Guidelines for a Mental State Examination (MSE)
Appearance
E.g. posture, body habitus, grooming
Behaviour
Features e.g. mannerisms, tics
Descriptor e.g. restless, agitated, aggressive
Cooperation and attitude
E.g. friendly, cooperative, uncooperative, suspicious, hostile, evasive, seductive,
perplexed
Affect and Mood
Affect: patient’s observable emotions
Range: e.g. flat, blunted, restricted, normal, labile
Appropriateness: appropriate/inappropriate in the context of the patient’s
speech or ideation
Mood: descriptors include depressed, anxious, normal, irritable, angry, euphoric.
If possible describe how the patient perceives their own mood, preferably using
the patient’s own words.
Speech
Rate: slow, normal, rapid or pressured
Volume: soft, normal, loud or shouting
Quantity: nil spontaneous, normal, talkative
Quality: accent, rhythm, impediments
Thought form and content (judged from listening to the patient’s speech)
Thought form: e.g. thought-blocking, racing thoughts, logical connection, flight
of ideas, loosening of association
Thought content: any pathological features such as: preoccupations,
overvalued ideas, delusions, ideas of reference, obsessions, compulsions.
(What is the subject matter of the patient’s thoughts or preoccupation? Any
suicidal or homicidal ideas?)
Perception
Any unusual sensory phenomena such as: hallucinations (especially auditory),
illusions, heightened perception, derealisation/depersonalization
Cognition
Level of consciousness: alert, drowsy (easily aroused), stupor (aroused only by
vigorous stimuli), coma (unable to be aroused)
Memory: immediate, short-term (recent) and long-term (remote)
Orientation: time, place and person
Concentration: abstract thinking capacity
Insight
An individual’s awareness of their illness and its effects and implications: e.g.
Good, partial or poor
Judgement
Ability to accurately assess a situation and act appropriately in response: e.g.
intact or impaired
Summary