Overview
This lecture reviews all components of the Mental Status Exam (MSE) for psychiatric assessment, detailing what to observe and document for each section.
Appearance
- Note general appearance: age, height, weight, dress, and grooming.
- Record hygiene (proper/poor), if appearance matches stated age, and if disheveled.
Behavior
- Observe cooperation, eye contact, and engagement during the exam.
- Report abnormal movements, level of activity, arousal, and gait.
- Include repetitive behaviors indicating conditions like OCD.
Motor Function
- Document psychomotor agitation or retardation, tremors, restlessness, or slowed movements.
- Note medication side effects impacting movement, such as with antipsychotics.
Speech
- Focus on production: rate, volume, clarity, and tone.
- Note rapid, slow, pressured, fluent, impoverished, or delayed speech.
- Report latency in responses.
Mood
- Record patient’s stated internal emotional state, ideally in their own words and in quotes (e.g., "good," "sad").
Affect
- Describe observable emotional expression: appropriateness, range, reactivity, and congruence with mood.
- Identify if affect is flat, blunted, restricted, expansive, labile, or normal.
- Note if affect matches the context (appropriate/inappropriate).
Thought Process
- Describe the organization and flow of thoughts (linear, logical, goal-directed).
- Note abnormalities: flight of ideas, tangential, or circumferential thinking.
Thought Content
- Record the specific ideas: delusions, obsessions, phobias, overvalued ideas, and preoccupations.
- Always assess for suicidal or homicidal ideation, paranoia, and ideas of reference.
Perceptual Disturbances
- Identify hallucinations (auditory, visual), illusions, or responses to internal stimuli.
Insight & Judgment
- Insight: patient’s awareness of their mental health and understanding of treatment.
- Judgment: patient’s ability to make sound, responsible decisions regarding care and life.
Cognitive Testing
- Memory: give three words, ask patient to recall after five minutes.
- Concentration: serial sevens subtraction or spelling "world" backwards.
- Orientation: confirm awareness of person (name, DOB), place (hospital, city), and time (season, month, year).
Key Terms & Definitions
- Affect — observable emotional expression by the patient.
- Mood — patient’s internal emotional state, often documented in their own words.
- Insight — understanding of one’s own mental condition.
- Judgment — ability to make responsible decisions.
- Thought Process — logical organization and flow of ideas.
- Thought Content — specific beliefs, ideas, or obsessions held by the patient.
Action Items / Next Steps
- Practice documenting all MSE sections during psychiatric interviews.
- Review example mental status notes and familiarize with terms and descriptors.