MENTAL STATE EXAMINATION FORM
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Appearance and behaviour: Physical appearance? Reaction to situation?
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Speech: Rate, volume and quantity of information?
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Mood and affect: Mood? Affect?
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Form of thought: Amount and rate of thought? Continuity of ideas?
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Though content: Delusions? Suicidal thoughts? Other?
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Perception: Hallucinations? Other perceptual disturbances?
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Sensorium and cognitions: Level of consciousness? Memory? Orientation?
Concentration? Abstract thoughts?
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Insight
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OVERVIEW OF THE MENTAL STATE EXAMINATION (MSE)
1. Appearance and behaviour
Appearance eg grooming, hygiene, clothing, hair, nails, other significant features
Attitude to situation and examiner eg hostile, withdrawn, seductive
Motor behaviour eg slowed down, restless, tremors, bizarre ( include description)
2. Speech
Rate eg slow, pressured (very rapid), monotonous
Volume eg loud, quiet, slurred
Quantity of information eg restricted amount of spontaneous speech
3. Mood and affect
Mood eg depressed, euphoric, suspicious, labile - (alternating between extremes)
Affect eg restricted, flattened (absence of emotional expression) inappropriate
4. Form of thought
Amount of thought and rate of production eg hestitant thinking, vague, flight of ideas
Continuity of ideas - refers to logical order of the flow of ideas
Disturbance in language or meaning eg uses words that don't exist or word salad
5. Content of thought
Delusions (particular problems arise from delusions of persecution, poisoning)
Suicidal thoughts, plans or intent
Other - eg obsessions, compulsions, hypochondriacal preoccupations
6. Perception
Hallucinations relating to sounds heard, visions, smells, tastes, tactile or somatic
sensations. Note in particular any command hallucinations. Does the patient think
that he or she may act upon these?
Other perceptual disturbances (derealisation, depersonalisation, heightened/dulled
perception)
7. Sensorium and cognition
Level of consciousness eg abnormal drowsiness, delirium, clouding of consciousness
Memory: immediate, recent, remote
Orientation: time, place, person
Concentration: ask the individual to subtract serial 7s from 100
Abstract thinking
8. Insight
Extent of individual's awareness of problem. Compliance with treatment.
The Mental State Examination is designed to obtain information about specific aspects of
the individual's mental experiences and behaviour at the time of the interview. The MSE
may also be used if the clinician feels that an individual under his or her care may be
experiencing a relapse of illness. This book does not attempt to explain how to carry out
a mental state examination. None-the-less, the following general guidance can be given:
 The mental state exam form provides a structure that encourages the examiner
to record his or her observations of the patient. The form is often filled in
after the conversation with the patient has been completed.

The actual conversation that the examiner has with the patient, while carrying
out these observations, should not consist of a series of direct questions. More
than a few direct questions turns the conversation into an interrogation and
may be counter-productive.

Mental state examinations are normally carried out where the person
examined is distressed. The first part of the conversation must indicate that
the examiner understands that the patient is distressed and that the reasons for
the distress will be listened to sympathetically.

Whether the conversation is exploring the patient's history or present distress,
it is about topics that are meaningful and personal to the patient (their story).
The patient needs to understand that the purpose of the exercise is for help to
be arranged for him or her by the person carrying out the examination.

An atmosphere must be created that will encourage the patient to feel free to
share his/her inner feelings, and be able to talk without fear of being criticised
or judged. Privacy is of great importance in creating this atmosphere and so is
confidentiality. The limits of confidentiality should be explained to the
patient.

If the patient is reluctant to discuss his or her feelings and thoughts, direct
questions are not likely to produce further results. Indirect probes may help,
for example - "If you could have three wishes granted right now, what would
they be?' Most patients will respond to this kind of indirect, open-ended
question and provide the examiner with conversational points which can be
explored further. "Why's that?" is a useful further question to keep the
conversation going when blocks occur.

Where possible, mental state examinations are better carried out over two or
three interviews rather than all at once. Except in an acute emergency (for
example, where it is thought that the patient may be harbouring ideas of
serious violence) where persistence will be necessary, the most important
outcome of any mental state examination is that, at the end, the examiner has a
better idea of what the patient is thinking and feeling and the patient trusts the
examiner and is willing to continue the conversation at a later date.