium.
Similarly, a global decrease in arousal and movement (described as psychomotor retardation, akinesia or stupor) might indicate depression or a medical condition such as Parkinson's disease, dementia or delirium.
A bland lack of concern for one's disability may be described as showing la belle indifférence,[27] a feature of conversion disorder, which is historically termed "hysteria" in older texts.
Thought may be described as 'circumstantial' when a patient includes a great deal of irrelevant detail and makes frequent diversions, but remains focused on the broad topic.
[36][37][38] Regarding the tempo of thought, some people may experience 'flight of ideas' (a manic symptom), when their thoughts are so rapid that their speech seems incoherent, although in flight of ideas a careful observer can discern a chain of poetic, syllabic, rhyming associations in the patient's speech (i.e., "I love to eat peaches, beach beaches, sand castles fall in the waves, braves are going to the finals, fee fi fo fum.
It would describe a patient's suicidal thoughts, depressed cognition, delusions, overvalued ideas, obsessions, phobias and preoccupations.
[39][40][41] A delusion has three essential qualities: it can be defined as "a false, unshakeable idea or belief (1) which is out of keeping with the patient's educational, cultural and social background (2) ... held with extraordinary conviction and subjective certainty (3)",[42] and is a core feature of psychotic disorders.
One can differentiate delusional disorders from schizophrenia for example by the age of onset for delusional disorders being older with a more complete and unaffected personality, where the delusion may only partially impact their life and be fairly encapsulated off from the rest of their formed personality—for example, believing that a spider lives in their hair, but this belief not affecting their work, relationships, or education.
Whereas schizophrenia typically arises earlier in life with a disintegration of personality and a failure to cope with work, relationships, or education.
Hypochondriasis is an overvalued idea that one has an illness, dysmorphophobia that a part of one's body is abnormal, and anorexia nervosa that one is overweight or fat.
A person can also describe obsessional doubt, with intrusive worries about whether they have made the wrong decision, or forgotten to do something, for example turn off the gas or lock the house.
In obsessive-compulsive disorder, the individual experiences obsessions with or without compulsions (a sense of having to carry out certain ritualized and senseless actions against their wishes).
A phobia is "a dread of an object or situation that does not in reality pose any threat",[44] and is distinct from a delusion in that the patient is aware that the fear is irrational.
[45] A perception in this context is any sensory experience, and the three broad types of perceptual disturbance are hallucinations, pseudohallucinations and illusions.
Language is assessed through the ability to name objects, repeat phrases, and by observing the individual's spontaneous speech and response to instructions.
Mild impairment of attention and concentration may occur in any mental illness where people are anxious and distractible (including psychotic states), but more extensive cognitive abnormalities are likely to indicate a gross disturbance of brain functioning such as delirium, dementia or intoxication.
Focal neurological signs such as these might reflect the effects of some prescribed psychiatric medications, chronic drug or alcohol use, head injuries, tumors or other brain disorders.
[54] As insight is on a continuum, the clinician should not describe it as simply present or absent, but should report the patient's explanatory account descriptively.
Traditionally, the MSE included the use of standard hypothetical questions such as "what would you do if you found a stamped, addressed envelope lying in the street?
Assessment would take into account the individual's executive system capacity in terms of impulsiveness, social cognition, self-awareness and planning ability.
Culturally normative spiritual and religious beliefs need to be distinguished from delusions and hallucinations — these may seem similar to one who does not understand that they have different roots.
