Mental State Examination (MSE) - OSCE Guide

Introduction

• The Mental State Examination (MSE) is a structured assessment of a patient's current mental state.
• Essential for psychiatric assessments to inform diagnosis and management.
• Divided into several domains: Appearance and Behaviour, Speech, Mood and Affect, Thought, Perception, Cognition, Insight and Judgement, and Risk.

Domains of MSE

1. Appearance and Behaviour

• Appearance: Assess hygiene, clothing appropriateness, any signs of self-harm, disease indicators, weight, and objects brought.
• Behaviour: Engagement, eye contact, facial expression, body language, signs of paranoia, and psychomotor activity.

2. Speech

• Evaluate rate, quantity, tone, volume, fluency, and rhythm.
• Indicators: pressured or slow speech, poverty of speech, monotonous or tremulous tone.

3. Mood and Affect

• Mood: Subjective description of emotional state by patient.
• Affect: Observed expression of emotion.
• Assess apparent emotion, range and mobility, intensity, and congruency of affect.

4. Thought

• Form: Flow and coherence, speed (e.g., loose associations, thought blocking).
• Content: Delusions, obsessions, compulsions, suicidal or violent thoughts.
• Possession: Thought insertion, withdrawal, broadcasting.

5. Perception

• Includes hallucinations, pseudo-hallucinations, illusions, depersonalisation, derealisation.

6. Cognition

• Assess orientation, attention span, concentration, short-term memory.
• Formal tests: MMSE, AMTS, ACE-III, MOCA.

7. Insight and Judgement

• Insight: Patient's understanding of their mental health issues.
• Judgement: Decision-making abilities; assess through hypothetical scenarios.

8. Risk

• To Self: Assess suicidal thoughts, deliberate self-harm, substance misuse, self-neglect.
• To Others: Assess any thoughts or plans to harm others.

Conducting the MSE

Opening the Consultation

• Wash hands, introduce yourself, confirm patient details.
• Explain consultation purpose.

Closing the Consultation

• Address any patient questions or concerns.
• Thank the patient, dispose of PPE, wash hands.

Communication Skills

• Emphasize active listening, summarising, and signposting throughout the examination.